Mental and behavioral health – What’s in a name?

“You say potato, I say potahto”

- George and Ira Gershwin, Shall We Dance

An acknowledged need without a shared language

Consumers are aware and concerned about mental health in their families and communities. But original consumer research we have conducted highlights the disconnect between the multiple kinds of mental and behavioral health needs consumers have vs the language and engagement used by health insurers when communicating covered services.

A national survey by the Kaiser Family Foundation (KFF) found:

• 90% of adults think there is a national mental health crisis

• 51% say someone in their family has experienced a severe mental health crisis

• 80% of adults indicate the cost of mental health care is a big problem

In our survey of approximately 3,500 insured adults, we found the majority were not aware of many mental and mental health services covered by their health insurance plan. The survey found the generic language used by the health insurance industry did not align with consumer’s language and priors, leading them to believe their family’s health needs were not covered by their insurance.

Terminology such as Mental Health and Substance Use Disorder and Applied Behavior Analysis leaves parents of a teenager with depression or a spouse with a substance abuse problem thinking they were on their own to find care.

The first steps in a longer term journey

It is a great first step forward to have mental and behavioral health acknowledged and prioritized. Employers are prioritizing coverage with ~30% adding mental health telemedicine services and ~15% expanding the number of in-network facilities and providers. Health insurers are responding with engagement and promotional campaigns. But it will likely be many years before a broad swath of employers and consumers internalize the broad range of conditions covered by their health insurance with the generic terminology commonly used today.

To underscore the point, below are some of the conditions and services covered by major health insurers and described by generic terms like Mental Health and Substance Use Disorder and Applied Behavior Analysis. It is no wonder consumers and employers think they need to purchase additional “wellness” products to address mental and behavioral health conditions, since health insurers are not doing a great job of clearly communicating the covered products and services.

Mental health disorders

• Depression

• Anxiety

• Bipolar disorder

• Obsessive-compulsive disorder (OCD)

• Attention-deficit/hyperactivity disorder (ADHD)

• Youth and teen mental health issues

Substance use disorders

• Substance use treatment

• Alcohol and chemical dependency treatment

• Detox programs

Other conditions and services

• Eating disorders

• Sleep disorders

• Grief and loss

• Alzheimer's disease and dementia

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavioral Therapy (DBT)

• Eye Movement Desensitization and Reprocessing (EMDR)

• Mindfulness practices

• Psychodynamic therapy

• Acceptance and Commitment Therapy (ACT)

There is a concern within the insurance industry that naming these many conditions specifically would be off-putting to some consumers or make them feel uncomfortable. That pre-conception flies in the face of the reality documented by the KFF survey referenced above, the documented prevalence of community need, and the desires of consumers for access to appropriate care.

Opportunity: a tool to seamlessly educate and engage consumers and employers

While health insurers recognize the importance of promoting covered mental and behavioral health benefits to their insured consumers, they are not well equipped to deliver clear, concise engagement targeted at the various consumer segments dealing with such a broad range of conditions.

Small, nimble companies and new market entrants who can deliver segment specific messaging and engagement tools will find health insurance carriers interested in learning more and potentially engaging with them for services.

Whether you say “potato” or “potahto” this is a market opportunity that is not going away anytime soon.

Copyright 2itive 2024

2itive is a Portland based consultancy founded by Erik Goodfriend, offering a unique combination of market intelligence, knowledge of healthcare payment systems and creative business strategy insights.

Feel free to contact us at info@2itive.com