State’s largest insurer has doubled spending on mental health care since start of the pandemic

In a sign of how the COVID emergency elevated the importance of mental well-being, the state's largest health insurer disclosed it has doubled its spending on behavioral health services since the beginning of the pandemic and aggressively expanded its ranks of providers to meet swelling demand.

Blue Cross Blue Shield of Massachusetts reported this week that it spent $1.3 billion on mental health services in 2022, up from $610 million in 2019. The number of behavioral health visits likewise doubled, from 4 million to 8 million.

Americans grappled with isolation, grief, and financial struggles brought on by the pandemic, and the effects have proved lasting. Nearly one-third of US adults reported feelings of anxiety and depression in February 2023. Deaths from drug overdoses, alcohol, and suicide are all on the rise.

"We had a mental health crisis brewing before the pandemic," said Dr. Gregory Harris, Blue Cross's senior medical director for mental health. "The pandemic just accelerated things."

Over the past five years, Blue Cross has expanded its network of behavioral health clinicians by 50 percent, with 18,000 providers now, Harris said. The insurer has taken other steps to make it easier for patients to find the appropriate level of care, he added. For example, several new provider groups under contract to Blue Cross have committed to see patients within two to five days and to collect data on the quality of care.

The state's second largest insurer, Point32Health, has also seen a significant increase in use of mental health services, but could not provide data as the company continues to contend with a ransomware attack that has compromised its information systems.

"The silver lining of the pandemic is that more people realized that they needed behavioral health care," said Jill Borrelli, vice president of behavioral health at Point32Health. "There was unmet need before the pandemic, and because we went through this communal traumatic event, there is also increased need."

Lora Pellegrini, chief executive of the Massachusetts Association of Health Plans, said another insurer in her organization reported a 30 percent to 40 percent increase in behavioral health expenditures since 2019.

Danna Mauch, who runs the Massachusetts Association for Mental Health, said the pandemic removed much of the stigma attached to mental health care, so that people are now much more willing to seek help than before, or are able to get care now.

"People came to understand that events outside of one's own control can impact our mental health and well-being," Mauch said. "It's not some character flaw or weakness."

Mauch praised Blue Cross for expanding its network and making it easier to get connected with care, as well as producing an ad campaign that drew attention to its resources. Those efforts played a role in the increased volume.

"But there are still long waits for access to care," Mauch said. As with most parts of the health care system, mental health professionals are in short supply.

Other new initiatives at Blue Cross include working with primary care doctors to embed mental health clinicians within their practices, so patients can begin their care in their regular doctor's office. These clinicians also provide consulting services to primary care doctors, enabling them to treat mental illness themselves.

Point32Health has also grown its network, Borrelli said. A team of account managers helps with claims to make it easier for small group practices and individual providers to join the network. The insurer also plans to increase payment to mental health providers on July 1, she said.

Point32Health employs "navigators" who help connect members with the appropriate services, and has hired "peer specialists" who have experienced mental illness or substance use disorder to work with patients, Borrelli said. The insurer also plans to hire "behavioral health coaches," who are not licensed clinicians but can provide practical advice, such as how to recognize and respond to triggers for anxiety.

"I think it's still a crisis," Borrelli said, acknowledging that not everyone can get care right away.

She expects the high demand to continue indefinitely.

Other insurers "have made significant investments to increase reimbursement rates, expand access to providers, and offer telehealth services to members," Pellegrini said in a statement.

Mauch, of the mental health association, noted that behavioral health costs make up a small percentage of health care expenditures, so a doubling of those won't mean doubling of premiums. According to the latest data from the state's Center for Health Information and Analysis, behavioral health expenditures accounted for 8.9 percent of health care spending in 2020.

"We should keep it in perspective," Mauch said. Improving mental health has been shown to save costs in other areas, as people with costly chronic conditions are better able to manage them when their mental health is strong, she said.

Felice J. Freyer can be reached at [email protected]. Follow her on Twitter @felicejfreyer.