What Can Science do to Promote Parity Between Mental and Physical Health in the Insurance Industry?




Health_Healthcare.jpgDespite the fact that science is now easing back the curtain and revealing the neuroanatomical correlates of mental illness, some insurance companies still refuse to cover mental health in their basic policies.

During our previous roundtable, I related my disappointment over the health insurance industry’s reluctance to grant mental health parity with physical health in its coverage. Despite the fact that science is now easing back the curtain and revealing the neuroanatomical correlates of mental illness, some insurance companies refuse to cover mental health in their basic policies. Later in the week, I tried to console myself by remembering that the bench-to-bedside journey of laboratory research averages seventeen years.

However, during some casual reading over the weekend, I was reminded of the fact that while molecular and cellular applications to mental health are relatively new, the biological basis of the same date back at least as far as Hippocrates in the fifth century B.C.E. (before the common era). Depression, for instance, known then as melancholy was presumed to be caused by an excess of black bile (melas, “black”, + khole, “bile”). “So,” I thought to myself, “why, given a twenty-five hundred year head start, has science seemingly regressed in the recognition of a mind-body connection when it comes to mental health?” What can science do to promote parity between mental and physical health in the insurance industry?

KEEP THINKING!

  • ronbachman

    Depression a Bottom Line Issue

    If CEOs Only Knew…

    If CEOs only knew…the highest cost medical condition impacting their company. It is likely that direct healthcare costs represent their company’s 2nd or 3rd highest expense (after salary costs). But costs to the corporate bottom line are more than just direct healthcare costs, indirect or related operational costs are just as important.

    CEO’s of small and large companies offer health coverage to their employees and families because they expect a return on their investment (ROI). They offer the security of healthcare coverage because they want their employees on the job, productive, and undistracted by health concerns for themselves or their family members. They offer benefits to attract and retain good employees, thus keeping down “turnover� costs of hiring, training, and replacing staff.

    It is the CEO’s job to look across multiple corporate silos and make decisions that benefit the overall organization. The problem is that corporate healthcare expense and the impact of illness is rarely measured across corporate silos as an ROI. New coverages and programs are not measured as investments. The benefit manager’s task is to cut the line item of healthcare costs. The easy response to cutting costs for the healthcare line item is to reduce benefits, increase copayments, and cost shift to employees. But some of these actions may not be best for the overall corporate bottom line.

    A November 2005 study by Dow Chemical Company in conjunction with Cornell University and the University of Pennsylvania developed an approach that models the financial impact of investing in a worker’s health. The study uses traditional business ROI modeling to measure the direct and indirect costs of nine (9) major medical conditions.

    The direct costs are, of course, the medical plan costs incurred as a consequence of an illness. The indirect costs measured in the Dow study are the costs of absences and impaired presenteeism (coming to work with an illness that impairs the usual level of productivity). The Dow study has a level of sophistication that includes multi-year interest discounting of costs and savings to achieve a Net Present Value. In addition, the study includes factors to reflect the different impacts of absences and impaired presenteeism by industry and type of job.

    Using a typical company profile, the results were astounding and unexpected. By nearly 2 to 1 over the next rated condition, depression topped the list of corporate costs. Depression was not the highest direct healthcare cost, but it was by far the highest corporate costs per worker (direct and indirect costs). 4.3% of workers suffered from depression, with a cost of over $25,000 per worker, more than double the second most impactful condition of stomach/bowel disorders at about $13,000 per worker. Depression related corporate costs were more than double the $12,000 corporate per worker cost of diabetes.

    If CEOs only knew…it’s not just about treating depression as a single diagnosis. Surveys show that employers do not understand the interrelationship between many diseases and depression – generally referred to as co-morbid conditions. Many employees can not effectively recover from or stabilize chronic and persistent conditions such as diabetes, asthma, heart conditions, hypertension, or cancer because of a coexisting level of depression.

    Without treating underlying depression, patients tend to be non-compliant with taking medications, making office appointments, and are not able to deal rationally with other medical symptoms. Untreated depression is also the underlying cause behind many payments made for treatment of digestive disorders, musculoskeletal, and cardiovascular diagnoses.

    Cutting costs and shifting risks to employees is easy to do. The harder analysis is to perform a real ROI analysis that includes direct and indirect costs. If healthcare was viewed as an investment with a desired ROI, the CEO might find that what are cuts in the healthcare budget and limits on mental health coverage are actually a drain on corporate productivity and profits.

    If company computers crashed and corporate production ground to a halt, the CEO would demand immediate action to re-establish the corporate brains. In developing a “knowledge-based� workforce, it is just as important for CEOs to take care of the “central computer� within each employee. Depression is a treatable chemical imbalance in the brain not a character weakness. Benefit managers should provide CEOs with cross-silo multi-year ROIs for health conditions affecting corporate human capital. In doing so, the evidence is clear that CEOs will find the number one overlooked health condition impacting the corporate bottom line is untreated depression.

    If CEOs only knew…that medical, clinical, and medication therapies have advanced such that depression and other mental health conditions have cure rates equal to and greater than many medical conditions. Depression can be cured. Treatments work. Medications are effective. No company, large or small, can avoid the issues and corporate costs of depression. Divorce, disability, and violence in the workplace can hit anyone at anytime. According to the Institute of Medicine 30,000 people die each year from suicide. 90% have diagnosed treatable depression. For a small employer the results can be devastating if a key employee or executive suffers from depression.

    If only CEOs knew… I believe they would respond to the facts and take actions in their own best interest, the interest of their employees, and the interest of their company. It’s time that this problem is addressed by CEOs, who can see the broad picture and understand the potential devastation that depression can have on the corporate bottom line.

    By Ronald E. Bachman FSA, MAAA President & CEO Healthcare Visions, Inc.

  • We have a bill in congress right now that would require equal coverage,it is the Paul Wellstone Fair and Equitable Treatment Act.The media doesn’t give this bill the attention it needs.There is enough support in the house and senate it just need’s to come to a vote.I would like to see the Church get more involved in this issue also because it is a social justice issue.I have a local cable acsses t.v. show trying to raise awareness to this issue.I can use some help.

  • Hello Ronald E. Bachman,
    Very nice points indeed. You’ve made quite a few so I will approach them in multiple posts so that our bloggers can “snack” as they wish.

    Regarding the comorbidity of disease and depression, I am happy to see that relationship fleshed out by someone one Corporate America. CEOs, as you imply, could be a major force in advancing physical and so-called mental parity in health insurance. Imagine the lobbyist pressures that could develop around this issue with Walmart or GM money behind it.

    Any physician flipping through their clinic copy of Harrison’s Principles of Internal Medicine will find a wealth of evidence supporting this comorbidity. Well said Ron.
    Keep Thinking!

  • Hello paxilbob,
    Thanks for the info on the Paul Wellstone Fair and Equitable Treatment Act. Kudos to you for your efforts in the area and hopefully you can share a little with our readers about your cable access TV show. You never know who might be willing to help.
    KEEP THINKING paxilbob!

  • Tony,thank you for the kind word’s.The cable show is going great and we will make a significanse in this country.My next guest is congressman Jim Ramstad who along with Patrick Kennedy re-introduced the parity bill in the house of representatives.We need a unified voice to speak out and gain some attention to this bill and it will pass!I am calling on all people to take some action and we can make a difference.I am sending a copy of a letter I sent the president,I never received a response but it doesn’t discourage me from moving forward.Thank you for addressing this topic on your Blogg site.Dear President Bush,first of all I would like to thank you for the great and courageous job you are doing as our President.You can never please everybody, but believe me this country is better off and safer with you at the helm.Your wife Laura, is one of the classiest first lady’s we have had in a long time.My issue is the passage of full mental health parity. I suffer depression and grew up in a family where my mother suffered manic depression, and all of her family from her parent’s down to all 5 children.That is where my passion comes from to make a difference in this country.I was fortunate enough to have excellent health care so when I finally got treatment for my depression my insurance company covered my treatment.It changed my life forever.I am now living instead of surviving.I want to make sure every person in this country has the same opportunity that I had.I am living proof that treating this disease is not only beneficial it is just the right thing to do.We have an untapped society of beautiful,compassionate,creative,intelligent,and driven people that just need a little or in some cases allot of help.I believe that this is the most universal discrimination in the history of our great nation.This effect’s every person that has a mind,regardless of race,color,gender,religion,lifestyle choice,age,it effect’s anyone who has a mind.That is why I call this the most universal,and why we as a society have allowed insurance companies to cover mental and physical illness’s differently is unacceptable. Our mind’s are equally as important as our body. I mean what good are our arm’s and leg’s if our mind isn’t working.You asked all of us to perform some kind of service for our country after the attacks of Sept 11.I think that was a great idea, and this is my service.I volunteer at a suicide awareness organization, and now I have started my own cable access T.V.show called “Inside Mental Health Issues”.My 2 main goal’s are to raise awareness of the Parity Bill in congress and to help break the stigma associated with mental illness.This show grew out of frustration of no one willing to give me credibility.I have contacted Senator Norm Coleman and Mark Dayton hoping they would help push for this but neither have ever even sat down with me to discuss this very important issue.I feel every health plan in America should be required to have equal coverage for mental and physical,and regardless the size of the companies that offer health care to their employees .Companies with fewer than 50 employees should not be exempt from this, these are the heart and soul of this country the small businesses.I don’t feel business owner’s ,or employee’s ,should have to take on extra cost’s it should be the health insurance companies, they are not hurting and we all know the profit’s these companies are making ,but it should not be at the expense of people that not only deserve coverage but need it.I don’t know who ever came up with the idea that our mind’s should be treated differently than our bodies but it is time to stop it now.Please consider passage of full parity where any company that offers health insurance must include equal coverage for your mind and your body just like everyone in congress receives.And all insurance companies that sell an insurance policy have to have equal coverage, then it will be an equal playing field and a standard in health insurance.Thank you for your time, I know you have the most powerful and stress full job in the world and I meant what I said,that we are not only fortunate to have you as our President because you are doing a great job, we are lucky we have people like you that are willing to take that position.May God bless you! paxilbob

  • One thing science can do to promote parity between mental and physical health in the insurance industry is to force the mental industry to adhere to the same standards as the physical industry:

    Require scientific evidences for every one of the so-called mental illnesses, require lab tests for every supposed chemical imbalance and require extensive evidences of successful treatment well beyond the placebo threshold.

    If “mental health” is to be treated like “physical health”, it should be held to the same scientifc standards.

    What is currently called “mental health” is a total fraud and should certainly NOT be covered by insurances.

  • Kathy Weimar

    Dear Bob I saw you on tv the other night. I two suffer from depression since 2002. I tried alot of different meds to over come this bad feeling I now found the right meds to take and feel I am on the road to recovery. You are the first person that described and can relate to how I have felt for a very long time I to would like to help other perple with this. Mayb e you can let me know how to do that I very much would like to meet you and maybe tell you my story. If you are interested please e-mail or call m e 651-738-0145 Thank you KaTHY

Tony Brown, BA, EMT

Tony Brown, BA, EMT, graduated cum laude from Harvard University. He served as an EMT in the US Army stationed in Germany.
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