How Surest helps with mental health care
For decades, the incidence of mental health conditions like depression, anxiety, obsessive compulsive disorder (OCD) and other disorders has been steadily rising in the U.S. Then came COVID-19. It’s not just anecdotal. The rise in people facing mental health disorders during the pandemic has been startling.
- According to a Centers for Disease Control and Prevention (CDC) study, nearly 41% of adults surveyed reported at least one adverse mental or behavioral health condition during the pandemic.
- More than 42 percent of respondents surveyed by the U.S. Census Bureau in December 2020 reported symptoms of anxiety or depression that month, a rise from 11 percent the previous year.
- Another CDC study, from June of 2020, found the prevalence of symptoms of anxiety disorders was three times higher than the second quarter of 2019, pre-COVID-19. The prevalence of depressive disorder was four times that of the same period in 2019.
Pandemic numbers from the CDC
- 31% reported symptoms of an anxiety or depressive disorder.
- 26% reported a trauma- or stressor-related disorder associated with the pandemic.
- 13% started or increased substance use "to cope with stress or emotions related to COVID-19."
Youth and mental health
Already on the rise over the past two decades, mental health disorders among America’s youth skyrocketed during the pandemic. A FAIR Health study analyzed data from over 32 billion private health care claim records and found huge increases in mental health claim lines in April and March 2020 compared directly to same months the year before the pandemic.
- 2X: percentage increase of mental health claims in March and April 2020 for individuals aged 13-18; other medical claims decreased by 50% overall during that same period
- 99%: increase in claims for intentional self-harm in the 13-18 age group in April 2020 over April 2019
- 64%: more claims for substance use disorders as a percentage of all medical claims in March 2020 compared to April 2019
- 93.6%: increase in claims for generalized anxiety disorder in the 13-18 age group, in April 2020, as a percentage of all medical claims
- 83.9%: increase in claims for major depressive disorder in the 13-18 age group, in April 2020, as a percentage of all medical claims
Telling trends
There are encouraging trends as well. Nationally, mental health consultations became the No. 1 use of telehealth services in 2020, a sign that more people are seeking treatment even if they can’t find face-to-face services. But the explosion of mental health issues is taxing the system. Already burdened by too few mental health practitioners, the U.S. health care system is struggling to meet the surge of need.
Mental and behavioral health—the two terms are sometimes used interchangeably, though behavioral health is a broader, blanket term that includes mental health—cases have been on the rise for decades. The health care community has drawn connections between deteriorating mental health and the rise of social media and the burnout associated with the always-on workweek. Other researchers note how the breaking down of stigma has broadly legitimized mental health care and led more people to seek treatment.
Surest data reveals similar trends.
Utilization of mental health services among Surest members increased sharply during the pandemic. In 2020, 59% of Surest virtual care visits were for mental health services. And Doctor On Demand, a Surest partner that provides virtual access to licensed physicians 24/7, indicates that mental health services are being consumed at increased levels.
Interestingly, Surest plan members use Doctor On Demand at a rate three times that of any other health plan supported by the virtual provider—and that large visit volume is most often for mental health treatments. Why is one plan’s use of mental health services so high?
For starters, Surest offers Doctor On Demand as part of their coverage at $0 additional cost to members. Also, Surest provides support with its service model, built primarily around the search capabilities of the Surest app. One differentiator of the Surest health plan is the way it encourages members to search for providers who will address their health concerns.
When someone has an issue and they’re trying to figure out where to go and who to see, they search Surest. When they’re in there, we prompt them to consider virtual care generally and Doctor On Demand specifically. - Tamra Lair, former Surest Chief Analytics Officer
Coverage built by care
During the pandemic, when people were hesitant to make face-to-face mental health care visits—and providers weren’t offering many—that virtual care offered solace and hope to Surest members suffering from disorders like major depression, anxiety, substance abuse and others.
"We don’t expect people to know they should call Doctor On Demand. But we’re digitally solving the problem they need to solve by providing alternatives when they’re looking for answers," Tamra Lair says.
But that’s just one way a health insurance company can help address the surge of mental health needs. A big part of the problem, according to former Surest Clinical Programs Manager Carly Hoffman, is the shortage of mental health care.
"There’s a dearth of providers. It’s unsexy, hard work," says Hoffman, herself a clinical therapist with over 10 years of experience. "You have to go to a lot of school to become a therapist or psychiatrist or social worker. That’s expensive. Unlike medical doctors, therapists are generally paid poorly. There’s really not much incentive other than having a good heart and a drive to do the work."
The lack of therapists means that often, when people suffering from mental health issues reach the point where they’re ready to see someone, help may be still weeks away. Open appointments are hard to come by. It’s hard to know how to find a provider when you need one.
"One of the most common calls we get in clinical advocacy is someone saying, 'I—or my child, or my partner—is so depressed, but I don’t know where to start," Hoffman says. "'Who do I see? What do I do?' They have no idea."
"That’s where Surest is really fantastic. Right on Surest, when someone searches for mental health or substance abuse-related terms, we display an option to connect to a clinical support professional. We’re saying, 'Do you need someone to help out?' We have licensed professionals who are actually advocates. We don’t tell them who to go see but, based on some criteria, we can identify help. We can say, 'Hey, here are the first five people near you who do that type of work and meet the criteria you set.'"
Another barrier is that mental health issues can be difficult to diagnosis. With many medical conditions, a blood or urine test can determine if someone has a disease. Not so with many mental disorders. And mental health conditions often come in a bundle that doesn’t easily untangle. Someone who suffers from anxiety may overuse alcohol, a depressant, in hopes of easing their symptoms, for instance.
This is where mental health and behavioral health intersect and often result in a dual diagnosis—which, in traditional health plans, may complicate coverage. But treating the mental health piece in a vacuum without addressing behavioral issues like substance abuse can delay the relief of healing. While the Surest clinical advocacy staff does not provide clinical therapy or treatment of any kind, they are experts at identifying and locating the appropriate resources for a wide variety of circumstances.
I’m able to identify different levels of mental health care and provider resources, to help people make informed decisions about the care and treatment options available to them. - Carly Hoffman, former Surest Clinical Programs Manager
Navigational aids
The issues don’t end when care begins. Paying for treatment is an obstacle many patients dread—and traditional health plans often do little to ease that pain. When someone already suffers from an anxiety disorder or major depression, dealing with a complicated health insurance claims process can feel overwhelming. Surest clinical advocates are a valuable resource when it comes to navigating the health care system.
"We have trained clinicians who are experts in insurance and can explain how the coverage and benefit works," says Hoffman. "I can look and can see why something maybe didn’t meet the definition of medical necessity. We can call the provider together, or I can show someone that they need a specific piece of information to potentially avoid an appeal or gain a better understanding of why there may have been one in the first place. So often I see clerical errors or some little thing that was missing that can make a big difference."
Surest clinical advocates do not provide treatment. But even when helping people discover their treatment options and available resources, Hoffman has found that a little bit of personal touch can go a long way. Sometimes, Hoffman says, the need is just to connect with another human voice.
"The work we do is so personal," she says. "Our hearts are in this. I had one member say to me, 'I’ve called so many people who sound like they don’t care. You sound like you care.' We sound that way because it’s true. We do care."
That personal caring helps Surest members find better health care.