How DPC helps employers with mental health parity requirements

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Have you ever decided to listen to the songs in your music library in alphabetical order?  This is one of those times when I realized someone might be able to write one of those “you might be a redneck” jokes about me.  It might go something like this…”If the first 20 songs in your music library include the word “ain’t” in the title—yoooouuuu might be a redneck.”  Well, OK then.  I’ll own that because I do have a music library that begins that way.

On a recent day of travel, I started listening to songs in my phone’s music library.  I stopped on a favorite that I love to sing while driving —  “I Ain’t Got the Blues Anymore” by Blackberry Smoke.  It’s a fun tune with plenty of southern twang.

But, it got me thinking about occassionally having the proverbial “blues” and how we as a society are finally starting to address the importance of mental health.  I hope we’ve outgrown the days when we suppressed those discussions and pretended like it wasn’t appropriate to talk about it.

I’ve long said that most employees don’t need to see a psychiatrist on a regular basis.  Lyra, a mental health provider produced a recent free report called the 2024 State of the Workforce Mental Health Report.  Additionally, I think Dr. Eric Bricker’s latest AHealthcareZ video summarizes the issue of mental health and substance use disorder.  

Most employees just need “talk therapy” which can build skills around resilience, coping skills and just dealing with everyday life.  When patients present with mental health/substance use symptoms, you probably see it first.  That means you can address it early on.  Let’s face it, we’re complex human beings and it’s a good thing that we are beginning to embrace the care we need to stay mentally healthy.  I’ve rarely had an encounter with my own DPC doctor when he didn’t ask me how I was really doing.  I know that cue.  It’s a free pass to unload something that might be weighing heavy on my mind.  No, he’s not a psychiatrist.  But, I probably don’t need that.  I just need someone who cares about me enough to open the door to a conversation about my emotional health.  

I could describe it like this – he gives me a chance to vent and then he reminds me to stop beating myself up for not being perfect.  It couldn’t come at a better time.  With the myriad financial, political, interpersonal tensions in our society, I think we could all use an opportunity to commissorate with someone who genuinely cares about our well-being.

I use this picture a lot.  This is our DPC doctor, Dr. Matthew Kramer, talking to my youngest when he was about to go off to summer camp for the first time.  I’d been asking him for weeks about camp and if he was excited, etc.  Each time he’d change the subject.  However, when Dr. Kramer asked, my kid immediately revealed that he was scared to go, which is the first time I’d heard him voice that concern.  You’ve probably experienced this firsthand, there’s a sacred bond between doctor & patient.  We share our innermost feelings with our doctors for a long list of reasons.  The main reason is probably because we know our doctors want us to be the healthiest versions of ourselves, and that means both physically and mentally.

Here’s the thing, the federal government said a while ago that it was going to require employer-sponsored health plans to treat mental health care the same as physical health care.  Well friends, this is where you come in.  There’s nary a health plan in America that has true mental health parity.  It’s mainly because there are fewer and fewer health professionals who want to participate with traditional health plans…sound familiar?

Here’s the good news for DPC – I maintain that health plans that incorporate DPC as an embedded benefit have the best chance of meeting this elusive mental health parity requirement.  DPC patients have much more time to “talk it out” with with their doctors.  Even if you don’t feel like a qualified mental health professional, you’re more accessible and know your patient’s quirks and what makes them tick.  Your patients are much more willing to open up to you because you have a relationship and you have time to hear them out.  This puts you in a unique position to help the employers near you meet their mental health parity requirements.

Let me be clear about these requirements – The US Department of Labor is saying that the actual requirement is that employers produce an analysis of the non-quantitative treatment limits (NQTLs) inherent in their health plan.  If they intend to comply and avoid being fined for not having this analysis, it would bewhove them to get with you and write out a summary of what their employees can access through your clinic  to support their mental health goals (I can help you with this).  Whatever you’re doing is likely an improvement over what employees are getting from their BUCA plans.

Here’s a call to action for you – if any employer you’re working with has more than 50 employees, they need to document what’s available to their employees who need support in their mental health journey.  Part of this could come in the form of a flyer from your office.  Make it one of the maketing collaterals you use to promote your practice.  Use Canva, put your logo on it, use a picture, get an employee testimonial, etc.  You know…easy stuff.  You can throw something like that together in just a few minutes.  Send it to your employer clients & prospects and just inform them that they are required under the Mental Health Parity and Addiction Equity Act to document how their plan does or doesn’t provide parity between mental health benefits and medical benefits.  They’ll be amazed that you know this requirement exists and they’ll thank you for helping them take one step closer to compliance.

Here’s something you can use – this 2021 chart is a little aged, but it will give you some insights into the transparency requirements written into law as of the passing of the Consolidated Appropriations Act of 2021.  You have a unique opportunity to partner with a knowledgable benefits advisor to shine a light for the employers in your area who struggle to navigate the complexities of health plan compliance.    The BUCAs are certainly NOT doing this and we can continue to throw them away by highlighting this issue.  BUCA throwing ought to be one of the new Olympic sports.  I believe we could win a gold medal! 

Well, that’s probably enough for now.  I’ll check in again with you soon.

About Cristy Gupton

A nationally recognized employee benefits advisor, Cristy Gupton has endeavored to solve healthcare challenges for employers since 1998.  Cristy has been named twice to Employee Benefits Advisor Magazine's Top 20 Women in Benefits Advising list.   In 2017, Cristy was credentialed by the Health Rosetta and Mitigate Partners, groups of the nation's leading healthcare consultants who provide transparent, employer-built health plans with direct primary care at the foundation.  Cristy has a BS in Public Health from UNC-Chapel Hill, a MS in Health Benefits Design and Health Informatics from University of Lynchburg and a designation of Global Financial Steward from Wake Forest University’s Center for Board Certified Fiduciaries. Other highlights: Spokesperson of the Free Market Medical Association, Carolinas Chapter Contributor to Industry Publications like BenefitsPro Magazine, Physician’s Outlook Magazine and DPC News Speaker at Wingate University’s Engaged Citizen’s Series, VAHU, SIIA, DPC Summit, Health Rosetta Summit (now called RosettaFest), Free Market Medical Association, BenefitsPro etc. Creator of Healthcare Smartypants, an employee education series meant to help employees become smarter consumers of healthcare. Creator of Sunlight Health Plans, a self-funded plan design for employers who embrace Direct Primary Care Cristy also serves her community and fellow citizens through organizations like Scouting America, and her local chapter of Rotary International.