In a move that has drawn criticism from some local psychologists, the Group Insurance Commission (GIC), the Massachusetts agency that oversees insurance for state employees and retirees, recently announced that it awarded a mental health care contract to Beacon Health Strategies for several of its plans. The contract will cover members on the UniCare State Plans and Tufts Health Plans Navigator and Spirit. Members with Fallon or Neighborhood Health Plan will see no change, as Beacon is its current mental health provider. The commission will retain United Behavioral Health for the Harvard Pilgrim plan.
The commission voted to award the contract to the Boston-based company after an open bid process, according to GIC’s Executive Director Dolores Mitchell.
“It is a very competitive, involved and thorough process,” says Mitchell, “which includes background on the company, extensive disruption analyses, interviews, a look at how well they are performing and what people who use them say about them.”
“They brought some unique characteristics to the table that we were interested in pursuing like extensive coordination, co-location with medical plans.”
After the announcement of the new contract, the Massachusetts Psychological Association received complaints from psychologists around the region.
“We have heard concerns expressed on the listserv,” says Elena Eisman, Ed.D., the MPA’s executive director. “People were dissatisfied in the past.”
The complaints did not come as a surprise to Mitchell, who says that this reaction is normal when changes are made.
“This will be the third behavioral health vendor we have used over the 20 years I have been at the GIC. Every time we change vendors, we get a reaction from providers and patients,” says Mitchell. “Beacon has been serving our other two health plans for years and I do not remember getting a single patient complaint.”
One concern is with the apparently limited number of contracts the company has with independent psychologists.
“We have over 180 active patients who may not be able to continue receiving their care with us due to this decision by GIC,” says Michael Goldberg, Ph.D., director of Integrated Behavioral Associates in East Weymouth. “We hope that their contingency plans take into account the evidence-based importance of the therapeutic relationship in treatment outcome and the negative impact that forcing mental health patients to change providers is likely to have.”
Beacon plans to approach providers to persuade them to contract with the company where possible.
Says Tim Murphy, M.P.P., Beacon’s chief executive officer, “With the 225,000 new members through this GIC contract, we will evaluate our network and contract with providers in areas that we feel do not have enough coverage.”
Whether psychologists in private practice will agree to contract with them remains to be seen. Several complaints were about poor reimbursement rates that the company offers to providers.
“Fees have been going down with all insurance companies,” says Patricia Geller, Ed.D., a Lexington-based psychologist, “but they [Beacon] seem to be at the bottom of the barrel.”
Beacon says that it has grown over the years because of a competitive marketplace. The company currently contracts with approximately 600 psychologists, according to Murphy.
A question of adherence to parity laws was raised as well since the GIC offers several options for medical health and has carved out mental health care for these groups.
“It goes against parity,” says Geller. “It should not be carved out, especially if one is not trying to limit access.”
The mental health plans have been “carved out” since 1993, according to Mitchell, because behavioral health was not receiving the attention it deserved within larger plans.
“The carve-out movement came to GIC 20 years ago to adjust for serious gaps in the quality of mental health coverage in some plans,” says Mitchell. “Just as we carve out pharmaceutical care, we feel that they do better in cost and quality and coverage.”
As the decision has already been made, the best recourse to dealing with many of these issues, says Eisman, will be to work directly with Beacon to address the concerns and to ensure that both providers and clients are given what they need to make it work.
“We are working to have a meeting with Beacon,” she says. “They have historically had a different network than they will with GIC and we are going to meet with them to figure out how to include more traditional behavioral health services and if we can facilitate it in any way.”
By Catherine Robertson Souter