Eating disorders are conditions that cost people – both the afflicted individual and his or her family – dearly. And unfortunately, treatment carries a hefty price tag as well. One of many reasons for this is that unlike other illnesses, the problems associated with eating disorders occupy a space where medical and behavioral health issues intersect. When insurance companies are asked to review and pay for treatment, this presents a unique challenge.
As service providers, we hear many stories of frustration about adequate coverage or reimbursement for treatment. We are equally concerned that patients receive the appropriate level of care at the appropriate time. For this reason, our team actively advocates for better understanding of these illnesses by insurers that will hopefully lead to a thoughtful redesign of benefits. We want to help insurers understand the short as well as long term savings they may reap if they help patients to address their disorder early on in its course.
To that end, the Comprehensive Care Centers for Eating Disorders went to Albany on November 4th to participate in an insurance roundtable sponsored by State Senator Seward, chair of the Senate Standing Committee on Insurance. To learn more about the Centers and what they do to help people receive the help they need in New York state, check out this related post.
Our team, along with a parent advocate and a representative from the National Eating Disorders Association (NEDA), spoke with representatives of major insurance companies, including Blue Cross/Blue Shield, Aetna, and Capital District Physician Health Plan (CDPHP) to discuss common roadblocks and provide suggestions for moving forward.
Senator Seward opened the meeting acknowledging that improved understanding of the behavioral and medical complications of eating disorders decrease relapse rates and save money. Dialogue is important to improve collaboration that will contribute to cost effective, quality care.
Dr. Attia followed by presenting a review of evidence-based treatments for eating disorders and the challenges that eating disorders create for providers and insurers. She reminded all that approximately 65% of all sufferers recover within 10 years if treated early and appropriately.
NEDA’s Kerry Dolan told the group that many of the 1,600 monthly calls their organization receives are about insurance. Dr. Sharon Alger and her team from Albany Medical Center described positive outcomes from their joint program planning with CDPHP, their local Capital District insurance carrier. After a review by CDPHP showed the high rate of multiple re-hospitalizations for patients with eating disorders, the insurance company decided to collaborate with Albany Medical Center and Live Well, a local intensive outpatient program (IOP) to mimic the “Mayo Clinic Model”, whereby short hospital stays of 2-3 days are used to re-feed if an individual is losing weight while in outpatient treatment. The patient is then sent back to an IOP which works to support them at home and in the community. This model, using expensive care for a safety net, resulted in cost savings as well as improved motivation for patients. In this case, the trust built between the treatment providers and insurer allowed for effective and efficient use of services, providing a compelling model of collaboration.
Other examples of successful collaborations were provided, and included education of utilization review/care managers at Optum by Dr. Attia in her role as Director of the Metropolitan Care Centers for Eating Disorders, and with Excellus by Dr. Mary Tantillo, Director of Western Comprehensive Care Centers for Eating Disorders.
The Senator and his staff were interested and supportive of ways for insurers and providers to continue to work together. Education for national vendors is one of the proposed next steps. To get this effort started, our group is slated to facilitate a webinar for medical directors of insurers across the state. In the end, we all agree that insurers’ fiduciary responsibility and good patient care are not mutually exclusive, and by working together, we may be able to help those in need.
