Volume 11 - November 4, 2009

Parity and the Bigger Mental Health Picture

An opinion piece by

Richard C. Bedrosian, PhD

Director, Behavioral Health


Mental health parity may improve coverage for those receiving specialty treatments, but will not affect the majority of people with mental health problems, most of whom never receive help.  Reaching these individuals requires innovative solutions, beyond traditional services.

Passage of mental health parity legislation has triggered anxiety among employers regarding impact on healthcare costs.  Ambiguities in the law have led to uncertainty about how it will be enforced, complicating matters further.

Continuing with the current approach to mental health problems, however, might be even  costlier to employers than parity – because  we’re not reaching enough of those who need help.  Millions of employees suffer silently, while their health and productivity are affected.

  • Nearly two-thirds with mental health problems never seek treatment.
  • Few obtain specialty services (<10%), while most are seen in primary care, receiving only medication.
  • Primary care providers are already overburdened.  Research indicates 80% of cases fail to meet standards of care.  

The cost of mental health problems extends beyond direct treatment, because these problems are more prevalent among those with other chronic conditions.  Such comorbidities escalate risk and raise costs, while treatment of mental health disorders results in improved outcomes and lower costs. 

Workplace-related costs (including absenteeism and presenteeism) associated with mental health conditions typically exceed healthcare costs.  Productivity loss may surface early, even for those with less serious problems.  Data show that around 15% of employees experience “sub-threshold” depression (depressed 1-2 days per week), resulting in twice the productivity impairment of those who are rarely depressed.   

Mental health parity may improve treatment access for those with severe problems, but it does not  reach  the millions who will never seek help. 

Disease management focuses on those with the most severe difficulties, while population management aims to reach people at all acuity levels.  Many healthcare organizations are taking steps to improve population management of mental health by:

  • Encouraging more screening for mental health problems in primary care;
  • Establishing integrated medical and mental health treatments as a standard of care for chronic conditions;  
  • Offering confidential alternatives to treatment and telephonic coaching, reaching those who because of shame or stigmatization, are not seeking help. 

Population management of mental health cannot be left solely in the hands of health plans, or “carved out” and delegated to managed-care organizations.  Employer-based initiatives can reach more people through these steps:

  • Encouraging use of EAP services;
  • Incentivizing employees for participation in screenings and interventions; whether using the “carrot” (rewards) or “stick” (insurance coverage contingent on participation), data indicate that employers can drive high participation. 
  • Including mental health components in all health promotions;
  • Offering confidential alternatives to “high touch” services, including digital coaching programs, to reach more people, especially those not receiving other help.

The role of digital coaching

Digital coaching involves automated behavior change interventions delivered through technology.  Unlike static Web content, digital coaching provides a behavior change plan tailored to each user’s unique demographic and psychological profile, thereby increasing personal relevance and efficacy.    

Just as ATMs do not replace services inside the bank, digital coaching should not replace “high touch” interventions (e.g., psychotherapy, telephonic coaching).   However, it will play an increasingly vital role because it addresses several barriers to population management:

  • Scalability and cost.  Digital coaching is readily deployed at low cost to unlimited numbers of users, without reducing services to individuals with more serious difficulties. 
  • Participation.  Data on 43,000 participants in three digital coaching programs indicate most participants were not in treatment, suggesting that the programs are reaching people who otherwise might not receive help:


In Treatment





Binge Eating


As noted earlier, using even modest incentives, employers have achieved high participation rates.

  • Confidentiality.  The anonymity and confidentiality of digital coaching programs have intrinsic appeal to those for whom issues of shame or stigma serve as barriers to seeking help. 
  • Efficacy.  Digital coaching programs for mental health problems have resulted in symptom reduction, reduced medical utilization, and improved productivity.   
  • Return on investment.  Because of its scalability and low cost, digital coaching has the potential to show an enormous return on investment, as illustrated by recently reported data on various interventions.  

In Summary

Mental health parity may improve coverage for those receiving specialty treatments, but will not affect the majority of people with mental health problems, most of whom never receive help.  Reaching these individuals requires innovative solutions, beyond traditional services.  Digital coaching is a scalable, cost-effective way of addressing this population, offering a confidential, non-stigmatizing, and efficacious alternative to traditional care.

About HealthMedia, Inc.
HealthMedia, Inc., a Johnson and Johnson Company, is the world’s innovator in combining advanced technology and behavioral science to effectively emulate a health coach via the web. HealthMedia applies its Fusion™ Technology to address the most problematic pain points facing the health industry today: participation, scalability, cost, efficacy, ownership, and return on investment. HealthMedia’s suite of interventions provide automated web-based coaching for wellness, disease management, behavioral health, and medication adherence with proven outcomes, increased compliance, reduced medical utilization, and increased productivity – boosting profitability for health plans, employers, pharmaceutical companies, and behavioral health organizations.


Dr. Rich Bedrosian is Director of Behavioral Health at HealthMedia, Inc., a Johnson & Johnson Co. If you are interested in contacting Dr. Richard Bedrosian contact Deborah Love at deborah@ihpm.org or call 480.305.2100.


IHPM’s web site is located at www.ihpm.org.


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