Polk County Steps Up on Mental Health

Polk County, Florida places a high priority on mental health in the workplace and on quality treatment outside of the workplace for employees and families. Their experience with disease management programs illustrated to them the value of treating the whole person, not just a part of a problem, so they implemented mental health parity in January 2008.

Prior to 2008, Polk County’s carve out plan for mental health and substance abuse treatment had a number of limits on the number of hospital days or outpatient visits allowed. As they analyzed chronic conditions among their employees and their dependents, they discovered that mental health problems were affecting people’s ability to improve physically and work abilities declined. The county began implementing disease management programs, primarily for diabetes and hypertension in 2005. They found tremendous value in the case management approach and in treating the whole person not just a part of the problem. In addition, they determined that most mental health treatment is now being delivered in outpatient formats, and they felt their risk was low in moving to full parity for mental health coverage.

In January 2008, Polk County began working with Aetna for their EAP and behavioral health treatment. Aetna also became the third party administrator for their self-funded general medical/surgical plan as well. There is now no distinction between mental health or medical visits. While there are some elements of utilization management, such as focusing on outpatient care, there are now no limits on hospital days or on the number of psychological or psychiatric outpatient visits. The plan does cover treatment in residential facilities for drug addiction and withdrawal, but the incidence of these cases has reduced a great deal.

The county’s disease management approach removes several barriers to treating chronic conditions. For people with diabetes, for example, easier access to pharmacy services is provided by clinical pharmacist onsite in their health clinic. To reduce financial barriers, all co-pays for treatment are waived as long as the participant completes their hemoglobin A1C checks, eye exams, and foot checks regularly. All medications are covered at a 100% level, including those for common co-morbidities such as depression, bipolar disorder, and hypertension.

Screening for depression is included in both the diabetes and hypertension management programs. Participants are referred to mental health professionals for psychotherapy as needed. Aetna has a “gap-in-care” approach that allows them to determine through claims analysis when adherence with treatment has dropped. Letters are then sent to the individual and to their physician to alert them to potential problems in discontinuing treatment.

In terms of costs, the county had expected to see mental health care utilization rise in the first year after parity, and it did increase slightly. Total health care costs, however, have not increased at all.

Last Updated: April 2016