Government Workers Union Drives Change for the State of Ohio

The government workers union drove the effort to adopt parity for mental health and substance abuse. In 1990, a behavioral health carve-out plan was initiated in 1 of the state’s 17 health plans.

Health Plans

The State of Ohio has had a joint labor management group (JHCC) for many years with equal representation from bargaining units, management, and union employees. The union drove the effort to equalize mental health and substance abuse benefits with their medical plans. In 1990, a behavioral health carve out plan was initiated in one of the state’s 17 health plans. Ohio was among the first states, and perhaps the very first, to include parity of substance abuse.

Behavioral health care expenditures for the 23,000 covered lives included in this plan dropped from $11 million in 1989 to $7 million in 1990.

Benefit manager Gary Hall was hired in 1990 to manage transition to the new behavioral health vendor. At the time of his hire, Hall was working as a psychiatric nurse. He was able to use his clinical and health system skills when talking with employees who were concerned about having to switch from a current clinician to a clinician within the behavioral health network. To smooth the transition and to ensure proper coverage as the regional networks were developed, the vendor worked with employees on a case-by-case basis. In some cases, the vendor allowed the employee 12 additional visits with the current clinician, and patients were allowed the right to nominate their clinicians for inclusion in the vendor’s network, upon review of credentials. Hall also has a business degree and a background in human resources.

Hall shares that prior to parity, coverage in some cases was too restrictive, but in other cases was overly generous and without accountability. Through the new plan, the state finally had some kind of handle on what their dollars were covering. Anecdotally, Hall feels quality of behavioral health care improved as well through the concerted effort and attention. He says “Mental health parity is still saving us money.”

In 1995, all mental health and substance abuse coverage came under one behavioral health plan managed by the vendor now operating as OptumHealth Behavioral Solutions. Coverage increased from 23,000 lives to 134,000 lives, yet costs only increased from $7.1 million in 1995 to $10.6 million in 1996. This is still less than what they paid for 23,000 lives in 1989. Next year, the state will be moving to a self-insured plan.

Employee Assistance Program

The employee assistance program is an internal model, which assesses and refers into the OptumHealth network of providers. All EAP visits have a $20 co-pay. EAP also provides “non-mental health” services, such as eldercare resources, financial counseling and referral, mediating “last-chance” agreements for discipline situations, critical incident interventions, and educational seminars.

Last Updated: July 2009