Recommendation 4: Support for dissemination and uptake. The National Cancer Institute, the Centers for Medicare & Medicaid Services (CMS), and the Agency for Healthcare Research and Quality (AHRQ) should, individually or collectively, conduct a large-scale demonstration and evaluation of various approaches to the efficient provision of psychosocial health care in accordance with the standard of care. This program should demonstrate how the standard can be implemented in different settings, with different populations, and with varying personnel and organizational arrangements.
Because policies set by public and private purchasers, oversight bodies, and other health care leaders shape how health care is accessed, what services are delivered, and the manner in which they are delivered, group purchasers of health care coverage and health plans should take a number of actions to support the interventions necessary to deliver effective psychosocial health services. The National Cancer Institute, CMS, and AHRQ also should spearhead the development and use of performance measures to improve the delivery of these services.
Recommendation 5: Support from payers. Group purchasers of health care coverage and health plans should fully support the evidence-based interventions necessary to deliver effective psychosocial health services:
• Group purchasers should include provisions in their contracts and agreements with health plans that ensure coverage and reimbursement of mechanisms for identifying the psychosocial needs of cancer patients, linking patients with appropriate providers who can meet those needs, and coordinating psychosocial services with patients’ biomedical care.
• Group purchasers should review cost-sharing provisions that affect mental health services and revise those that impede cancer patients’ access to such services.
• Group purchasers and health plans should ensure that their coverage policies do not impede cancer patients’ access to providers with expertise in the treatment of mental health conditions in individuals undergoing complex medical regimens such as those used to treat cancer. Health plans whose networks lack this expertise should reimburse for mental health services provided by out-of-network practitioners with this expertise who meet the plan’s quality and other standards (at rates paid to similar providers within the plan’s network).