Like many health insurers, Blue Cross and Blue Shield of Minnesota has found itself under pressure from fast-growing spending on mental health care.
Last week, the company came under fire from some mental health providers in Minnesota for reducing talk-therapy reimbursement rates.
But Blue Cross has been looking for new ways to get people help and to rein in costs. Its answer may lie in the internet.
Blue Cross has invested in a four-year-old Minneapolis firm, Learn to Live, that offers a battery of online treatment options. The internet-based therapy is getting good marks from employers, workers and experts.
Many people take advantage of quality online mental health treatment when they have access to it, said Tom Vanderheyden, president of diversified business for Blue Cross.
"We're seeing engagement rates in the 30 to 50 percent range, which is statistically stunning," he said.
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Those statistics are a huge selling point Blue Cross makes to employers shopping for health plans.
"The sales pitch is we have got a technology that is going to help 75 percent of your population who is impacted today by mental health conditions," Vanderheyden said. "We can have a healthy difference in their life, and they're going to show up more productive and happy in your workforce. And then they're not going to have as many [insurance] claims."
Mental illness hurts its victims and the economy, said Karen Cassiday, an Illinois-based psychologist and president of the Anxiety and Depression Association of America.
Some estimates say anxiety, depression and other psychological conditions drain the economy of more than $100 billion annually.
"The biggest chunk of those costs is lost productivity," Cassiday said, because most people with mental illness avoid treatment for a variety of reasons — including stigma, cost and time.
In many areas, it's just difficult to find providers.
The software can save employers money, too, by reducing clinic visits.
Turck, a manufacturing company based in Plymouth, is in its third year of offering its 700 employees access to the Learn to Live product.
Texas-based salesman Scott Sorensen said the online tool helped him with issues he would not have addressed otherwise.
"We all experience a little bit of stress and anxiety and I said, 'I'm going to do this one and I was surprised at just the little things that can help you with life,'" Sorensen said.
One of the most interesting things Sorensen said he's learned is to identify what are called "automatic negative thoughts," or ANTS.
"Like, 'No one will like me at the party I've been invited to,' or 'the work meeting will be a waste of time,'" he said.
The software taught him to recognize and neutralize ANTS.
"It's like, 'Oh geez why am I worried about traffic? It's probably not going to be that bad,'" Sorensen said. "Or, 'Why am I worried that I'm going to see my world's worst enemy there from high school — the kid that bullied me? That's not going to happen.'"
Online therapy dates back almost 20 years. The National Institute of Mental Health said research shows it can be effective — sometimes even more than face-to-face therapy.
But to be effective, the therapy must be grounded in proven methods and coupled with personalized coaching, said the national mental health institute's Adam Haim. The problem is that many online mental health programs are useless, he added.
He said three quarters of the depression apps on the market don't work.
"They have no evidence base, and a recent analysis showed that only about 2 percent of the 'depression' apps that are on the market place can substantiate any claims of effectiveness," Haim said. Learn to Live is an exception, though, and its endorsement by a major health insurance company sets it apart from all the online, self-help noise, Haim said.
He also said evidence-based online therapy tools could help more people suffering from mental illness get the help that's in such short supply.
Turck chief financial officer Bob Diem said Learn to Live is helping his employees and their families, plus fewer of them now take medications to treat mental illnesses.
Therapy visits are down 18 percent; severe depression cases fell nearly a quarter, and high-cost emergency room visits due to mental illness are down nearly two-thirds.
"We were running 20 people a year, obviously in crisis, going to the ER, and now we're down to seven," Diem said.
It's not just businesses that are warming to Learn to Live.
The University of Minnesota is rolling out the online therapy option to roughly 50,000 students this fall.
The University of St. Thomas made it available late last year. Health and wellness administrator Madonna McDermott said the program has proven effective and students who likely would have quit because of struggles with depression, anxiety or other conditions have been able to stay in school.
"We already have some early comments and indicators that this is definitely making a difference," McDermott said.