Leveraging research for health insurance coverage of Mindfulness-Based Stress Reduction: insights from policy makers,...

Mindfulness-Based Stress Reduction (MBSR) is a well-studied treatment that health insurers typically do not cover in the United States. To understand how research can best support efforts towards coverage, researchers must partner with individuals who occupy diverse roles within a health system (for example, policy makers and practitioners).

We sought to understand from key informants (policy makers, health insurers, healthcare administrators, clinicians, MBSR students/patients and teachers): the barriers/facilitators of MBSR coverage, how they use research to make decisions, and which research outcomes they find most important. We also sought to understand whether perspectives for individuals with direct policy influence differed from those without.

We conducted qualitative interviews informed by the SPIRIT Action Framework with a role-diverse advisory group. Data were analysed using a rapid data condensation approach.

Responses of those with and without direct policy-making influence were generally aligned. Research was framed as important to coverage decisions. When considering coverage decisions, participants reported wanting information about: (1) MBSR's worthiness as a covered treatment (is it 'good', usable and a sound financial investment?) and (2) a clearer definition of the service and its coverage. Barriers were identified related to both the billing code being created as well as being used, although MBSR's ability to address the policy priority of mental health in an un-stigmatising way could facilitate coverage. Participants also recommended next steps to advance the case for coverage.

Our findings suggest that research is frequently integrated into decision making across roles, though other factors are weighed in coverage decisions.