Why should insurers cover Mindfulness-Based Stress Reduction?

Brown University researchers take a deep dive into the barriers that are disincentivizing health insurers from covering the mindfulness–based health program.

Over the last 40 years, hundreds of randomized controlled trials have explored the health effects of mindfulness practices, including Mindfulness-Based Stress Reduction (MBSR). The majority of these studies have shown that the MBSR program promotes health and well-being and holds potential for addressing mental health and psychosomatic problems like depression and anxiety.

Yet, MBSR is generally not covered by health insurance in the U.S.; only the Veterans Health Administration includes mindfulness-based treatment in its benefits package. 

The situation is similar in most countries around the world, with the exceptions of Singapore, Germany and Switzerland, where MBSR is covered under certain health care plans. As a result, access to mindfulness-based interventions remains limited globally, particularly for low-income individuals who bear significant physical and mental health burdens. 

A new study led by Eric Loucks, associate professor of epidemiology, medicine, and of behavioral and social sciences and director of the Mindfulness Center at the Brown University School of Public Health, systematically examined the requirements MBSR must meet to become a covered practice by U.S. health insurers.  

In this first phase of a five-year project, the research team administered qualitative interviews with health insurers, health care administrators, policymakers, clinicians and MBSR instructors and patients. The goal was to determine “if, how and when” MBSR should be covered, the main barriers to coverage, and the highest priority evidence needed to influence these decisions.

MBSR is an eight-week course, with 2.5-hour weekly sessions, one day-long retreat, and roughly 45 minutes of guided meditation home practice per day. Loucks and his team note that MBSR was developed within a medical framework, as a type of “participatory medicine that takes place in group settings and challenges class members to discover and tap their personal resources for learning, health and transformation.” It is commonly seen as a complementary practice that is integrated into other evidence-based health interventions. 

The barriers to coverage are many and interlocking, including the perception that MBSR is not a medical treatment; concerns that the burden on participants is too heavy, as MBSR involves a significant time commitment; challenges with the delivery of MBSR by non-licensed providers; and the fact that MBSR is often billed as group therapy, which restricts compensated time to just 90 minutes per session. Researchers also point to a lack of advocacy for coverage in the U.S. and that “no entity seems likely to reap large economic benefits for health coverage for MBSR.”

But as the number of Americans who meditate regularly has recently doubled, and the evidence supports the efficacy of MBSR, health insurers, clinicians and policymakers are increasingly calling for coverage of MBSR as a standalone service, the authors write in their report. 

What is most needed to inform coverage decisions, the authors suggest, is a comprehensive synthesis of evidence on the conditions effectively treated by MBSR, its impact on stress reduction, and its effects on PTSD and trauma symptoms. This work is already in progress, as researchers from Brown and the University of Wisconsin-Madison are building a database dedicated to supporting systematic reviews and meta-analyses to evaluate interventions like MBSR.

The research team and members of the study’s advisory board are working to meet these expectations in the next five years, which could eventually lead  to the establishment of a billing code that would allow MBSR to be categorized as a standalone treatment, if the evidence supports that.