Contributors: Wren Keber, Lisa Soroka, and Z. Colette Edwards, WG'84, MD'85
To learn more about Wren, Lisa, and Colette, click here.
In this sixth article in our series, we begin focusing on behavioral health (BH) services. The inextricable connection between physical and mental health is increasingly being acknowledged. This evolution presents an opportunity to improve health outcomes key to increasing quality and the patient experience and driving down the total cost of care. External factors such as legislative changes, investment in expanded access, increased demand, limited provider supply, and a historically fragmented market create a “perfect storm” of challenges and opportunities for innovation. We highlight some of these within the context of recovering and thriving in a post-pandemic environment.
Increased focus on developing a whole-person care model is in direct juxtaposition with the historical view of siloed mental health services, where both the delivery and payment components were separated from physical health services delivered to patients. In addition, these services also were housed in separate and distinct locations. This historical framework for BH services rapidly changed in the past five to eight years and is still evolving today.
As a result of the COVID-19 pandemic, increases in general chaos, uncertainty, fear, distrust, and misinformation have eroded mental health in virtually every corner of the country. This (global) state of affairs has had a far-reaching impact at both an individual level as well as society as a whole. The decline in emotional well-being is true regardless of sex, gender identity, age, socioeconomic status, and race/ethnicity. However, evidence strongly supports a more prominent deterioration in mental health status within historically marginalized/disenfranchised populations, as well as teens, the elderly, and those with pre-existing mental health disorders. Additionally, the historical stigma surrounding mental health, which had been on the decline, has fallen even further in the wake of the pandemic (though it is far from being eradicated completely).
This phenomenon has created an unprecedented demand for BH services, and unfortunately vastly increased unmet need. Reimbursement levels and access points for such services are, at best, unchanged – and are in fact often deteriorating. A majority of adults (67%) think it’s harder to find a mental healthcare provider than it is to find a physical healthcare provider. A staggering 43% of the same adults say they needed substance use or mental healthcare in the past 12 months and did not receive that care.1
We have outlined some opportunities as we see them today – and have offered tactical suggestions on how to make the most of the situation and ways to start to address today’s BH realities, while moving into a post-pandemic (or presumably someday endemic) environment.
- Consider new partners interested in expanding access to BH services. Health systems can begin by evaluating regional demand and current levels of access for BH services. Given the reality that demand is far outpacing access almost universally, opportunities exist for a wider variety of stakeholders interested in investing to expand the number and types of services offered under the BH umbrella. For example, in 2021, private equity and family offices have invested heavily in outpatient mental health services companies, medication-assisted treatment (MAT) organizations, and opioid treatment programs (OTPs). These equity sources are keenly interested in partnering with existing healthcare delivery systems (i.e., health systems) that offer behavioral health services to maximize the impact of their investments in these assets. We have seen these types of partnerships encompass joint branding, clinical management, and even managed care contracting. These novel partnerships start to ameliorate access point - and other - issues when these assets are aligned with community needs. Leaders in existing payment and delivery organizations might consider aligning with these emerging equity sources as potential partners. However, in pursuing these relationships, it is critically important to ensure the arrangement does not result in higher costs of care. Additionally, these arrangements should prioritize material increases in access/availability, incentivize improvement in quality of care and reducing health inequities, increased clinician autonomy, and sufficient reimbursement to create and sustain effective programming. Recent studies have shown a mixed picture with regard to the impact of private equity in healthcare, sometimes delivering only a short-term fix with outsized profits for investors who move on quickly to the next deal.
- Leverage the increased appetite for innovative payment arrangements. The quest for value increasingly extends into the behavioral health space. In recent years, contracting networks engaged in improving quality and managing total cost of care are realizing the benefit of including behavioral health providers in their network. Network executives are learning how to bring together a more inclusive, multidisciplinary care team under maturing care management programs to align traditionally fragmented provider types with value-based payment objectives. Organizations with contracting networks (e.g., ACOs, IPAs, CINs) should evaluate whether their networks would benefit from the addition of behavioral health providers. Conversely, behavioral health providers may find it advantageous to align with one or more integrated networks in their service area, to gain access to important clinical data, new ability to contract in conjunction with physical health services, and other people, processes, and technology supports. Lastly, it goes without saying that networks which successfully integrate BH providers into their business model increase in value to payers, which are increasingly interested in financially supporting integrated networks that meet quality and financial goals.
- Explore data infrastructure investment opportunities. Focus is growing on the importance of integration and availability of behavioral health data in care delivery. For example, payers and providers are starting to engage in meaningful discussions regarding funding for data infrastructure and policy to compliantly exchange behavioral health data across the entire care continuum. When physical health providers are equipped with a longitudinal view of the patient that includes behavioral health data, they are uniquely enabled to consider all patient needs when rendering treatment and coordinating care with other providers.
However, investment is only part of the equation when it comes to the wide array of behavioral health data. Frankly speaking, it is hard to include behavioral health providers in information exchange initiatives due to state-specific confidentiality and privacy laws for mental health and federal laws around sharing alcohol and substance abuse disorder (SUD) information known as 42 CFR Part 2.2
Organizations interested in investing in infrastructure for data exchange must understand the disclosure and consent requirements for the types of data to be integrated. Many regions have established (or are developing) stakeholder coalitions to align policy with technology realities and clinical care needs. When these complexities are well-managed through adoption of a data governance model and sharing standards, investment in data structure can pay dividends long into the future. The upsides include more comprehensive reporting on BH outcomes (strengthening the value proposition for services), less friction in the care management function of integrated networks (easing provider burden), and even patient engagement (to support care plan compliance).
In Part B of this sixth installment, we will look at additional opportunities and practical tactics for organizations to address the customarily low reimbursement for BH services and complexity of contracting relationships with payers in this space. Increasingly, organizations are maximizing opportunities that exist in the current environment to best position themselves for a more comprehensive delivery model and financial success.
Contact Wren at: [email protected]
Contact Lisa at: [email protected]
Contact Colette at: [email protected]
References:
- National Council Mental Wellbeing, “Access to Care Survey Results” (2022). https://www.thenationalcouncil.org/wp-content/uploads/2022/06/2022-Access-To-Care-Report.pdf Accessed July 29, 2022
- Unlocking and Sharing Behavioral Health Records: Movement Emerges to Exchange Sensitive Records through HIEs (ahima.org) https://library.ahima.org/doc?oid=106320