More than 55% of adults with mental health issues went untreated in 2020, largely due to the supply-demand mismatch that exists in behavioral health. Integrating behavioral health care into medical settings presents an opportunity to change that — and benefit behavioral health providers — but not without policy changes.
The problem is most primary care providers lack the training, guidance and resources they need to provide good integrated care that improves outcomes and saves money in the long run.
The Bipartisan Policy Center — a Washington, D.C.-based think tank that promotes bipartisanship — has issued a new set of recommendations in hopes of changing that. The task force has released 10 recommendations focused on the development of integrated care standards, as well as financing models, technology tools and training guidelines to make integrated care possible nationwide.
“One of our major goals was [to] in fact make it more feasible for primary care providers to deliver services of behavioral health nature to patients,” Sheila Burke, a fellow at the Bipartisan Policy Center, said during a March 31 webinar accompanying the release of the recommendations. “We believe we can do that by providing them with additional support, with technical assistance and with compensation.”
The group’s recommendations include ways to address the provider workforce shortage to better facilitate integrated care. That includes updating and expanding the list of clinicians able to provide covered care under federal health care programs, as well as updating network adequacy rules to make sure health plans have enough behavioral health providers in their network able to take on new patients.
Additionally, the task force recommends creating financial incentives to encourage primary care providers to deliver integrated care, as well as making permanent some COVID-19-era telehealth flexibilities and encouraging other technology adoption.
As NeuroFlow’s Co-Founder and COO Adam Pardes can attest, technology is key to making integrated care work. The technology-enabled care integration platform captures user-generated behavioral health insights, which it reports to providers to help them guide patient treatment and collaborative care. Those insights are captured continually, not just when a patient visits a doctor’s office.
“One of the reasons that [integrated care] hasn’t really been adopted as widely as it needs to be, is because it’s really costly, you end up needing to hire a bunch of people [to make it happen],” Pardes told BHB. “Anything that can be automated … is where technology comes in, … making it easier to do this just at a much greater scale than has ever been done before.”
In his view, integrated care just improves what’s already happening in primary care settings.
“In a given year, 70% of all antidepressants are written by primary care physicians, not by psychiatrists,” Pardes said. “Whether you like it or not, behavioral health is generally treated in primary care first, so you have to equip folks with the tools to be able to support their patients.”
The Bipartisan Policy Center says its recommendations would arm providers with those tools and ultimately help about 1 million Americans. Plus, it would cost the federal government a net $2.2 billion over the course of the next 10 years, a projection that includes $6.9 billion in costs and $4.7 billion in savings.
“For too long, we have marginalized mental health and addiction to the periphery of medicine, as opposed to making the house of medicine acknowledge that part of medicine is also dealing with mental health issues,” former Rep. Patrick J. Kennedy, who chairs the Bipartisan Policy Center’s Behavioral Health Integration Task Force, said on the webinar. “That integrated care model, the value-based purchasing model and all of those [things] that are recommended in this report do a lot to add to the previous success that we had when we passed the Mental Health Parity and Addiction Equity Act.”
Behavioral health provider impact
For behavioral health providers the benefit of integrated care is two-fold: First of all, it helps lessen the pressure put on them by the workforce shortage, which frequently leads to care delays for patients and burnout for clinicians.
Secondly, it gives them the opportunity to work collaboratively with medical health providers to improve patient outcomes and save money. Just like patients with primary physical health issues have mental health needs, the opposite is also true, especially for patients with substance use disorder (SUD).
But integrated care presents some roadblocks for behavioral health providers, too. One such struggle is interoperability and sharing information with other providers.
“Integration … is critical to [being] able to access that information,” Burke said. “Many of the behavioral health providers, particularly those in small settings, don’t have the resources … [or] the tools available to them for information sharing. The HITECH Act authorized $27 billion to increase essentially the utilization of electronic health records, but excluded behavioral health providers.”
As such, the Bipartisan Policy Center’s report includes recommendations for a financing mechanism to help behavioral health providers pay for the sort of technology necessary to make integrated care possible. Specifically, the group recommends that funding be structured as a forgivable loan.
You can read the Bipartisan Policy Center’s full report here.