Health care stakeholders are focusing on access to behavioral health today – and outcomes for tomorrow.
The shortage of behavioral health providers, coupled with the complexities of getting patients to the right level of care, has created a number of access hurdles for the behavioral health sector. This, in turn, has placed access as the top priority for payers and providers.
However, once access issues are solved, industry stakeholders advise that the future will be focused on measurable outcomes.
“We haven’t really addressed the supply constraints in meaningful ways, which could be done by … adding more providers to our pool; these are slow coming, but initiatives are underway,” Samir Malik, co-founder and CEO of firsthand, said during a Flare Capital webinar earlier this week. “Or helping providers practice more top of license or be more efficient.”
firsthand is a Nashville, Tennessee-based startup that helps patients with serious mental illnesses find resources in their community. The company has raised $14.8 million in venture funding.
Access to behavioral health providers can be particularly difficult for patients with Medicare or Medicaid.
In fact, roughly 43% of the 28,000 providers who refuse Medicare reimbursement work in behavioral health disciplines, according to Centers for Medicare & Medicaid Services (CMS) data.
“As a payer – and a Medicare-predominant payer – probably our first, second and third challenge right now is access to care, and getting folks into the care that we already know that they need,” Dr. Taft Parsons, enterprise medical director of behavioral health at Humana Inc. (NYSE: HUM), said during the panel. “What we’ve found through a lot of the work that we’ve been doing is that there just simply are not enough providers. And in particular, there are not enough insurance-participating providers to deliver all of the care that we know that our members already need.”
Louisville, Kentucky-based Humana is a for-profit health care insurer. Its behavioral health efforts include a substance use disorder program for pregnant women and several initiatives related to addressing social determinants of health needs.
Parsons noted that a larger percentage of the members at his organization with a documented behavioral health challenge are getting their medication management from their primary care provider. This could lead to primary care providers practicing outside of their comfort zone.
Instead, he said it’s crucial to find ways for members to get to behavioral health specialists so that they can have their treatment plans “optimized.”
Another major barrier to care is navigation issues. It can be a challenge for patients to find an appropriate provider that also takes their insurance.
“I think that where the access also needs to really be directed is around getting people to the right type of care,” Sandra Kuhn, head of commercial enablement at Headspace Health, said during the webinar. “An individual who’s suffering probably doesn’t have a lot of information about all the different options, or the different ways that they can receive support and treatment.”
She noted that part of the aim of Headspace Health, which was born out of a $3 billion merger between Ginger and Headspace, is to help funnel patients to the resources they need. Headspace Health’s services include a mindfulness app, as well as virtual mental health coaching, therapy, psychiatry and self-care resources.
Outcomes are the future
While care providers and payers are tasked with handling pressing access issues, innovators are able to look at what’s next for the behavioral health space.
“As an innovator, I think about the chapter to come on the other side of that, which is outcomes as the innovators today start addressing the access problems,” Malik said. “Now’s the time to start building for scale towards outcomes generation to welcome that next chapter to come.”
But startups aren’t the only stakeholders looking to change the way the behavioral health industry generates outcomes.
“As an industry we’re just scratching the surface of quality,” Parsons said. “We are starting to see some organizations really kind of delving into different types of measurement-based care where they’re looking at actual clinical outcomes, and the type of treatment being provided. But that’s not the norm yet.”
Typically, when operators are tracking outcomes, they’re doing so in regard to process measures or similar areas. While that’s important, it’s not necessarily measuring quality directly, Parsons explained.
Outcomes measures are key to the value-based care movement, particularly for payers.