Behavioral health stakeholders are looking to make preventative mental health measures as normal and regular as the old-fashioned annual physical.
Industry players have begun to evaluate the benefits of screening for mental health conditions. This fall, the U.S. Preventive Services Task Force came out with draft recommendations to screen for anxiety in adults, pregnant and postpartum people, along with young people ages 8 to 18.
Since the beginning of the COVID-19 pandemic, rates of anxiety and depression have skyrocketed. Rates of anxiety rose by 25%, and major depressive disorders increased by 27.6% globally in 2020, according to a Lancet study.
Preventative measures could help patients get into care faster and potentially save money by averting a mental health crisis. In fact, every $1 invested in mental health and addiction prevention services yields $2 to $10 in savings, according to a joint analysis by the National Academies of Science, Engineering and Medicine.
Treatment for anxiety disorders is relatively low, said Dr. Gbenga Ogedegbe, a member of the U.S. Preventive Services Task Force and director of the Institute for Excellence in Health Equity at New York University (NYU) Langone Health. But screening could be a chance for providers to detect anxiety in patients who may not have sought out care.
“If you screen people, then they can have significant follow up because [clinicians] can connect them to care,” Ogedegbe told Behavioral Health Business. “But when you don’t do that, then there are a lot of folks who are just walking around. They don’t have symptoms, they don’t have signs, but they actually are suffering from anxiety disorder.”
Prevention benefits could be key
While there may be many benefits to mental health prevention efforts, the bulk of insurers aren’t set up to offer these types of services.
“I think the best way, and the easiest way, for people to get early intervention and treatment for a behavioral health condition, just like with asthma or diabetes or hypertension … will be using their health care benefits to access that care,” Michelle Guerra, a senior consultant in population health and health equity at RTI Health Advance, told BHB. “I think right now, the [way the] preventive benefits are structured under a medical plan are not really set up for that.”
Today, the bulk of preventative benefits are used in the primary care setting. This could be an opportunity for PCPs to offer universal behavioral health screenings and on-site referrals. Co-locating a PCP and a behavioral health specialist could make accessing services easier for patients.
The behavioral health provider could be available for short-term counseling or connecting patients to online modules, said Guerra.
Having a behavioral health provider on-site can come with its own set of challenges. For example, the cost, resources and infrastructure needed to implement this type of integrated care may inhibit many primary care offices from offering these types of services.
Still, prevention efforts could be cost effective. Just like in physical health care, if a condition is caught early it could require less time and expertise to treat.
“Not everybody needs to see a psychotherapist or psychologist or a psychiatrist,” Guerra said. “That’s not really meeting them where they’re at and providing the best value care for what they need.”
Accessing mental health care can be particularly difficult if a patient does not have a diagnosis. Typically, a clinician will need to submit a claim with a diagnosis in order to get reimbursed for services. But this could mean patients are excluded from care early on in their mental health crisis.
Cigna is an example of a commercial insurer that has taken steps to implement preventative behavioral health measures, Guerra noted. It has teamed up with digital provider Ginger to offer in-network coverage to behavioral health coaching.
“Early intervention programs invest in benefits up front,” Guerra said. “That’s value-based care, and then you can potentially prevent all those costs downstream.”
Is digital the answer?
Digital health’s popularity exploded with the onset of the COVID-19 pandemic.
The bulk of these technologies focused on the lower-acuity space for behavioral health. Now, some stakeholders claim these tools could be a front door for patients who need preventive services.
“I think teletherapy and telehealth is certainly a key component to the current care continuum for individuals,” Vittoria Lecomte, CEO and founder of Sesh, told BHB. “I think the prevention component of the care continuum has to do with something that is more approachable and accessible than the current traditional options.”
Sesh is a digital health company that provides virtual group mental health support led by certified therapists.
While some payers cover virtual tools, many offer digital packages to employers. This may be an opportunity for employers to consider preventative mental health measures.
A recent Credit Suisse survey found that 29% of health benefits managers said depression was a major concern for their company.
“I would say their employers definitely have a responsibility to their employees,” Lecomte said. “I think the difficulty with relying on insurance absolutely is that with insurance, there’s still often a copay. There’s also a limited amount of solutions that are related to your specific insurance and insurance plan. So it’s important to think about how we can lower the cost of therapist-led access to support and contribute to this preventative care.”
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