Too few people are getting the health care they need. This is especially true of behavioral health care, where one in five adults suffer from mental health conditions.
Now one behavioral health CEO says he’s had enough.
“There’s a growing consensus around the fact that the system is broken: it’s not meeting the needs of the patients that it’s designed to serve, and even more frustrating, it’s not really addressing the needs of the clinicians that work within it,” says Erik Osland, CEO of evolvedMD. “There’s a lot of things we can tackle within a broken system.”
What Osland sees is an overriding lack of health professionals tying physical health to mental health, despite a longstanding industry knowledge of the connection, he says. This leads to gaps in communication between primary care providers and mental health providers and gaps in care for patients, all of which causes a disconnect between care providers and insurers.
“The net result is that the vast majority of patients — 50 to 70 percent — who need or could gain value from behavioral health services never receive them,” Osland says. “Those patients get sicker both from a mental and a physical health perspective. That impacts our communities and our providers and other things downstream, until finally there’s a significant impact on the expense that it costs to manage patients with complexity whether it’s physical or behavior or combination of both.”
What providers and patients need is a system that connects physical health with mental health so that patients aren’t receiving half of one and half of the other rather than an equal total that simply has two parts. Osland is here to advocate for that system, and what “collaborative care” means in the context of improving behavioral health.
Inside ‘Collaborative Care’: what it is and why it matters
Osland views the need for a new behavioral health system as one that begins by better aligning primary care with behavioral health care. The three elements of a new system: it must be integrated, it must be comprehensive and it must be collaborative.
That last term is key.
“At evolvedMD, we believe that Collaborative Care is a centerpiece to the future of the health care system,” Osland says. “I think a lot of folks can talk about ‘collaborative care’ in a number of ways, and we talk about it through a behavioral health lens. We’re talking about a very specific clinical delivery model.”
The connection between primary care and behavioral health care is the way that physical illnesses are compounded by mental and behavioral care needs. As Sarah Hanchett, Chief Clinical Officer of Collaborative Care at evolvedMD, has written, a person with both a physical illness and a mental illness — say, diabetes and depression — is not going to get adequate health care when focused on just one or just the other. And the out-of-pocket costs to this person due to the disconnect in insurance will continue to wear him down.
This is the landscape that harms behavioral health patients. As Osland and Hanchett note, in 2022, over 60 million adults reported a mental illness affliction. Nearly half received no treatment, while the ones who did get treatment did not get it from behavioral health specialists but from their primary care provider, what evolvedMD views as “the front door of health care,” Osland says.
Still, there are challenges. Per evolvedMD:
- Doctors lack resources, funding and training to treat mental health conditions
- Only 13% of patients diagnosed with mental health conditions receive “minimally adequate treatment”
- Patients with physical and mental health conditions incur three-to-six times higher annual health care costs
Add it all up and the system yields bad patient outcomes.
“Whether you’re a clinician or a support staff member, we have built a system of behavioral health that is largely underfunded,” Osland says. “The incentives are not aligned to delivery highly coordinated care. In many cases, clinicians come in with a need to be developed, but they aren’t supported in their developmental process. They aren’t given the resources they need to manage their patients. And as a result our providers are burning out at an unprecedented rate.”
What new research reveals about the power of primary care tied to behavioral health care
A May 2024 research paper from the Bowman Family Foundation[1] shows the power of bringing evolvedMD’s Collaborative Care model (CoCM) to behavioral health. Among the findings, which span from 2007 to 2024, was lower health care costs, less depression and more mental health care:
- CoCM patients had 114 more depression-free days, and lower mean outpatient health costs of $594 per patient than usual care patients
- Over four years, CoCM group total health care costs were $3,363 lower than patients receiving treatment as usual
- During the 12 months following initiation of CoCM in a 2015 study, there was a 13% per member per month total health care cost savings for CoCM patients as compared to the “treatment-as-usual” comparison group
This is what evolvedMD is bringing: helping primary care and physical health locations integrate behavioral health care with their other services. By tying behavioral health to the primary care mission, Osland notes, everyone gets what they need: patients, providers and payers.
“We need more patients to be able to access care,” Osland says. “This is why integrated care, and collaborative care specifically, is the future of behavioral health. Let’s graduate patients and send them back to their lives where they can be healthy and productive.
“I’m trying to encourage folks to realize that if we’re going to continue to make investments and spend time and energy on behavioral health, let’s do it on something that’s innovative and disruptive,” Osland says. “Let’s not just accept the status quo. Let’s see true change. There is no point in pursuing anything less than that.”
This article is sponsored by evolvedMD. To learn more about how evolvedMD is becoming the front door of behavioral health, visit evolvedmd.com.
[1] “Mounting Evidence That Use of the Collaborative Care Model Reduces Total Healthcare Costs” May 2024
