Viewpoint

Improving Behavioral Health Access in a Time of Severe Provider Shortage


Petra Esseling
Advisory Board

Behavioral health needs are highly prevalent, comorbid with other chronic conditions, and associated with increased clinical care and cost. The 20% of Medicaid patients with behavioral health problems account for 46% of total Medicaid spending on health services. Spending on behavioral health services in total is projected to reach almost $240 billion by 2020, up from about $150 billion in 2009.

Petra Esseling

Petra Esseling

Despite high need and urgency, patient adherence is low. One might think that puts the onus on patients, but a major reason for this gloomy picture is the severe shortage of mental health professionals across the country—a shortage that’s only going to increase. We already fail to meet 50% of demand. Many in the current cohort of psychiatrists is getting ready to retire. Medical students enter more lucrative specialties than psychiatry.

But there is good news. Health systems are launching new ways of delivering and organizing behavioral health services.

Here are four ways they are improving access and meeting the surging demand:

1) A new wave of primary care-based services. The integration of mental health services in primary care is common best practice nowadays. The collaborative care model has shown positive financial return on investment (5% to 10% in lower overall health care costs) and is increasingly reimbursed by CMS and other payers. Health systems are now looking for ways to scale integrated behavioral health through virtual care and to expand services to substance abuse treatment.

Despite the uncertainties surrounding the reimbursement, health systems have stepped up their investment in centralized behavioral health service units, staffed by behavioral health consultants and psychiatrists, to connect virtually to patients in affiliated primary care offices. The assessment and treatment of behavioral health problems doesn’t require a physical assessment, making virtual treatment a viable option to achieve scale.

So far, integrated behavioral health services focused predominantly on anxiety and depression. Providers increasingly screen for substance abuse disorders and are starting to offer medication-assisted treatment.

2) IT-enabled care delivery. In addition to virtual care, providers are deploying technologies to enable cross-team collaboration, engage patients in their care, and monitor response to treatment. While many health systems partner with third-party vendors, some health systems are building out their own capabilities. Tools to facilitate improved team-based care, care team reach, and self-management are the major trends I’ve seen.

Despite the fact that behavioral health and physical conditions are highly comorbid, providers commonly work in siloes. Digital communication platforms facilitate collaboration among multidisciplinary care team members and allow providers to engage patients between visits. This is less costly (and frustrating) than playing phone tag with patients and can prevent costly interventions, including hospitalizations. Mobile health apps and virtual platforms are helping patients to practice evidence-based self-management.

3) Specialized emergency care. Approximately one in eight emergency department visits is associated with behavioral health needs. These visits are three times longer than those of patients with non­psychiatric needs and significantly more costly. Many emergency departments are too loud, bright, and busy to help patients in a behavioral health crisis stabilize. Health systems are investing in a variety of specialized emergency services, including telepsychiatry, holding units, ED co-located crisis services, and behavioral health-specific emergency units.

4) Partnership-enabled community resources access. Given limited resources, community partnerships are as important to a sustainable behavioral health management strategy as they are to addressing patients’ nonclinical needs. Health systems are investing in a wide range of partnerships, including those with schools, to offer preventive and early intervention services, EMS providers to ensure appropriate referrals and prevent avoidable acute utilization, and community behavioral health centers to enable post-discharge and ongoing support.

Petra Esseling is a consultant with the Advisory Board’s research division.