Focusing on the full continuum of behavioral health needs, including education and prevention, that address innovative strategies to expand behavioral health access for members is essential to reducing mental health disparities and improving overall population health outcomes. Clearlink understands that achieving improved outcomes at a lower overall cost is possible, but the path to success for each plan may be different. Restructuring outdated and ineffective payment structures, expanding access through innovation and technology, and using advanced analytical models to stratify populations to identify underlying, undiagnosed behavioral health conditions and health inequities, can be achieved.
Behavioral health analysts agree that the rise in mental health diagnoses—and the corresponding increase in medical costs—shows how important it is that U.S. health insurers improve their behavioral health offerings to address mental health disparities and access to care. Under- and untreated behavioral health disorders create a lower quality of life for patients and higher indirect and direct costs to the healthcare system and society at large. In the past, payers have focused on managing the cost of behavioral health care through their utilization management programs, not recognizing nor focusing on the impact untreated behavioral health conditions have on overall cost of care. The reality of disparities in mental health care, including limited access and focus on mental health awareness and early prevention programs, has arguably had a greater impact on healthcare spend and poor quality outcomes.
The following behavioral health strategies provide a path for payers to address these issues and realize a new vision for the health system—one that meets the needs of individuals in our nation through accessible, coordinated, and effective care.
1. Increasing Behavioral Health Access through Integrated Care
Integrated care is the solution for bringing more behavioral health access to patients. On average, one study found that when a member has a behavioral health diagnosis and receives outpatient treatment, they have fewer emergency room or inpatient facility visits overall, decreasing costs by up to $1,377 per member per year.1 However, access to behavioral outpatient care goes beyond the savings it offers for the health plan. The most important factor is that it helps patients develop and cultivate tools to manage their mental health symptoms, allowing them to not only feel better, but also avoid future medical services through improved management of their overall care.
The same study found that the additional costs of behavioral outpatient care are offset by the total cost of care savings to the payer and that this return on investment was sustainable for over two years.1 These healthcare costs are typically 2.8 to 6.2 times higher for people with comorbid physical and mental health conditions. Integrated care for behavioral health extends resources and support to high-risk populations that typically do not seek behavioral health treatment in traditional mental health and substance use disorder settings.
Overall, patients, providers, and payers benefit from improved health outcomes and lowered costs when integrated care is utilized to increase behavioral health access. It allows primary care providers to deliver treatment on the mental health front, giving patients access to more help and reducing the stigma that keeps many people from seeking treatment.
2. Ensuring Compliance with Rapidly Evolving Federal Legislation
Federal programs are emerging to help states meet the behavioral health needs of their residents. Last year, Congress passed the American Rescue Plan Act, which provided billions of dollars for the behavioral healthcare system.
More recently, the departments of Labor, Health and Human Services (HHS), and the Treasury issued a report that health plans are failing to deliver behavioral health benefits.2 Demand for mental health treatment services increased significantly during the COVID-19 pandemic, making it even more concerning that patients cannot receive the behavioral health care they need. On the substance abuse front, HHS plans to evolve legislation to allow providers new methods of treating addiction, including increasing access to take-home doses of methadone and allowing telehealth appointments for medication assistance.3
Changing the infrastructure to allow better and more efficient access to behavioral health treatments is the way to ensure patients have their needs met. The American Rescue Plan Act includes provisions to improve communities’ safety net and expand reach beyond delivery care systems to schools, shelters, and other core public service agencies with an aim to reduce mental health disparities. 4
3. Managing Behavioral Health Benefits
When payers contract with managed behavioral health organizations, they separate clinical management and reimbursement for behavioral health services, essentially keeping a bifurcated system from physical health services.5 This can create misalignment and layered complexities for patients and delivery system providers, resulting in a system that undermines whole person care. Having the management of behavioral health services “carved out” has a steep cost to patients, delivery system providers, and plans who continue to face new requirements from States that align with the evidence surrounding integrated, whole person care.
The solution? Insource the management of behavioral health services. Since the machinations of healthcare are the same between behavioral and physical—billing and claims, scheduling, managing providers, and more—it makes sense for behavioral health staff and physical health staff to leverage the same management structures and tools to create an integrated system that benefits, patients, providers, and payers.
Addressing the split between behavioral and medical managed care systems allow plans the flexibility and innovation to reward and incentivize delivery systems and providers through value-based payment arrangements that focus on quality, integrated care models, and access. Plans managing behavioral health care have more control over their care management model of care, payment integrity systems, population health risk stratification designs, and impact on overall member and provider satisfaction results.
4. Implementing Value-Based Payment Behavioral Health Strategies
Increasing reimbursement for behavioral health not only allows for more efficiency and value but also improves access, quality, and healthcare costs.5 The way this works is by rewarding performance through two models:
The basic model limits financial risk for smaller practices by allowing behavioral health providers to earn an additional percentage of their annual reimbursement as an incentive based on performance in defined areas.5
For larger practices, the advanced model gives behavioral health providers payments that vary depending on their attributed population’s health, cost outcomes, and purposeful partnerships with large primary care practices engaged in their own value-based care contract arrangements to improve clinical quality and reduce cost of care.5
Linking the providers’ payments to how they can improve access to care for their patients allows for better integrated care and patient experience.
5. Scaling Point Solutions for Behavioral Health Disorders
Not only does an underlying and untreated substance use disorder correlate to poor health outcomes, it is also a contributing factor to higher overall costs of care for payers. Some new ways are in development to address these issues, like offering virtual medication and therapy to patients who would benefit. Another factor for plans to consider, specifically when risk stratifying populations for targeted interventions and programs, is that substance use is often highly correlated to mental health conditions like depression or trauma. Therefore, when patients are treated, it’s important for this information to be available to their providers.
Ideally, behavioral health conditions, including mental health and substance use issues, would be screened and evaluated by a primary care provider and closely coordinated with any relevant physical health conditions to ensure treatment is as effective as possible. Plans can offer effective advanced analytic data models and tools for treating providers to improve individual and population-based health outcomes through collaboration and proactive healthcare.5
6. Expanding Health Analytics and Population Health Programs
As noted throughout the strategies above, health analytics management is the best way to measure the impact of behavioral health outcomes and population health programs across the continuum. Measuring interventions across the identified population can provide a clearer image of member needs, resulting in better care and outcomes.
There isn’t one solution to solving this problem. Each patient is unique, and it’s essential to meet their individual healthcare needs. Focus on the emotional, medical, and social needs to understand the issues they are facing as they seek care.6 And overall, establish trust to ensure they continue to seek treatment and ultimately achieve positive outcomes.
Improving Behavioral Health and Reducing Total Cost of Care
Improving behavioral health integration practices benefits patients, providers, and payers alike. It’s vital to work on reducing mental health disparities in your health plan to ensure all members are receiving the best treatment possible and getting what they need—and it doesn’t hurt that establishing solid behavioral health services helps payers improve the total cost of care too.
Clearlink is an expert in helping health plans strategize, implement, optimize, and integrate behavioral health programs. We offer strategy-through-execution solutions for coordination of care, improved health equity, cost-of-care savings, and more. Contact us today to learn how we can help you.
- Cigna Study: How Much Behavioral Health Treatment Can Lower Total Cost of Care, Fierce Healthcare
- US Departments of Labor, Health and Human Services, Treasury Issue 2022 Mental Health Parity and Addiction Equity Act Report to Congress, US Department of Labor
- HHS Moves To Make Permanent Pandemic-Driven Opioid Treatment Options, KHN
- The 2021 American Rescue Plan Act’s Major Health Care Provisions
- Behavioral Health: A Payer-Based Strategy For Improving Access And Quality During COVID-19 And Beyond, Health Affairs
- Industry Voices—Health Plans Paying Price for Unaddressed Behavioral Health Needs, Fierce Healthcare