Integrating primary care with behavioral health services, improving mental health provider training, and policy changes were highlighted as strategies to combat the growing epidemic of mental health and substance abuse during a session principal at AHIP 2022.
In combating the mental health and substance abuse epidemic, evidence has shown that integrating behavioral health care into primary care has led to significant improvement in clinical outcomes and cost. However, panelists at a keynote session at AHIP 2022 note that several barriers remain in integrating behavioral health care, which has historically been siloed from physical health.
Shantanu Agrawal, MD, MPhil, Anthem’s chief health officer, opened the discussion by acknowledging the impact of COVID-19 on mental health, which he described as a “growing crisis” characterized by substantial demand and uneven access to care services. . Even before the pandemicDisparities between physical and behavioral health care were shown to be worsening for American families seeking affordable and available mental health care and addiction treatment.
“What I find is that many primary care providers [PCPs] they really don’t feel comfortable addressing behavioral health issues, they don’t feel comfortable not knowing exactly what to do, and they often end up being referred to those services, which I think is more and more challenging,” Agrawal said.
“We need to better support our PCPs, doctors, nurse practitioners, all of the above, with better training on different kinds of topics. And provide them with consultation services – assist them in their ability to retain behavioral health issues within their practices and address them.”
Along with PCPs, Agrawal said diversification of the behavioral health workforce, including health coaches and peer support counselors, is warranted to meet the high demand for mental health services.
“We need to do more to bring as many different types of care – access as possible and that includes digital care, virtual care, both asynchronous and synchronous – and do everything we need to do from a policy and payment standpoint so that that is really possible. she added.
“And finally, there are models that we and I know a lot of other companies are working on that really integrate physical and behavioral health care; any time you really bring these needs together and combine them with providing care for social needs at the same time, that has a tremendous impact on outcomes.”
Addressing further the usefulness of collaborative care models, Miriam Delphin-Rittmon, PhD, Under Secretary for Substance Use and Mental Health, HHS, and Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), said that integrated care has become a priority at HHS as data has shown substantial improvement in health outcomes when primary care is combined with mental health and substance abuse services.
“It creates additional entrances to services and supports people who are struggling with mental health or substance use services,” explained Delphin-Rittmon.
He noted that one of the programs that HHS has helped support and fund is the Screening, Brief Intervention, and Referral for Treatment (SBIRT) model within the primary care setting, which helps identify individuals who are struggling with mental health or substance use issues and connects them with services and supports.
Since people in behavioral health settings are often not connected to PCPs, Delphin-Rittmon added that evaluating primary care conditions in behavioral health settings can also help with overall health and wellness.
“So really what this means, from a training and education perspective, we have to think about training a little bit differently, and it’s important to expose both clinicians and behavioral health providers to screening within each of the other fields, so that people can connect to vital services.”
In her work as CEO and co-founder of Psych Hub, which provides multimedia education to people dealing with mental health issues, Marjorie Morrison said one strategy her organization employs to improve quality is to train providers and certify them in care specialties. behavioral.
“Once they act more like specialists, everyone wins. The consumer gets better care, better output in fewer sessions, the provider has much less burnout, and there are savings in total cost of care,” said Morrison.
“At a high level, mental health can be very confusing. You have types of providers, psychiatrists, psychologists, social workers, coaches, peers, then you have different types of interventions like digital CBT. [cognitive behavioral therapies], [as well as] symptoms and diagnoses… when you think about how confusing it is for the average consumer, they need to be informed.”
From a policy and reimbursement perspective, Morrison emphasized the disparity in incentives for PCPs who can be reimbursed for diabetes, weight loss or smoking cessation education, but not for mental health.
By taking a holistic approach, he noted that the move to telehealth can also help provide consultations for lower-acuity patients to lower levels of care providers, such as peers and coaches. But to do that, integrated models that can reimburse these providers are justified.
“We need to be able to save our psychiatrists and psychologists for those who need that help. We were also able to start driving measurement-based care, feedback-informed care, and quality reimbursement. To be able to start taking risks and doing value-based contracts, we have to be more innovative in our reimbursement.”
“There are political restrictions on the different types of providers that can be reimbursed for these services. Part of the problem is simply implementing what we know works and that doesn’t necessarily require a lot of policy changes, it requires making a variety of changes to health systems and organizations like mine,” Agrawal concluded.
“I think the pandemic really put this on display: It forced all of us to make changes that, frankly, we could have done before… It’s about implementing things that you know work. and encourage changes in the ecosystem when necessary.”
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