Though truly bringing mental health care into the fold with clinical care may ultimately require some major policy overhauls, there are "significant quick wins” key players can go after now, experts say.
When Rocky Mountain Health Plans refocused on connecting members with primary care—and community health centers in particular—they knew could either meet behavioral health needs with in-house specialists or connect them with the right provider, said Patrick Gordon, associate vice president of community integration.
There are plenty of opportunities for small change, Gordon said, that can improve outcomes for patients even though a significant reshaping of the delivery system is a ways off. “Broad system change will take a heavy lift, but we can start now,” Gordon said, speaking at a Bipartisan Policy Center event on Thursday on how to bridge the gap between behavioral health and clinical healthcare.
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John Auerbach, CEO of Trust for America’s Health, said a good place for stakeholders to start is looking at the services patients use the most and where they’re the most comfortable. For example, his organization looked first at community health centers and mental or behavioral health clinics and used that as a baseline for where to reach the patients with the greatest need when looking for ways to plug away at smaller changes.
Other options may mean offering services outside of the traditional healthcare system entirely. Jill Bohnenkamp, Ph.D., assistant professor at the University of Maryland School of Medicine and core faculty at the university’s Center for School Mental Health, said a school is the “ideal place to serve students.” Building strong behavioral health options into schools can be a crucial preventative measure, she said.
This is especially true in rural areas that may struggle with access to care generally, Gordon added.
Another starting step, Gordon said, is bringing leadership of behavioral health providers to the table. When they’re included in the dialogue, they’re more likely to get skin in the game.
Behavioral health providers should be offered a piece of the shared savings from these efforts in exchange, he said.
Though starting small can pay off, there are still major roadblocks for providers and payers looking to address this issue, Auerbach said. These obstacles can vary significantly from state to state and between types of insurers.
Technology investments are one of the biggest barriers, he said. Many behavioral health providers, in particular those in nontraditional settings such as schools, may not be sure how to use telemedicine and may not have access to the tools needed to succeed.
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Licensing issues and contracting regulations can also make the process difficult, he said. In a review of Massachusetts regulations, Auerbach said he and his team identified 100 regulations that can get in the way of integrated care.
Payment models have also not quite caught up to these new approaches to care, he said. Reimbursement is also especially problematic for providers operating outside of traditional care settings.
“It’s one headache after another,” he said.
In Massachusetts, the team devised a workaround that could potentially be expanded to other states. They appointed a nurse who would field waiver requests from providers looking to get around some of these burdensome regulations, and she would connect with the needed regulators to see these requests through.
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In the future, policymakers will have to consider ways to make it easier for providers to follow these rules, Gordon said. At present, it falls to them to simply find a way to navigate regulations.
“It’s the least efficient, most burdensome way to do this,” he said.