Issues such as the opioid epidemic and an increased suicide rate in the U.S. are increasing demand for behavioral health care services even as challenges such as workforce shortages and payment policies are restricting patient access.
But policy changes such as improved reimbursement could help the nation's hospitals better address those access issues, according to a new analysis from the American Hospital Association.
"While nearly one in five Americans is affected by a behavioral health disorder, many individuals are unable to access the services they need," the authors of the report wrote. "Hospitals and health systems play a central role in meeting the health needs of their community."
- Prevention and screening: Improved reimbursement for screening and monitoring of behavioral healthcare needs.
- Coordination and integration: Improved support for coordination and integration, such as including behavioral health in value-based payment models and reimbursing for transitional care from inpatient to home or community-based settings.
- Community partnerships: Changes to the Stark Law that would allow hospital and physician practices to coordinate care for patients through value-based payment models.
- Workforce development: Support for workforce development such as encouraging telehealth, increasing training funding or student loan forgiveness and addressing scope-of-practice laws.
- Infrastructure development: Funding to support infrastructure development to better address behavioral health care needs.
- Destigmatizing care: Funding support for community campaigns or services that reduce the stigma associated with obtaining behavioral health care services.
"Policymakers should work with hospitals and health systems, as well as patients and community-based organizations to develop policies that address the social, structural, and financial barriers that constrain appropriate access and use of behavioral health services," the authors wrote.
The return on investment
Improving patients' access to behavioral health care isn't just important for addressing individuals' overall healthcare but it could also save U.S. hospitals millions, the report said.
Only 43% of the 44.7 million adults with any mental health disorder received treatment and fewer than 11% of patients with substance use disorders received treatment in 2016, the report said. Meanwhile, in 2013, costs associated with the treatment of mental health disorders reached $201 billion and are expected to surpass $280 billion by 2020, the report says.
The report points out multiple efforts by individual health systems to reap a return on their behavioral health care investments.
For example, Yale New Haven Psychiatric Hospital developed a multidisciplinary inpatient Behavioral Intervention Team which was associated with a reduced length of stay and demonstrated a return on investment of 1.7 to 1.
The Robert Young Center for Community Mental Health in Illinois implemented a patient center medical home in its hospital and reduced ED visits by 46% and cut psychiatric admissions by 50%. Cherokee Health Systems in Knoxville, Tennessee, reduced ED visits by 68% and hospital care by 37% after co-locating behavioral health professionals in their primary care facilities to enable real-time screenings.
Intermountain Healthcare in Utah studied its own use of an integrated team-based approach in the primary care setting over 10 years and found, if adopted nationally, it would save $4 billion annually.
"Increased access to behavioral health services is associated with improved health outcomes and quality as well as lower overall health costs," the authors of the report wrote.