Improved data, reimbursement vital to better behavioral care coordination

Current approaches to managing behavioral health benefits and reimbursement create challenges for effective care coordination, according to a new report from the Massachusetts attorney general's office.

The AG set out to examine how behavioral health services are administered and how well that aligns with the goals of healthcare reform.

Attorney General Maura Healey is focusing on behavioral health in the cost trends report because "it's really important to look at the whole health of the patient," according to radio station WBUR.

"We need to get to a place where we treat people who've got mental health, substance abuse issues in the same way we treat patients with diabetes or with cancer or with broken bones," Healey said.

Among the report's findings:

  • Providers treating behavioral health conditions need better data; behavioral health data lags compared to advances in data for other areas of health expenditures.
  • Providers and managed behavioral health organizations have little to no financial incentive to coordinate care.
  • Complex approaches to managing behavioral health benefits challenge efforts to improve historically low behavioral health reimbursement rates.
  • Lack of comparable and reliable data on behavioral health capacity and utilization constrains effective resource planning.
  • Gaps in behavioral health quality metrics hinder effective quality measurement and analysis.

The report notes that behavioral health is the top primary diagnostic category for age groups 44 and under at Massachusetts acute care hospitals. It adds that patients who have a combination of a medical and behavioral health problem, such as asthma and anxiety, spend between two and two-and-a-half times more on healthcare than patients with just a  medical condition.

Hospitals are improving access to behavioral health services to ease the burden on their emergency departments. With global payments, providers have a greater sense of urgency in keeping patients healthy, both physically and mentally.

A recent report from the National Alliance on Mental Illness, however, found insurance companies fall well short of providing mental health and substance abuse coverage, and that exchange plans had denial rates nearly twice the rate for other medical care.

A study published in the journal Psychiatric Services found that about 25 percent of exchange plans violate a federal mental health parity law that requires insurers to offer equal benefits to physical and mental healthcare, FierceHealthPayer previously reported.

To learn more:
- read the report (.pdf)
- here's the WBUR story