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Solving the Behavioral Health Crisis in Primary Care Practices

by | Sep 14, 2018

The shortage of behavioral health providers is a major public health concern in our country. According to a report from the Health Resources and Services Administration, the supply of workers in selected behavioral health professions will be about 250,000 workers short of the projected demand by 2025. The shortage is especially severe among psychiatrists. More than half of the counties in the United States have no practicing psychiatrists. Rural areas are more adversely impacted than urban areas. The shortage of behavioral health professionals is due to many factors, including low reimbursement and burdensome paperwork requirements from insurance companies, which has caused many providers to only accept private pay patients.

About 111 million people live in a behavioral health professional shortage area, according to the U.S. Department of Health and Human Services.

Unfortunately, this shortage comes at a time when demand for behavioral health services is increasing. Nearly 1 in 5 individuals in the U.S. has some sort of mental health condition, according to the Journal of the American Medical Association. As the stigma associated with mental illness declines and the number of individuals with health insurance increases, the demand for behavioral health treatment is flooding the existing health care delivery system.

Health plans are feeling the effects of this crisis every day.

Members call and complain that they are unable to access behavioral health care services, while provider services staff are struggling to build a network. A shortage of behavioral health providers may even result in corrective action plans from large group customers, government payers and accrediting bodies. As many organizations work to solve this issue, three main areas of focus have emerged: increasing the number of behavioral health professionals, increasing access to telepsychiatry, and integrating behavioral health care into primary care offices.

Many health plans have already started working on programs to integrate behavioral health and primary care. By providing additional support to primary care offices, health plans can provide a viable solution to the behavioral health provider shortage, improve quality, and reduce the overall cost of care. One example is the screening and treatment of depression. Primary care practices that implemented universal screenings for depression found the incidence among chronically ill patients to be as high as 70%. Patients suffering from depression are less likely to take charge of their health and follow through on treatment plans, which can lead to higher health care costs in the long run. By addressing the underlying mental health issues, primary care providers can better meet the needs of these patients.

One successful model involves the use of specially trained behavioral health care managers to work on-site at the practice. Typically, the care managers are social workers or registered nurses who are dynamic, empathetic professionals with a talent for developing trusting relationships with patients. The care managers use motivational interviewing techniques, which include unconditional positive support and an assessment of the patient’s readiness for change. In collaboration with the patient, the care manager devises a care plan to coincide with wherever the patient is at in the stages of change model. Care managers can typically spend more time with patients than a standard medical care appointment would allow. They follow the patients closely, sometimes weekly if needed, to celebrate small victories along the way and deal with any setbacks or obstacles that may arise. The care manager’s hands-on approach can be extremely effective in keeping patients on track.

Medical Advantage has partnered with several practices in Michigan to help them incorporate behavioral health care managers into their care delivery process. Looking back on our experience, I have come up with a few key lessons that are important for anyone seeking to implement this model:

  • Choose the right person for the job. The care manager is the foundation of the program. When you select a care manager, pay specific attention to interpersonal skills, including empathy, good listening skills, and the ability to work with patients in a non-judgmental way. The care manager should have strong organizational skills to follow up with patients in a consistent and timely manner. The care manager should also be knowledgeable of community resources and support groups that are appropriate to each patient’s needs.
  • Provide training. Even a seasoned care manager will need training. The care manager should receive special training in motivational interviewing, if he or she has not previously been trained. It is also important to train the office staff on the role of the behavioral health care manager and how to refer a patient to the care manager for assistance.
  • Enhance communication. In addition to training, it is important to ensure ongoing communication between the care manager and the rest of the office staff. Team huddles can be a great way to facilitate communication. In addition, there needs to be a forum for the care manager to communicate with the patient’s primary care doctor and share information.
  • Develop a referral process. There will be times when a patient needs more support than the care manager can provide. Primary care practices should develop referral processes for times when a behavioral health specialist is needed, such as a psychiatrist or master’s level clinician. The care manager can follow-up to ensure that the patient does not fall through the cracks.
  • Keep patients informed. It is important to let patients know that the behavioral health supports are available and that they are free of charge. Flyers or posters can be placed in the waiting room or patient rooms to educate patients and encourage them to discuss any mental health issues they are struggling with.

The integration of on-site behavioral health care managers in primary care practices has the potential to improve access to care and provide hands-on assistance for patients with mental health needs.

Medical Advantage has experience and expertise building and sustaining these models in primary care practices. One of the biggest challenges is funding. Primary care practices have limited resources to implement new programs. Health plans have the potential to expand these programs for their high-volume primary care offices. The programs can yield positive outcomes in terms of increased quality scores and reduced cost of care, especially for chronically ill patients.

One way to begin is by partnering with a single primary care office and exploring the possibility of a pilot program for enhanced reimbursement for behavioral health screening and intervention. This small change has the potential to lead to holistic system changes in the future. Medical Advantage is excited about the possibilities and we are open to a variety of partnerships to expand this model to more primary care practices.




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