Those two words sum up the relationship between primary and behavioral health care.
As frustrating as it is, behavioral health is an often-overlooked component of comprehensive patient care. In the traditional model, primary care physicians are the patient’s first access point to behavioral health treatment. According to a study published by the Medical Group Management Organization (MGMA), 20 percent of all visits to primary care doctors included at least one behavioral health indicator (i.e., depression, screening, counseling, etc.).
The physician may miss important signs of a behavioral illness if they do not screen the patient. However, even if the physician identifies the illness, they may be so overwhelmed with administrative burden that they have to refer the patient to a behavioral health specialist. That specialist may have little availability for new patients, thus limiting access.
That patient may end up being one of the 17.7 million U.S. adults who experience appointment delays or cancellations, the 7.3 million who can’t get their prescription when they need it, or the 4.9 million who could not access the right care.
Untreated mental health conditions cost the U.S. economy $300 billion per year in hospital readmissions and healthcare resources. Depression alone can increase a patient’s risk of developing cardiovascular and metabolic diseases by 40 percent or more, and may double the risk in patients with preexisting heart disease. For primary care physicians in risk-based arrangements, this is an exceptionally difficult challenge to navigate.
The wide-scale shortage of mental health practitioners, barriers to entry, and payer limitations make referring patients to this much-needed treatment difficult. For doctors, seeing their patients return to the hospital for treatments that will not ease their symptoms can be disheartening.
How can physicians in value-based care arrangements provide comprehensive patient care with a fragmented behavioral health system?
Again, it’s complicated. It will require integrating these two areas of medicine, and that’s when a value-based care framework can help close the gaps.
Stepping Up Care Coordination
According to the American Medical Association, the successful integration of primary care and behavioral health means that patients can access the treatment they need within the practice. Currently, this integration exists on a spectrum — on one end, the PHQ-9 assessment; on the other, a team-based approach that involves primary care physicians and behavioral health specialists.
Many physicians fall on the PHQ-9 assessment end of the continuum (or the traditional model I described earlier). However, studies show that a team-based approach to primary care and behavioral health produces the best results. In fact, physicians in the study reported that 50 percent of their patients saw a five-point reduction in their PHQ-9 assessments, while 32 percent saw an up to 50 percent improvement in their scores.
Building Supportive Technology
For physicians in value-based arrangements, behavioral health presents unique challenges, especially around the absence of official quality measures (as of this article’s publication date).
Some physicians may use metrics like behavioral health screenings and hospital readmissions to assess the quality of care. However, this lack of standardization presents physicians with a major problem: they may not have the technology to support whatever quality measures value-based care programs decide to use.
To set physicians up for success, they may need an integrated — or, at the very least, upgraded — technology stack that provides access to the following key features:
- A super-charged electronic health record (EHR). Physicians’ EHRs should have powerful tools to help them screen for behavioral health disorders with customized care gap reporting. If the physician does not have a clinical behavioral health team in the office, the EHR should have a tiered referral system to help them refer patients to high-quality, low-cost specialists that are in-network.
- Virtual scribes, coders, or billers. Virtual support with notes, coding, and billing can help optimize revenue cycles, boost collections, and increase attribution in value-based arrangements. These aspects will be critical to integrating behavioral health, which can be notoriously expensive to treat.
- A robust patient portal. Behavioral health will require a high degree of engagement from patients, as well as more visits, frequent follow-up appointments, and medication management. They may also have to experiment with different medications before finding one that works best. A robust patient portal can send critical appointment reminders, as well as make health records, prescription information, and referrals easily accessible, all of which help patients take charge of their care.
However, this technology isn’t useful to patients if it isn’t accessible, which leads us to …
Implementing Telemental Health
“As consumers, your patients want — and expect — the usability of Amazon and convenience of Uber in their healthcare journeys,” observed Chris Voigt, Executive Vice President and Chief Technology Officer, in his post about overlooked value-based care tech.
The same concept applies even more so to behavioral health, and one of the best ways to achieve this is through telehealth, also known as telemental health. From March through August 2020, telehealth made up 40 percent of outpatient mental health and substance use disorder treatment. Despite the decline in virtual care since 2021, 36 percent of patients with substance use disorders and mental health conditions have continued to use virtual care in 2022.
In an age where everything is “on” — online, onsite, on-demand — telehealth is an absolute must in both primary care and behavioral health. Aside from helping physicians keep their schedules full, telehealth can make care accessible to patients and is irrefutably critical to a physician’s continued success in risk-based arrangements.
Providing a Seat at the Table
As incredible as analytics are, data only tells one side of the story.
To lead a successful integration of these two different worlds, accountable care organizations (ACOs) will need to engage physicians and providers in clinical informatics. They will also need to give them a seat at the table in major decisions. Physician input is critical to building the technology needed to support and properly document care. Aside from physician input, ACOs can elevate their voices further with a physician-led governance structure.
With input from their partners, ACOs should take a smart, methodical approach to risk-based arrangements. Bumping to the next track may look great on paper, but organizations should only continue to take on more risk when their physicians are ready.
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