John Figueroa

home

authors

john-figueroa

As the number of individuals seeking healthcare services continues to climb, the lack of access to essential outpatient resources remains a particularly troublesome patient hurdle. In 2017, the National Institute of Mental Health conducted a 

 that found one in five adults in America live with a mental illness, representing nearly 20% of all U.S. adults.

Adults seeking treatment or preventative health services are often unable to access quality behavioral healthcare. Additionally, continued stigma surrounding mental health issues, combined with an inadequate workforce within the field and a disparity of community-based resources from county to county, make it difficult to pinpoint exactly where individuals fall through the cracks and become discouraged from seeking treatment.

Managed care organizations can play a role in reducing costs and improving care by significantly enhancing outpatient services and establishing new partnership models for more effective outpatient treatment.

Here are five ways managed care can have an outsized impact:

Take steps to address the workforce skills gap in mental health services. The U.S. is facing an overall shortage of mental health professionals. Currently, 

 Americans live in a federally designated Mental 

. Rural areas often have few mental health providers and in urban areas, the providers are inundated as patients are wait-listed and generally left in a state of limbo. Earlier this year, the Pepperdine Graziadio Business School and Dignity Health Global Education announced a partnership to offer online certificate courses to provide training for data professionals. The agreement combines Pepperdine Graziadio's experience in creating applied learning and Dignity Health’s access to healthcare data, informatics, and real-life scenarios. Professionals trained through management-healthcare collaborations such as this can help effectively resolve patient care as well as cost issues.

Integrate outpatient behavioral health with primary care. Historically, clinical care has been segmented into silos, with mental health providers operating independently from primary care. Creating a one-stop shop through better integration of behavioral health and primary care can help ensure that patients receive treatment early and ultimately, drive down costs for patients and care providers. For example, Genoa Healthcare integrates outpatient mental healthcare with pharmacy, telepsychiatry, and medical management services. This allows psychiatrists access to additional information needed to diagnose and properly address patients. Genoa’s telepsychiatry services provided a solution to many adults and families that were unable to access behavioral healthcare and created a model that was patient focused.

Surprising Perceptions About Mental Health

 Incentivize providers to include integrated pharmacies where care is received, creating wraparound services for patients. Patients that receive behavioral health services at community mental health centers are often prescribed medication critical to the treatment of their mental illness, including schizophrenia, bipolar disorder, anxiety, and depression. A 

Southwest Michigan Behavioral Health study

, funded by Genoa Healthcare, examined the benefits of placing an integrated pharmacy within the mental health service delivery setting. Patients using these integrated pharmacies had higher medication adherence rates, lower hospitalization rates, lower emergency department visits, and a cost savings of $58 per member, per month versus those filling prescriptions at pharmacies outside of the care setting. Further replication of this model could improve patient health and reduce costs.

Ensure quality improvement by working with care providers outside an in-patient hospital setting. Managed care organizations can take steps to 

partner with community-based organizations

 that provide critical outpatient services. Additionally, with a focus on technology companies, such as those using 

, managed care organizations can help increase the availability of much needed psychiatric care for those in need.

Adopt integrated care approaches to improve their effectiveness. Nystrom and Associates in Minnesota is an example of a quality-focused organization that has practiced in an integrated care model in behavioral health for more than a decade. The results have been astonishing, surpassing all payer quality indicators and leading to a seamless care model for patients in 15 clinics with more than 75 distinct service offerings. The model is so effective that Nystrom has more than 1,000 referral sources across inpatient and other community settings demonstrating the positive impact of true integrated care.  

 over the next 20 years. Integration, data management, and proper training are critical first steps to develop a solid foundation for improving quality and delivery of this care. Operating in a managed care setting provides a unique opportunity to identify the areas where we can truly make an impact and make smart investments in education, services, and efficiencies.

Pepperdine Graziadio Business School board

, and former CEO of Genoa Healthcare, a behavioral health pharmacy, telepsychiatry, and medication management company.

Articles

The steps health executives should take to improve mental healthcare.

How Outpatient Services Can Impact Mental Health

Despite efforts to destigmatize mental illness, patients who seek psychiatric care face more barriers to care than those with physical disorders. Yet just last month, in one of the first actions related to repealing and replacing the Affordable Care Act (ACA), the U.S. Senate 

 to reduce or eliminate access to mental health services-an initiative that would severely impact mental health patients’ access to pharmacies and drugs.

Mental health: The secret sauce to healthcare reform

Any discussion in Washington, D.C., on repeal or replacement of the ACA must focus on how to preserve, not curtail, mental health services and pharmacy access as essential benefits for all beneficiaries, including individuals with pre-existing conditions. Anything less is discriminatory against individuals with mental illness.

Mental Health Parity and Addiction Equity Act in 2008

. More recently, the ACA established policymaker intent in mental health parity, mandating mental health services and addiction treatment, as well as pharmaceutical access, as two of 10 essential health benefits.

 depends on psychotropic medications to stabilize their condition. When access to these drugs is limited, the results can be disastrous. Approximately 30% of mental health patients who face barriers to accessing medications experience treatment lapses or discontinuation. 

 that examined restrictions on medication access and psychopharmacologic treatment on individuals with Medicare or Medicaid showed that 69% of patients had adverse events, including significantly higher rates of emergency room visits, hospitalization and worsened side effects that interfered with functioning. These events result in higher costs for payers from avoidable complications.

There are a number of barriers that impede medication access, including a complex insurance system and cumbersome requirements by some payers to re-categorize long-acting injectable antipsychotic medications and other critical injection medications as “specialty” medications, necessitating them to be filled by mail-order. But the ACA helped to mitigate the most significant barrier: people can’t take medication to manage their behavioral disorders if they can’t access mental healthcare services in the first place. An estimated 30%  of individuals who received coverage through the ACA have a mental or substance use disorder, according to the federal 

Substance Abuse and Mental Health Services Administration

. By mandating preventative screenings, therapy and medication, the ACA helped individuals access services for mental health and addiction treatment at early stages, when they are more likely to adhere to their medication regimen.

Another important benefit of the ACA is that it directed millions to 

 (CMHC), with a specific focus on integrated behavioral health services in primary care. Under the integrated model, pharmacy services are often embedded right into behavioral health centers, facilitating collaboration between pharmacies and providers on treatment plans for patients. This model is radically successful in facilitating access and adherence to medication, and mitigating avoidable adverse events. A 2016 peer-reviewed 

Journal of Managed Care and Specialty Pharmacy

 showed that integrated care models that feature onsite pharmacies within CMHCs produce higher medication adherence rates than community pharmacies, as well as lower rates of hospitalization and lower emergency department utilization.

President Trump promises to move quickly and decisively to repeal the ACA, but he also promises “

.” That’s encouraging, but healthcare stakeholders, including payers, should take note of the social and financial value of pharmacy benefits, supporting them as a critical component of ACA reform and all aspects of healthcare policymaking. It is only when we, as a society, passionately and vigorously protect these benefits that we can claim there is true parity for the mentally ill-a clear benefit for our entire society.

John Figueroa is chief executive officer of 

, and a member of the Board of Visitors of Pepperdine Graziadio School of Business and Management. The third annual

 Pepperdine Graziadio Future of Healthcare Symposium

 will be held in Los Angeles in March 23, 2017, featuring Ezekiel Emanuel, MD, one of the principal architects of the ACA.

ACA repeal or replacement must focus on how to preserve mental health services and pharmacy access.

Author | John Figueroa

Articles

How Outpatient Services Can Impact Mental Health

ACA reform must preserve mental health pharmacy access