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 national survey 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, 89.3 million Americans live in a federally designated Mental Health Professional Shortage Area. 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.
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- 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 telemedicine, 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.
Demand for mental health services is
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.
John Figueroa, MBA, is a member ofPepperdine Graziadio Business School board, and former CEO of Genoa Healthcare, a behavioral health pharmacy, telepsychiatry, and medication management company.