The Urgent Case for Proactive Behavioral Healthcare

The need for behavioral healthcare services has been increasing for several decades and this growth has accelerated exponentially due to COVID-19 and its impact on daily life.

At the same time, access to necessary care has not kept pace despite the demand. The gap between access and demand will continue to grow to dangerous levels this year, unless payers and providers find new ways to optimize the limited behavioral healthcare resources currently available.

The increasing demand for behavioral health services is largely driven by two groups of patients:

• Those who needed treatment prior to the pandemic, but who did not receive it due to lack of access, stigma, and other barriers. These patients are now so overwhelmed that they are seeking treatment.
• Those who were functioning fine prior to the pandemic, but who now need treatment because of it.

Forty one percent of Americans report experiencing anxiety or depression during the pandemic, and 12% say it has led to increased alcohol consumption or substance use. The rate of depression has skyrocketed, with a recent JAMA study finding that depression symptoms in patients are three times more prevalent than prior to the pandemic. In January, when more than 3,000 physicians were asked to identify the biggest public health challenge that will arise after the pandemic, 86% cited mental health issues and depression.

A Problem Compounded: More Patients, More Severe Cases

Along with an onslaught of patients with behavioral health conditions exacerbated by the pandemic, the healthcare system is also facing a higher proportion of patients with more severe conditions. That’s because nearly half of patients have deferred healthcare during the pandemic, according to studies from both Willis Towers Watson and Kaiser Family Foundation.

As these patients return to the healthcare system, many will be diagnosed with conditions at more advanced stages—and patients with behavioral healthcare problems are no exception.

Already, we are seeing an increase in patients with behavioral health problems presenting to emergency departments, particularly children and adolescents. Between April and October 2020, hospitals experienced a 24% increase in mental health emergency visits for children ages 5 to 11, and a 31% increase for children ages 12 to 17.

Patients with behavioral health problems deferring care also increases the likelihood that these patients will experience other or worsening health problems. That’s because these patients are at higher risk for conditions such as cardiovascular disease, diabetes, stroke, and substance abuse.

A Proactive Approach: Enhancing Access by Maximizing Resources

With the increasing need for behavioral health services, many plans and providers are working hard to identify solutions. Policy initiatives, including the CARES Act, which is providing $425 million to The Substance Abuse and Mental Health Services Administration, will be instrumental in supporting these efforts.

Telemedicine is one of the most promising approaches payers and providers are employing to expand access to behavioral healthcare services. As payers have expanded telemedicine reimbursement and as states have passed legislation reducing telemedicine regulations, significantly more providers have started offering it to their patients and more patients have been able and willing to use it. While telemedicine is not available or appropriate for all behavioral health patients, it has safely connected many to critical care resources during the pandemic.

A growing number of payers and providers are also using artificial intelligence and predictive analytics technologies to optimize the use of available behavioral healthcare resources. These technologies incorporate claims data, historical data, clinical data, social determinants of health, and other information to identify patients at risk for behavioral healthcare problems, particularly those who would benefit from treatment.

This proactive approach is especially useful during the pandemic, as plans and providers can identify patients at risk of behavioral health problems, even if those patients don’t have a current behavioral health diagnosis or haven’t recently engaged with the healthcare system. Once plans and providers identify these patients, they can intervene more quickly to provide behavioral health services. This optimizes resources and lessens the growing gap between need and supply, as engaging patients early can prevent conditions from escalating, which means patients require lower levels of care or less frequent care.

Health Equity: A Critical Part of the Equation

As payers and providers work to expand behavioral healthcare access, improving health equity must be a key element of all initiatives. Racial and ethnic minorities have experienced disproportionately worse mental health outcomes due to the pandemic. They have also experienced higher rates of substance use and suicidal ideation. This in itself is very troubling, but raises even more concerns because research suggests that racial and ethnic minorities tend to receive treatment for behavioral health conditions less often than other populations due to factors such as discrimination, lack of access, and stigma surrounding mental healthcare.

Payers and providers must ensure behavioral healthcare services are easily accessible to underserved patient populations, including recognizing that these populations likely have less access to telemedicine due to poor or no internet connections and limited phone minutes. They must also ensure that patient outreach and engagement initiatives are culturally and linguistically optimized. AI and predictive analytics tools that base predictions on clinical and nonclinical risk factors, such as social determinants of health, can be a key asset for plans and providers committed to improving equity when it comes to behavioral healthcare access and services by identifying underserved patients and matching outreach and treatment approaches that best meet their needs.

Looking Ahead

Payers and providers will face unprecedented behavioral healthcare challenges over the coming months. They must implement a variety of solutions to ensure patients can access the care they need before their conditions escalate—and they must act quickly. The sooner payers and providers transition behavioral healthcare from a narrowly reactive model to one that is holistic, inclusive, and proactive, the healthier our patients and our healthcare system will be.

David Ramirez, MD, served as Chief Medical Officer at CalOptima and Chief Quality Officer at CareMore Health. A physician advisor to Prealize Health, he is board certified in internal medicine and completed his residency at Cedars Sinai Medical Center and graduated from Harvard Medical School.

Erica Kaitz, LCSW, leads the Clinical Operations team at Prealize Health, contributing to the company’s clinical portfolio and helping connect Prealize’s world-class data science to better patient outcomes. Formerly the behavioral health director for Cigna Health-Spring of Illinois’ government programs, she is a licensed clinical social worker, and completed her Masters of Social Work at Columbia University and post-graduate training in psychiatric crisis and community mental health settings.