The ongoing mental health and substance use crises persist with little clinical progress. Financial incentives tied to value-based care are essential to address this issue. With the prevalence of mental health conditions increasing 30-50% since 2020, the time is now to improve healthcare integration and align physical and mental health resources, including substance use disorder.
Recognizing this imperative, Bamboo Health’s Chief Clinical Officer Nishi Rawat led healthcare executives in a discussion about the path forward for greater integration between physical and behavioral healthcare. The panel titled ‘Bridging the Gap: Improving Behavioral Health and Physical Health Integration’ combined expertise from Dr. Nishi Rawat, chief clinical officer at Bamboo Health, Dr. Lynn Simon, president of healthcare innovation and chief medical officer across community health systems, Dr. Virna Little, co-founder of Concert Health and Dr. Ravi Kavasery, deputy chief medical officer at Blue Shield California.
The panel discussed key actionable insights, including the need for financial incentives to integrate physical and behavioral health and current challenges inhibiting whole person care.
Financial Incentives Hold Key to Solving Access Issues
Payment parity is necessary to fix broken models and address access issues. Without payment parity, it is challenging to consider how to expand access for both behavioral and physical health needs. Reimbursement rates must also change to incentivize healthcare providers – assessments can’t be reimbursed due to hospital billing systems, and reimbursement rates, in general, are low.
As an alternative to the current reimbursement challenges, value-based care models may help provide improvements to both clinical and financial outcomes (according to Dr. Simon), although there still may be barriers to success (e.g. access). Dr. Rawat emphasized several implementation challenges:
- The imbalanced relationship between payers and behavioral healthcare providers, specifically disparities in reimbursement
- Lack of in-network care (¾ of members blame their insurer when they can’t access care)
- Lack of objective and systematic quality measures
- Lack of useful technology (not even interoperability and data exchange)
- Lack of clinician readiness as a result.
Whole Person Care Remains a Hot Topic for Integration
If physical health and behavioral health are not better integrated, mental health and SUD care will continue to fall by the wayside. This means that emergency departments will also continue to face the burden. Each of the panelists offered several definitions and factors when we refer to ‘integration’:
- “Collaboration and communication, specifically as it relates to coordinating care among providers. For us, we’re working on the primary care side to support our PCPs with access to behavioral health providers (remotely). But we are also tackling the issue on the acute side with assessment and placement support – this isn’t quite as integrated but the focus is attempting to deal with the challenges of overwhelmed emergency departments and help with care coordination and follow-up.” – Dr. Simon
- “We need to better define integration and its core components. Shared training, a shared care plan and shared accountability for physical and behavioral health providers.” – Dr. Little
- “Integrated care is about managing every touch point where a patient touches the ecosystem of care delivery and using it as an opportunity to coordinate and provide care across the entire spectrum of behavioral, physical and mental needs.” – Dr. Kavasery
Implementation of better integration can also be challenging with fewer staff. Dr. Kavasery suggested one training opportunity for dealing with fewer staff would be to widen the means of access for people to become healthcare providers. Additionally, he recommended offering training in evidence-based therapies like Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) to help address staffing shortages in behavioral health and expand expertise. Training individuals in a more collaborative model can enhance both accountability and measurability.
Hospitals and Emergency Departments Face Burden
It’s impossible to discuss integration without acknowledging the need to solve ED overwhelm. EDs are overwhelmed with lack of staff and patients experiencing wide-ranging behavioral issues that may require more longitudinal care. Dr. Little shared a recent anecdote of a patient with suicide risk who was in the ED for two weeks. Although the hospital provided some level of care, Dr. Little noted that this person could have benefitted from the support of community health and primary care resources. However, that access was not available.
To minimize these downstream effects in the EDs, it’s essential to enhance support for primary care and community health providers by adjusting reimbursement rates and incentivizing care. Health systems, payers and behavioral health providers must collaborate now to make these necessary payment changes possible. Without change, EDs will continue to experience overwhelm and provider burnout, leading to less access to care, and ultimately, higher suicide risk and prevalence of untreated mental and physical health conditions. We cannot afford to continue waiting.
To learn more about the importance of whole person care, please contact us today.
