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By Ontrak
October 21, 2022

It starts with care coaches: Right-sizing care to address behavioral health needs

By Judy Feld, MD, MPH, MMM
Ontrak Health Chief Medical Officer.

Despite several decades of effort (and some innovation), our healthcare system remains ill-equipped to systematically address behavioral health needs. And the consequences are growing more dire by the day.

Behavioral health condition prevalence is up 300 percent since the start of the pandemic. When we double click into that data, we find a whopping 41 percent of US adults report symptoms of Anxiety and/or Depressive Disorder.

Untreated behavioral health needs drive real costs, both social and monetary. Recent data shows that 5 percent of health plan members account for 44 percent of total claims costs. In real dollars, that’s more than $1 trillion annually across the insurance industry.

The high costs associated with conditions like hypertension, high cholesterol, and obesity can frequently be influenced by unaddressed behavioral health conditions. So, we know that treating behavioral health conditions like depression, anxiety, and substance use disorder can go a long way toward reducing overall claims costs—and promoting durable healthcare outcomes.

Effectively treating behavioral health needs requires a strategic, multi-pronged approach. But there are several challenges currently preventing scalable solutions.

Below I explore some of these challenges. Then, building on best practices, I highlight a path forward.

What’s holding us back from delivering the behavior healthcare members need?

From our experience at Ontrak Health helping thousands of members get behavioral health treatment, we’ve identified several barriers that impede meaningful access.

Too many members are referred to specialists. Many PCPs don’t have the requisite training to directly treat behavioral health conditions. Others simply don’t have the time.

No matter what the ultimate causes of the problem are, members are too often referred to specialists who may not need this level of care. Care that, in principle, could be managed in a primary care setting.

There’s a lack of specialists. Compared to traditional mental healthcare, there are fewer professionals who specialize in behavioral health treatment. This lack of supply is made more acute by the prevalence of referrals.

Often it can be months after a referral before a member can get an appointment.

Compounding these challenges, many behavioral health specialists don’t participate with insurance plans—and maintain a private practice. In part this is due to the high demand for specialists. But also, many specialists point out that health plans don’t adequately reimburse care.

Obviously, the prevalence of private practices significantly limits access for millions of members who can’t afford expensive, out-of-pocket treatment.

Some health plans have tried to fix this problem by expanding their network. However, network expansion continues to prove difficult, as there simply aren’t enough specialists available in the first place.

There’s a lack of specialist oversight. Finally, even among health plans who manage to meaningfully expand their behavioral health network, there’s rarely infrastructure to assure treatment quality. Although case managers play an important role, they can’t keep up with the volume to get members the support and treatment they need. So, it’s difficult to ensure members are getting the most from specialist intervention.

Is collaborative care the answer?

In the past decade or so, we’ve seen a rise in collaborative care model (CCM) implementations. These models are designed to deliver behavioral and mental healthcare in the primary physician setting, where members may be more comfortable.

CCM are often structured where the PCP serves as ‘quarterback,’ then specialists and other healthcare professionals play a supporting role.

CCM has proven clinical outcomes, but it’s comparatively difficult to scale.

First, CCM puts a significant burden on PCP offices, which are already stretched thin. Second, many health systems don’t have the organizational or operational structure in place to execute this model effectively.

For example, some PCPs don’t have multi-disciplinary teams. Others don’t optimize their healthcare records management system for CCM.

Finally, there are significant cost hurdles. Payers in many states don’t structure reimbursement in a way that supports CCM. And other research has shown inconsistent ROI.

Taken together, CCM is promising, but not widely implemented because of these many hurdles.

The path forward: PCPs need support to practice at the top of their license.

Any sustainable path forward requires that we address behavioral health needs—without relying exclusively on specialists.

Many advocates insist that primary care training should include behavioral health, so PCPs can provide more comprehensive services in their office setting. In the same way that PCPs routinely perform diagnostics for hypertension and cholesterol, they would be able to perform similar evaluation for, say, anxiety or substance use disorder.

The truth is many behavioral health conditions could be treated in a primary care setting—with the right financial and institutional support.

This means, among other things, that continuing the move toward a value-based care model makes sense. We obviously can’t add yet another burden onto the shoulders of PCPs (who are already stretched thin) without properly structuring and incentivizing that kind of treatment.

But we also can’t ask PCPs to do this on their own. We know from the limitations of the CCM that it’s difficult to build a robust support network for PCPs. So, we need to build on the strengths of the CCM, while acknowledging real-world limitations.

Support for PCPs starts with care coaches.

At Ontrak Health, we know that successful behavioral health treatment starts with care coaches—who specialize in member-centric, whole-person care. Care coaches can do comparatively heavy lifting at comparatively lower cost.

Care coaches provide support for PCPs by helping members through their treatment plan, offering personalized guidance and regular follow-ups to keep members on track.

In this respect, successful behavioral health treatment requires intensive, human-centered support. Above all, members need consistent 1:1 engagement to truly drive better outcomes.

It’s very challenging to provide this level of engagement, given the demands of the PCP role and the way teams are usually structured. Even the most advanced primary care provider groups can struggle with this issue.

That’s why Ontrak’s model is built to scale care coaching in a way that drives ROI across the healthcare delivery value chain. It’s an integrated care model built on components of the CCM, which affords more efficient use of resources.

Not all care coaches are the same.

Like anything in medicine, better outcomes require dedicated training and evidence-based techniques.

Ontrak Care Coaches receive National Board-Certified Health and Wellness Coach (NBC-HWC) designations or become board-eligible after joining. Representing ethnic and racial diversity, they are trained to engage patients with a combination of empathy and listening skills.

Upon enrollment, coaches use motivational interviewing and other evidence-based strategies to:

  • Help the patient complete standardized assessment, such as for anxiety (GAD-7), depression (PHQ-9), and other conditions.
  • Identify and mitigate social risks and barriers to care.
  • Develop a collaborative coaching plan.
  • Co-develop SMART goals and a measurable behavior change plan

Ontrak Care Coaches collaborate closely with providers to create an integrated care plan we can track and measure. Bi-directional communication (care coach and provider notes) is a cornerstone to successfully taking a patient to and through care.

By working closely with members using regular coaching sessions, we can help create new healthy habits, stronger engagement with providers, and ultimately help members become more proactive participants in the healthcare system.

We change lives.

We all know someone who is struggling with unaddressed behavioral health needs. And we know how hard it is to get them the care they need.

The good news? You can make a difference—and change thousands of lives.

With Ontrak Health, help is here.

Ontrak health combines AI-driven analytics with hands-on health coaching to give members the support they need to live their best self. Because of our unique focus and scale, we can mobilize targeted resources to drive durable health outcomes.

Schedule a demo today.