By Mary Lou Osborne, President and Chief Commercial Officer, Ontrak Health.
Unaddressed behavioral health needs impact people’s lives in profound ways. Beyond the human element, it also adds significant pressure on health plan medical loss ratios, utilization, and quality measures.
Members who need help with issues like anxiety, depression, substance use disorders, and serious mental illnesses often struggle to access the care they need.
Health plans are taking steps to address these challenges, but sometimes the approach does not go far enough to engage members in care. So, how can health plans be more proactive when it comes to behavioral health?
I think it starts by asking the right questions. Below are four questions health plan leaders should be asking to help guide their focus—and take a more proactive approach to behavioral healthcare.
#1 Do we make it easy for our members to access behavioral healthcare?
Health plans may invest significant efforts in expanding their behavioral health networks and launching various initiatives. However, if the onus is placed entirely on members to seek out available treatments, many individuals with unaddressed behavioral health needs may never get the treatment they need.
There are often social and logistical barriers preventing members from accessing care. So, overburdening members with the responsibility for seeking treatment is not a sustainable approach and doesn’t lead to positive outcomes.
Instead, health plans should consider implementing outreach strategies that target underserved members. With the help of predictive analytics and AI, new technologies make it possible to analyze millions of claim files to impute behavioral health diagnoses. Health plans can identify and prioritize both mid- and high-acuity members. Then, case managers or care coaches can engage these members through active listening and motivational interviewing, guiding members to the right care and treatment.
#2 Is behavioral healthcare truly integrated for our members across the healthcare delivery ecosystem?
Integrating behavioral healthcare into the broader healthcare ecosystem is crucial. Health plans should not silo or compartmentalize behavioral health in programs, initiatives, or apps. Instead, it’s important to look for ways to seamlessly integrate behavioral and mental health with physical health services to ensure comprehensive and holistic care.
To that end, it’s more important than ever to build processes to facilitate bi-directional communication and information exchange between behavioral health providers, primary care physicians, and care coaches. Among other things, bi-directional communication can help:
– Foster provider collaboration.
– Support the effectiveness of behavioral health care and treatment.
– Support members every step of the way, including adherence to treatment plans.
By contrast, when behavioral healthcare is marginalized within a health plan, it often results in members being marginalized as well.
#3 Do our members have genuine access to behavioral health providers?
While health plans may have a substantial number of in-network behavioral health providers, members may still struggle to get the care they need.
Why? Because there’s often no availability.
Due to the shortage of behavioral health providers and the high demand for their services, even large provider networks may struggle to offer timely appointments. Some members may endure extended wait times—often 3-6 months or longer—before they get an appointment.
So, although members may have access on paper, it’s meaningless in practice if providers are overwhelmed and appointments are unavailable.
This is where having strong relationships with behavioral health providers can really help by creating favorable payment terms and administrative support. In addition, using technology to help increase telehealth visits, AI-generated notes, and bi-directional communication can increase availability of behavioral health providers by making better use of their time.
Finally, care coaches can better support members, which can lead to fewer intensive interventions, helping members get the right care at the right time. This in turn creates capacity for referrals, freeing up more availability for higher-acuity members who require behavioral health specialist care.
#4 How do we use data and analytics to identify gaps in care—and measure outcomes?
To address the three questions above, health plans must establish a robust data collection and measurement system. After all, if you don’t maintain readily accessible data, how can you understand performance around behavioral healthcare?
Accurate measurement is the cornerstone of true accountability. To that end, health plans must establish and define clear behavioral health goals and targets. Health plans need streamlined processes to frequently compile and analyze data cross functionally to meaningfully assess outcomes and track progress.
Among other things, health plans should track and measure:
– Clinical outcomes for members with behavioral health conditions
– Improvements in behavioral health assessments: GAD 7, PHQ 9
– Appropriate reduction in emergency room and inpatient utilization
– Genuine network access and availability to behavioral health providers
– Timeliness to provider visits and follow-up treatment
– Provider participation in bi-directional communication: PCP, therapist, care coach
Finally, health plans need ways to turn insights into action. Be ready to develop a proactive plan, based on available data, to drive better outcomes.
Ask the tough questions. Change lives. Save Lives.
To improve the lives of members, health plans need a proactive approach to behavioral healthcare. And that starts with asking the right questions. From there, we can mobilize around shared goals: Engaging members. Integrating behavioral healthcare. Increasing access and collaborative communication. And meaningfully measuring outcomes.
Ultimately, we want to achieve a healthcare system that treats both physical and behavioral health issues, holistically, which can save lives and enhance overall wellbeing.