As behavioral healthcare challenges have accelerated over the past several years, they’ve also spotlighted various advancements and opportunities that will drive the future.
Insurers, care providers, employers, and government policymakers can build on these disruption factors and radically transform the behavioral health sector. This will create value for consumers, businesses, and society.
Insurers in Behavioral Health
Insurers provide a crucial link between patients and providers by selling insurance quotes, administering claims, and paying financial compensation for unexpected incidents. Nevertheless, in recent years, some commercial health insurers have adopted policies and practices that contribute to delays in patient care and place unnecessary burdens on enrollees and providers.
One example is prior authorization requirements, a significant source of frustration for insurers and providers. Rather than relying on fax machines or call centers, insurers often use proprietary plan portals that require providers to log in to the system and complete idiosyncratic insurer-specific requirements.
Insurers and providers can collaborate in ways that reduce the administrative burdens associated with health insurance/provider interactions. In particular, value-based purchasing (VBP) models that compensate providers on a capitated or sub-capitated basis may reduce the need for health insurer prior authorizations and individual claims adjudication. This is a promising approach to increasing behavioral health care quality and patient access, like Sam Lee Prospect Medical, as one of their goals.
Care Providers in Behavioral Health
In the same way, medical technology is rapidly improving, as is the state of the art in behavioral health. With a focus on evidence-based medicine and a growing emphasis on quality of life, care providers have many new and better ways to deliver innovative treatments, such as ADHD assessment and diagnosis, to patients with mental illnesses.
From digital triage to augmented and virtual reality technology, many innovations can help care providers improve the patient experience while driving down costs. In the end, though, the collective effort of care providers, insurers, and government policymakers will have the most impact. Ultimately, this will enable the most meaningful changes to happen in real time and make the fabled future of behavioral health a reality. The biggest challenge will be identifying which ones are worth deploying in each situation and ensuring they all happen on the same page. The best way to do this is to establish a data-sharing platform that connects all the puzzle pieces.
For employers, behavioral health is a critical part of their work and an essential component of their human capital. However, their ability to support employees with behavioral health needs is impeded by many factors: excessive professional licensing requirements that limit entry-level salaries and career opportunities, challenging work settings and schedules, low private-sector payments and reimbursement rates for the field, and a lack of clear pathways for careers.
Increasingly, employers must go beyond traditional employee assistance programs and introduce new products that integrate mental and physical wellness treatments into the workplace. These services target prevention and resilience and the capacity to develop an individual’s understanding, insight, abilities, ethics, or social capabilities.
Recruiting and retaining an adequate workforce to meet the current demand for behavioral health services is critical. State and local governments should take steps to build career pathways and a workforce pipeline that brings young and aspiring talent into these professions. Incentives such as tuition reimbursement, student loan forgiveness/ repayment, training stipends, and health insurance subsidies should be developed and expanded to address this challenge.
As insurers, care providers, and employers continue to innovate in this space, governments have a unique opportunity to help lead the way. They can focus on developing a holistic approach to behavioral health that addresses all the drivers of need, including preventive care, and drive overall cost reductions.
Specifically, government policymakers should focus on creating pathways for affordable initial treatment, limiting patient cost-sharing, enforcing network adequacy provisions, and expanding provider payment rates. This will allow more people to get in the door and receive care.
In addition, government policymakers should work to close the coverage gap for people who do not have access to Medicaid. This will require a lot of work, but it is an essential step toward addressing inequities in mental health and substance use care.