The following is a guest article by Trip Hofer, CEO of AbleTo.
The COVID-19 pandemic has placed a much-needed spotlight on behavioral health in the U.S. Over the past several months, we have seen surging numbers of patients reporting untreated depression, anxiety, and stress, as well as unprecedented numbers seeking care through teletherapy at home. As a result, we have also seen outdated processes and approaches to care come to light that point to an underlying crisis.
The industry is waking up to the sobering reality of this crisis, but several barriers continue to prevent patients from accessing the high-quality behavioral health care they need to experience concrete results and lasting recovery.
Interstate regulations in the U.S. have remained a consistent roadblock to increasing patient access to behavioral health care. For doctors that treat physical conditions, being licensed in a certain “compact state” allows them to practice in 29 other states. This freedom does not exist for mental health practitioners. In most cases, they are limited to practicing only in the states they are licensed in, typically one state, resulting in shortages of psychiatrists and behavioral specialists in select areas.
The federal government realized this supply issue early on during the pandemic, spurring a temporary lift on regulations to improve access to virtual care. By breaking down licensing barriers, regulators allowed providers practicing in Tennessee, for example, to see patients virtually in Massachusetts.
Such policies should be explored further with the aim of making them permanent beyond the COVID-19 era. Putting them in place will provide patients with broader access to care and better enable them to select the provider that is right for them.
Siloed Approaches to Care
The way behavioral health care is treated in isolation from other areas of medicine is another major barrier to adequate treatment of these rising issues. While the medical community treats most organs of the body with coordinated treatment across all specialties, the brain is a different story. Emotional and behavioral health issues are treated in separate silos from traditional medical care, prohibiting patients from getting the support they need.
Almost all physical health services use a holistic approach to treatment. For example, patients with chronic conditions like diabetes may see a specialist for a focused treatment plan, but that regimen takes the patient’s other comorbidities into account. The care regimen ordered for a patient with Type 2 diabetes will typically differ from a patient with both diabetes and hypertension.
The same approach should be in place for mental health, but this level of coordination between providers does not occur. A patient with a chronic condition may need to be assessed for potential mental health issues, as research shows patients with a chronic condition are at significant risk for depression. The opposite may also be true: a patient suffering from depression has a 40% higher risk of developing cardiovascular and metabolic diseases. Separating these closely linked aspects of health inhibits patient outcomes and recovery. We need care systems that coordinate much more closely.
A Solution Through Integration
There is an opportunity to coordinate care more efficiently by focusing on how the patient care journey is directed from their very first touchpoint: primary care. Integration with the primary care physician (PCP) is vital to ensuring patients are accurately assessed and referred. However, PCPs do not always have the depth of training required to support individuals with mental health needs, and the idea that therapists would share notes with a PCP following a session is a foreign concept. The PCP office frequently acts as the “front door” for patients first entering the health care system. We need to embed behavioral health into this experience to overcome the current silos in care delivery.
There are some examples of this type of coordination being introduced with success. Some health systems immediately offer professional mental health assessments to patients who report chronic pain. Why do they do this? Because of the evidence that has emerged demonstrating a direct link between mental health issues and chronic pain. We are also seeing some providers embed mental health services into their pain clinics – a prime example of how combining physical and behavioral health care can improve patient outcomes on several metrics.
Virtual care offers an efficient way to integrate behavioral health into the primary care or outpatient clinic model, especially among smaller clinics that lack the resources or space to hire their own behavioral health providers. Teletherapy can achieve this integration efficiently, at scale, and at a lower cost.
Setting a New Standard
The circumstances surrounding COVID-19 have led to the rapid expansion of access and coverage for virtual platforms. In such a short time, the adoption of virtual care has been accelerated by a decade. This is a welcome development, but it comes with increased scrutiny. In the race to expand new services, we need to stay acutely aware of the quality those services offer to patients.
The industry should be cautious about opening the floodgates for greater access to virtual care without engaging in the hard work of setting robust quality standards. This means taking several important steps. First, providers should carefully vet the digital services they refer patients to, and then establish processes for following up on results to properly integrate physical and mental care. Moreover, payers need to carefully examine the evidence and outcome claims made by mental health services they cover to ensure a real return on investment for their own health plans as well as for the patients in need. High-quality programs will not only show tangible improvements in patient populations over time, but they will also demonstrate savings in several metrics, including spend on related physical health care.
With these clearly defined strategies in place among providers and payers, the industry will be in a better position to improve behavioral health care at scale.
About Trip Hofer
Trip Hofer is CEO of AbleTo, a leading provider of technology enabled behavioral health care. He is an accomplished leader with deep experience developing high-growth health care companies. Previously, Trip served as President of Accordant Health, a CVS/specialty company, and held senior leadership roles at OptumHealth and Health Dialog.