To Address Our National Mental Health Crisis, Primary Care Practices Should Embrace Value-Based Care

The COVID-19 pandemic left a lasting impact on our society and institutions, and few industries felt – and continue to feel – its effects more than healthcare. Among the many lingering issues, either driven or revealed by the pandemic, is the rising demand for behavioral health services – and a system that is struggling to meet it.

Doctor with patient

Because of existing mental health accessibility issues, patients are increasingly relying on their primary care clinicians to recognize and manage their behavioral health issues. In many instances, providers may be the only people who observe a patient’s need for help.

While primary care clinicians regularly address and manage behavioral health conditions, they are ill-equipped to provide the support needed for a growing population of patients, some of whom may have more complex conditions that would benefit from specialized care.

Additionally, behavioral healthcare can be prohibitively expensive for many patients – quality behavioral healthcare treatment plans may include ongoing therapy and require multiple visits. Due to the demand for behavioral health services, many providers are able to choose not to accept insurance and require patients to pay out of pocket.

The result: For many patients, behavioral healthcare remains inaccessible.

On-Premises Support

One promising solution for increased access to behavioral healthcare would be for primary care practices to include a behavioral health specialist as part of the practice. Though currently rare, embedding behavioral health services in primary care practices offers significant advantages for patients and providers.

First, it removes the stigma of a behavioral health condition. Many still do not view behavioral health problems as medical problems. But a behavioral health diagnosis is a medical issue, just like asthma, heart disease, or diabetes, and it needs consistent treatment and management like any other medical condition.

Second, too often even when a provider recommends that a patient reach out to a psychiatrist or counselor, the patient does not follow through to seek help once they leave the primary care practice. This presents even more issues for the patient, as mental health diagnoses can have a significant effect on a patient’s ability to manage other co-existing medical problems. Not to mention that once a patient leaves an office, waitlists and costs associated with seeking additional medical treatment remain obstacles.

With a behavioral health provider as part of the primary care facility, we can remove the stigma of behavioral health treatment and ensure the patient immediately receives the care they need. The primary care practice is where patients receive treatment for all their other health issues, and the patient is much more likely to agree to the care if barriers to access are removed.

The Long Game: Leveraging Value-Based Care for Better Patient Outcomes

While embedded behavioral health services may address patient accessibility issues, they still do not address the financial challenges for access to behavioral healthcare or the relative shortage of behavioral health clinicians, especially in more rural areas.

One potential solution to solving access to behavioral health clinicians lies in the provision of their services virtually via telehealth, which allows access for more patients. These virtual consultations can be conducted from an exam room within the primary care or even medical specialist office. Virtual group therapy sessions are also an opportunity to improve access.

The answer to clinicians receiving appropriate payment for their work? Moving away from fee-for-service models and embracing value-based care.

Value-based care models allow physicians to focus on a holistic view of the patient. Through value-based care, physicians look at the entirety of what each patient needs, rather than billing for each individual service. This model connects payment to outcomes, rather than volume. Moreover, integrating behavioral health into primary care can lower the total cost of care for payers by improving outcomes of chronic medical conditions, giving providers more flexibility to treat mental health conditions, and allowing patients more access to treatment.

Through value-based care arrangements, the primary care practice can increase its focus on the patient’s care. Value-based care payment models align incentives between payers, providers, and patients: everyone benefits from improved care delivery, more holistic care, and better patient outcomes.

Clearly, solving our national behavioral health crisis won’t be easy. With increasing demand, limited professional resources, and a complicated reimbursement process, behavioral health issues represent one of many challenges facing our healthcare system. Yet by embracing alternative care delivery and payment models, we could help clinicians provide more support for those in need and drive better overall health outcomes for the populations they serve.

Dr. Nele Jessel is Chief Medical Officer at athenahealth.

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