The Unique Solution to Lack of Behavioral Access
August 3, 2018
Behavioral health is a hot topic in the news and is heavily referenced related to mass shootings, suicides, maternal care, and the opioid epidemic. Underpinning the issue are provider shortages, provider costs and reimbursements, and lack of patient access to behavioral care.
Addressing the core of the problem requires understanding the metrics behind access and provider shortages – including demand for, and the supply of, providers. It is widely published that nearly 1 in 5 US adults suffers from mental illness each year, equalling 18.2% of the population, or 41,352,548 adults.
According to the Health Resources & Services Administration, 588,000 behavioral health providers are serving adult populations – a capacity for a provider to see every adult who is suffering from mental illness 25 times a year. Theoretically, every adult with a mental illness could visit a provider every 14 days; however, this is not an accurate picture, as provider accessibility is limited by:
- Number of providers with a rate that patients deem affordable
- Total number of providers that accept insurance
- Patients with a lack of insurance that covers mental health
- Lack of mental health professionals in any specific town or rural area
While the above issues are all supply-oriented, they are limited to segments of the population. A comprehensive resolution to the problem lies in removing barriers to access for all populations.
Behavioral Access: A Multi-Dimensional View
Solving the access problem starts with examining the issue from the patient’s perspective, counter-intuitive to how the US healthcare system established care practices. The entire US health system is working against social programming, reinforcing the access problem. When people are ill they go to these resources for care:
- Primary Care Providers
- Urgent Care Centers
- Emergency Departments
The situation is no different for a patient with a mental illness. Unfortunately, when mental health patients arrive at familiar points of care seeking help, they are routinely met with provider groups only trained to evaluate the severity of their mental health diagnosis. For low severity cases, providers will typically make a referral to a behavioral care provider, which can take a considerable amount of time for both staff and patients. In an emergency event or case of severe mental distress, the patient will be routed to an emergency department.
Only 17% of emergency departments have a mental health professional on call. Typically, emergency departments serve as the last line of support for people struggling with mental health issues. The emergency department patient mix will typically include 20% mental health diagnosed patients and it can be as high as 40%. Emergency departments understaffed in behavioral care results in:
- Extended wait times for Mental Health Diagnosed (MHD) patients
- Longer wait times for all patients, including those not afflicted by a mental disorder
- Patients with less severe MHD being discharged with little to no follow-up information regarding their conditions
- Severe MHD patients admitted to Emergency Departments awaiting available space in a specialized mental health facility
Healthcare organizations evaluate care options based on revenue, while patients weigh the direct cost. This mismatch leads to the shortsighted view of behavioral care that includes:
- Providers not serving a rural area because the population is too low to build a sustainable practice
- Actuaries can’t justify mental health coverage as the path to rehabilitation is unclear, so a cost can’t be identified, and coverage is not extended
- Hospital administrators debate offering behavioral care as reimbursement economics can simply make it an unsustainable revenue generator
- Patients don’t seek care because it is too expensive or inconvenient
Behavioral health access is turning into a crisis in multiple areas such as addiction, suicide, and poor outcomes in care for patients with diseases like diabetes and heart disease. Treating mental health disorders earlier can, and will, prevent severe cases that could otherwise result in expensive undesirable outcomes, thus lowering the total cost of care for these patient populations.
Behavioral Care as a Cost Savings
If healthcare groups examine mental health services between cost savings versus a traditional cost/revenue model, behavioral care triumphs as more universally economical. The idea isn’t novel, it just doesn’t garner much attention outside of healthcare circles, and is more commonly seen in:
- Value-Based Care
- Accountable Care Organizations
- Patient-Centered Care
- Collaborative Care Models
These initiatives are focused on serving the patient as a whole instead of the traditional siloed approach of treating individual symptoms. In order to be successful, healthcare has to incorporate behavioral health, which has been found tremendous results, including:
- Higher patient adoption of mental health services
- Increased compliance in patients with chronic conditions
- Reductions in readmission rates in hospitalized populations
- Overall improved mental and physical outcomes
Payers are quickly realizing the cost savings of integrating behavioral healthcare and providing incentives for adoption. For example, the Centers for Medicaid and Medicare issued reimbursement codes for behavioral health integration in primary care, providing new revenue streams. Further elevating the importance of behavioral access, CMS will negatively impact reimbursement for providers that are not found to be improving the health of patients with chronic conditions. In addition, CMS is limiting reimbursement in cases where patients are readmitted to hospitals for the same diagnosis. The incentives optimally will incite sustainable change, but integrating behavioral health is still a significant challenge, requiring a revolutionary approach to integration.
Bridging Resources Through Virtual Care
For 7 years, WeCounsel has been quietly serving its mission to:
“promote continuity of care and access to mental health services by providing professionals and their clients with a convenient and effective tool for facilitating successful sessions online.”
This original mission developed out of a source of pain for the company’s founder and his family. A close family member was struggling with PTSD and decided to seek inpatient treatment. Upon graduating from a program, the family member realized the need for continued treatment, but the closest trained provider lived 2 states away. This resulted in the family member moving to another state for over 2 years, pulling her away from the support system of family and friends. With that struggle, WeCounsel was born.
Today, WeCounsel maintains a network of thousands of behavioral professionals using the company’s telehealth platform, bringing down the barrier to access by creating a more convenient and engaging way to deliver behavioral care.
The company behind WeCounsel also developed a flagship enterprise solution under the brand VisuWell. The platform is one of the first asset-light and consumer-centric telemedicine platforms serving healthcare organizations that focuses on primary care and urgent care providers.
“Over the last seven years we developed an inside view of the access challenge in behavioral care,” said CEO Sam Johnson. “As we spoke with behavioral professionals, one common theme arose across all certification levels – the vast majority of providers were seeking a way to find new clients with the goal of creating a sustainable practice. On the other hand, we have healthcare organizations, insurance companies, and the federal government saying that there is a shortage of behavioral health professionals or a simple lack of access. At that point, we knew we were the company most uniquely positioned to solve the crisis through the excess capacity in our network of mental health professionals and our ability to virtually transport them to traditional points of care.”
Today VisuWell and WeCounsel work together to serve as a bridge to connect behavioral professionals to patients of primary care providers. The model utilizes an on-demand referral process and virtual waiting rooms, resulting in:
- Referral time reduction from days or weeks into minutes or hours, and lessening the traditional, time-intensive administrative process
- Increase in patient follow-through due to the speed of the referral process and increasing overall patient compliance
The two companies are shifting the demand to be where capacity exists, a healthcare market disruption that is reshaping healthcare for the better. Providers interested in being a part of, or leveraging the WeCounsel network, can get more information below. We look forward to working with you as we help to serve those in need.