The nonprofit organization Catalyst for Payment Reform is hosting a series of webcasts this month focused on “Addressing Today's Leading Challenges.” I was invited to cover behavioral health -- specifically, the changing behavioral health landscape for employers and the need to develop innovative strategies to bend the cost trend and improve care.
The issue: Just to put things in perspective, mental health is a bigger issue than most realize. One in five adults and 43.8 million people experience a mental illness each year in the US, according to the National Alliance on Mental Illness. Behavioral health issues are often not addressed and tend to exacerbate other health issues. About one quarter of patients with chronic conditions have undiagnosed depression. In addition, the US is seeing a rapid rise in opioid abuse (as discussed in an earlier post). Along with the cost of medical claims (direct and co-morbid spend), employers may also feel the effects of behavioral health issues in increases in absence and disability and worksite accidents or safety incidents.
Not easy to fix: To start with, there is a stigma associated with obtaining care. Those who need care are often hesitant or unwilling to seek help. But even if a person is ready to begin treatment, access to care can be challenging. There is a shortage of behavioral health providers such as psychiatrists, and only about 50% of providers actually participate in networks. In some cases, programs are not integrated and so it is difficult for the plan member to know which program to use and when. On top of that, poor member compliance with treatment strategies is not unusual.
Good news: There is a lot of innovation going on in this area. Greater awareness of the major barriers to accessing behavioral healthcare (such as cultural influence, access issues, and cost) have spurred the development of tools and services that address them. A myriad of apps, niche vendors, and targeted programs are available to fill gaps in care delivery and offer solutions across the continuum of behavioral health needs. ACOs and other integrated care models have emerged and continue to evolve.
What should employers do?
This last point is perhaps the most important of all. You can have great programs but if your people are not comfortable using them, not much will be accomplished. The challenge is to promote acceptance of the fact that we all have problems, that sometimes we need help, and that asking for help is the quickest, most courageous way to get better.