Overcoming 3 barriers to better behavioral health care
There’s an elephant in the room of doctor’s offices around the country: Behavioral health.
Patients are hesitant to discuss it. Primary care physicians are hesitant to ask. ER physicians aren’t equipped to manage it. The healthcare industry as a whole is struggling to address America’s hidden epidemic thanks to the stigma surrounding mental illness.
If 1 in 5 adults experience mental illness, why are we so scared to talk about it or get help? For Leana Lopez, Senior Manager of Clinical Integration and Innovation at Medical Home Network, it’s just human nature.
“Human beings are uncomfortable talking about behavioral health issues. We’ve always categorized it as a separate thing,” Lopez says. “We are comfortable talking to our primary care doctor about a stomach ache or headache, but what if the cause is depression or anxiety? Or a mixture of physical and mental states that are triggering the symptomatic feelings? It’s always been hard to help people address mental health concurrently to physical health because the healthcare system hasn’t been set up to do so.”
This stigma associated with mental illness has snowballed through decades of neglecting the behavioral health system. According to Lopez, there a several barriers the industry must overcome before we can begin to reverse this.
Supported by Texture Health’s population care management solution, Medical Home Network (MHN) reduced the total cost of care for 170,000 attributed lives by 3.5% in year one and 5% in year two.
Barrier #1: Lack of Behavioral Health Training
To accelerate the movement towards integrated physical and behavioral health, Lopez believes the way we educate healthcare professionals must evolve. We must better train medical providers on the right questions to ask, how to recognize the signs of mental illness, and effective medication management.
“Primary care is where many people first exhibit behavioral health symptoms or needs. Yet primary care physicians are not required to have much training in this area, which causes apprehension towards treating mental illness¬—particularly with managing medications,” says Lopez. “Despite many behavioral health conditions being co-occurring or co-morbid with physical conditions, physicians aren’t equipped with the expertise or knowledge to address a patient’s mental health needs. So instead, they send them to social workers or other behavioral health providers, who are already managing overwhelming caseloads.”
More collaboration and coordination between physical and behavioral health resources will reduce the strain on behavioral health providers, while simultaneously providing better overall care to patients.
Barrier #2: Behavioral Health in a Silo
Information sharing is one of the biggest challenges facing behavioral health.
“Traditionally, behavioral health is addressed through various agencies and community resources that don’t talk to each other,” Lopez says. “As we’re thinking about integrating behavioral health, there must be cultural, structural and even legal changes to allow providers to address mental healthcare across the full continuum.”
Unfortunately, these changes can’t happen overnight. Until then, Lopez believes relationships will help “unsilo” behavioral health. Building relationships with providers across historically disparate social service agencies, community mental health centers and local hospitals will ease transitions of care, reduce duplication of services, and lead to better coordination of care.
Barrier #3: A Tendency Towards Reactive, Episodic Care
The shift from episodic care to proactive, preventative care is occurring across the healthcare system in general, but is this translating to behavioral health? According to Lopez, there is still much progress to be made.
“We wait for patients to come to us with a crisis. We don’t intervene at a time when the person is in a less scary or less risky place in their journey—where they’re interested and ready to receive care and treatment,” Lopez says. “Instead of waiting for the situation to become costly and dangerous for the patient, we need to meet them where they’re at, when they’re ready.”
When this isn’t possible and people still end up in the ER with a mental health or substance abuse crisis, it’s important to create connectivity to other care settings. At Medical Home Network, this is done through a medical home model, where patients are connected to one source of truth on their care. If a patient does visit the ER or go inpatient, the medical home is notified, enabling a follow-up plan to be initiated and executed.
“Behavior Change is Behavioral Health”
Fundamentally, better behavioral health relies on changing a person’s behaviors. While evolving cultural or legal aspects of the healthcare system will help, it will be obsolete if we’re unable change the way people think and act.
“The key to good care management is behavior change. It’s about helping patients identify their goals and change their behaviors to reach those goals,” Lopez says. “For example, a care coordinator can educate patients about depression and tell them to do certain activities to deal with their condition. However, it won’t help the patient unless they set practical, relevant goals for themselves to do the things that make them happy. Only then will they begin to feel better and move towards living a healthy life with their diagnosis. No one will be successful unless all providers collaborate to activate this type of improvement for the patient.”
Leana Lopez is a licensed clinical social worker, providing clinical support and oversight to Medical Home Network. She offers consultation and training for care management programs, creates community social service partnerships, and leads behavioral health initiatives for the 12 hospitals and health centers in the MHN ACO. To learn more about MHN, visit http://medicalhomenetwork.org/.
3 investments in behavioral health every ACO should consider
The main goal of an ACO is to provide the best possible outcomes at the lowest cost to care. One way ACO leaders can do this is to start thinking strategically about behavioral health. Whether it’s borrowing best practices from primary care practices or paying more attention to national health trends, take a look at how ACO leaders could invest in behavioral health.
It’s no secret that a chasm exists between payers and providers that makes alignment and collaboration difficult. A care management platform can significantly improve the historically contentious relationship between payers and providers by enabling data sharing, streamlining communication, and empowering providers to take on contracts with downside risk.