Even before the COVID‑19 crisis, the behavioral health provider shortage was challenging health systems and communities, and health systems without a defined care model for delivery of mental health services will continue to be affected.
Behavioral health’s status as the most underserved need in healthcare has only been exacerbated as demand spikes across the US.
- According to a Kaiser Family Foundation (KFF) report, the percentage of adults reporting symptoms of anxiety or depression jumped from 11.0% in 2019 to 41.1% in 2021.
- This 273% increase in reported incidence further complicates a nationwide access backlog that prevents patients from receiving care in a reasonable and timely manner.
- Further, alcohol and substance use is up 12% through the pandemic, impacting mental and physical health.
Demand for behavioral health services will continue to grow, and new solutions are required to extend already scarce behavioral health resources to meet communities’ needs.
Outsized Share of Costs
A recent Milliman cost report reconfirmed what we’ve been hearing for years: patients with behavioral health conditions drive an outsized share of healthcare costs. The study examined claims of 21 million Americans and found that 27% of patients with a behavioral health diagnosis drove 57% of total costs. But even as behavioral health starts garnering nationwide attention, the added focus is bringing to light the extreme provider shortage and, in some cases, outdated and inefficient care models that do not maximize workforce performance.
Workforce Shortages and Constraints
On top of the spiking demand, workforce supply constraints are worse than ever, with only 1 psychiatrist in clinical practice for every 9,500 US residents. Even healthcare providers encounter their own behavioral health shortages—according to the KFF report referenced above, essential healthcare workers are 40% more likely to experience anxiety or depressive disorders than nonessential workers during the pandemic. So health systems are not just planning for broader patient populations but also for their own managed populations.
While we are approaching the end of the public health emergency in the US, these workforce implications will continue to impact care for years to come.
Choosing the Right Care Model
This challenging supply-and-demand dynamic requires that hospitals and health systems adjust the way they provide introductory care and manage ongoing care needs. Many care models have been researched and evaluated over the last 20 years (one such model, COMPASS, is outlined in figure 1); however, nationwide adoption of a consistent model is lacking. Many systems still offer behavioral care in a silo or not at all. The way we provide care is now being challenged more than ever to move to a more efficient and cost-effective approach. A relatively stagnant workforce supply that cannot expand quickly enough to meet the changing needs of the market will require innovative use of professionals to help patients navigate the complicated behavioral health landscape, direct appropriate utilization of scarce resources, and ensure timely coordination of care.
Many behavioral health programs today rely on incredibly scarce psychiatrists for care that can and should be provided by other members of the team. This approach is not working—choosing another model can have a direct and measurable effect on downstream costs, workforce constraints, and provider burnout (not just in the behavioral service line but across the system). Maximizing provider utilization requires an effective care model (a planned, organized, and repeatable approach to improving patient health). A system constrained by available workforce resources, for example, might first consider the COMPASS model to maximize utilization of available professionals at the top of their respective licenses. A homegrown or hybrid of multiple models can also be an effective approach for a health system, allowing providers and service line leaders to drive change within an organization.
Source: https://aims.uw.edu/compass-care-mental-physical-and-substance-use-syndromes
Choosing the right model can be a challenge; defining considerations and metrics to select the best one for your scenario will expedite the process and ensure that you create the most effective model for your situation.
Common Considerations
Organizational change is a complex process and can have a negative impact if poorly executed. Involving all key stakeholders and having a robust and well-documented approach is crucial to both picking the right model and easing what can be a complex implementation. When we are examining care models, we typically consider and analyze the metrics below.
Metric | Definition and Implications |
Primary care and psychiatry physician and APP shortage/deployment | Various models require more behavioral health–trained professionals. These may not be ideal for communities with significant shortages. In addition, state-level constraints of top-of-license practice for APPs and other care providers should be considered. |
Revenue opportunity and payer implications | Focusing on accurate coding/documentation and alignment between care model and reimbursement methodologies can improve service line revenue on a per patient basis. |
Cost structure | Controlling direct costs is critical for success in behavioral health. Systems may need to adjust the care approach (e.g., care setting, provider type, offered services) to be as efficient and cost-effective as possible. |
Operational and facility constraints and capital requirements | Certain care modalities require capital and space that may not be available. Selecting a model that can flex with both current constraints and planned capital improvements allows the behavioral health service line to grow with minimal future care model disruptions. |
Downstream cost implication | Medical patients with ongoing behavioral health challenges drive excess costs throughout the system. Care models that can be tailored to the needs of specific patient populations will have outsized returns for some patient profiles (e.g., medical service line–specific behavioral healthcare approaches). |
Provider reaction | Culture eats strategy for breakfast—a common but true adage. Without provider and workforce buy-in, a new care model will likely fail. Appropriate work standards should be defined to ensure providers are incentivized to practice in a coordinated model. |
The above considerations drive an effective and involved decision-making process that not only ensures that the proper model is created but that everyone in the organization is excited and ready to implement it. The resulting benefit is an aligned provider workforce striving to improve patient health in a coordinated fashion. These investments also have a direct impact on reducing medical and behavioral system costs and improving profitability .
Published June 16, 2021