Behavioral health is the most underserved healthcare need across the majority of US communities. According to the National Alliance on Mental Illness, only 43% of adults with mental illness receive care, and just 64% of adults with serious mental illness receive the additional level of care they need. This is in part due to the fact that, in the US, 115 million people currently reside in a Mental Health Care Professional Shortage Area.
Further, Health Affairs reports that behavioral health disorders are now the leading driver of spending, at $201 billion (these high costs are inextricably linked with the shortage of behavioral health providers). While the build-up of preventive care for mental illness does require strategic and capital needs (for both access and staff), as these patients progress through the system (into the hospital), care becomes increasingly expensive, and utilization of low-margin services (e.g., emergency department, inpatient units) climbs. Meanwhile, patients with less acute conditions aren’t treated as quickly, increasing the risk that their condition will spiral into a more severe or acute state.
As health systems look to address the gaps in the care continuum to change this dynamic, they must ask a fundamental question: do they need more psychiatrists, or are there other alternatives to pursue?
Behavioral Health Provider Shortage: By the Numbers
HealthLeaders reported in 2017 that 42% of primary care providers could not access a psychiatrist for their patients. And in 2016, more than half of the US counties did not have a single psychiatrist. To fully meet the care needs of the US population, Merritt Hawkins estimated that 15 psychiatrists are needed per 100,000 people, but the national ratio of practicing physicians in the specialty currently sits at only 9 per 100,000.
Many health systems have tried to manage the shortage by doubling down on recruiting efforts; and while it is important, recruiting success alone will not close the behavioral health care gap. Merritt Hawkins noted that mental health remains their top retained search from year to year, indicating that these are the most difficult positions to fill. As fewer new psychiatrists are entering the workforce than required, the shortage will linger and impact behavioral health service lines well into the future. Even if health systems are able to overcome physician recruitment challenges, the investment and ongoing costs required to achieve the target of 15 psychiatrists per 100,000 population may not be financially sustainable.
Behavioral Health Workforce Gaps: Assess, Identify, Plan
The reality is that many health systems do not know exactly where in the behavioral health ecosystem their care gap is, or the extent to which it impacts their bottom line. An important first step is to understand the community’s behavioral health care needs. Once the health system understands its community’s needs, it can then execute on a recruitment strategy that is based on a thoughtful behavioral health care management model, inclusive of nonphysician provider deployment and increased use of telehealth services, both of which can help close a portion of the recruitment gap without draining most of the recruitment budget.
Minimize Gaps: Providers Operating at Top of License
Behavioral health service lines must ensure that their providers are working to the top of their license. Physicians are an expensive resource, and they often manage myriad behavioral health tasks that should be transferred to others within the ecosystem. Moving providers to the top of their license will reduce the costs of care as work allocation is efficiently distributed where the lower-cost providers are maximizing their contribution. Making these changes will also decrease your system’s demand for psychiatrists, and in turn reduce investment into one of the costliest recruiting efforts.
While the scope of practice can vary by state, the table below details how key responsibilities might be shared by the team members in an efficient delivery model.
Sources: Salary.com and MGMA DataDive 2020 Provider Compensation, 2019 Data.
Maximize Behavioral Health Access: Enabling Telehealth
Along with maximizing top-of-license care, utilizing telehealth is critical to maximizing clinician output and potentially reducing psychiatrist demand. Telehealth can unlock efficiencies through cost sharing over a larger patient population, extension of the behavioral health resources into hard-to-reach areas, and staffing backup and support. Telehealth’s importance is further evident in rural parts of the country with low population density that have trouble supporting a full-time, in-person psychiatrist. These programs can also be shared across systems and service areas to consolidate costs and reduce the nonclinical expense involved in providing care.
Solving the behavioral health dilemma will require a concerted effort from health systems across the country. The shortage and demand for services has a unique impact on every market; to better understand your specific behavioral health workforce needs and identify actionable care delivery strategies to reduce the cost of care, contact the ECG team.
Published January 6, 2021