While the fear, uncertainty, and isolation of the COVID-19 pandemic have practically disappeared, the mental health crisis sparked by these issues have not been so easily erased. Moreover, the number of people who need mental and behavioral health services continues to surge.  

October is National Depression Education and Awareness Month. The goal of this designation is to encourage universal health literacy regarding the signs and symptoms of depression and bring awareness to varieties of help and treatments available. But most importantly, the designation was created to highlight the need for more accessible and affordable mental health screenings. 

A Growing Crisis

Mental and behavioral health issues came into the spotlight in the midst of the COVID-19 pandemic, but these same issues continue to disrupt and negatively impact the lives of millions of Americans every day. While it is true that mental health diagnoses spiked during COVID, new cases continue to rise. In 2021, , 8.5 percent of adults had at least one major depressive episode for which 39 percent of affected adults did not receive any form of treatment. In 2022, the percent of adults who had at least one major depressive episode climbed to 8.8 while the percent of affect adults who did not receive any treatment declined to 36.3. Reasons cited by many adults for lack of treatment ranged from stigma, fear, and financial barriers to a general lack of health literacy regarding treatment options. 

Promoting the importance of mental and behavioral health screening is more crucial than ever as the need for these services continues to grow. Current events — economic downturn, possible new fears of unemployment, world wars, crime, etc. — continue to generate stress and anxiety for countless people. With no foreseeable end to any of these issues, mental health continues to be a growing crisis. 

Value-Based Collaborative Care that Includes Both Medical and Mental Health

A lasting mental health crisis is likely to challenge the world for years to come. Given the unprecedented scale and urgency of this crisis, it’s critical that we find new ways to identify those in need of services and adopt new ways to address the growing number of patients.  

It is time to look beyond the limitations of traditional care, where patients who have both medical and mental health problems receive treatment in separate clinical settings at different times, typically in an office environment and with a referral from a primary care provider (PCP) to a behavioral or mental health specialist days, weeks, or even months after their visit.  

Both physical and behavioral data are key components of whole-person health. Therefore, a different approach — a collaborative one supported by engaging in a value-based care reimbursement model where practitioners are paid based on the quality of service they provide and the clinical outcome — is needed. It’s also time to embrace the age of telehealth, remote patient monitoring, and virtual care that is quick (often immediate) and focused on the needs of the patient when they need care. 

Starting with Primary Care to Identify Mental and Behavioral Health Issues

Mental and behavioral health conversations should be part of every PCP’s routine health screening. As a patient’s first point of contact in the healthcare system, PCPs play a huge role in promoting overall wellness, including mental health. Starting with the basic questions of PQH-9 or PQH-7 instruments for depressive and anxiety symptoms, respectively, and/or a social determinants of health (SDoH) screening tool, all of which are built into HealthEC’s care management module, CareConnect™ Pro, practitioners can ask patients to examine their mental health status, current living conditions, transportation issues, food insecurity, financial capabilities, and much more. Issues in any of these areas can often serve as a “red flag” and demonstrate a need for the practitioner to learn more during their visit with their patient. Using the additional data provided via assessments facilitates the development of care plans with appropriate follow-up appointments, making referrals if needed for telehealth mental health services, and providing patients with social welfare services are considered best practices and the next steps to ensuring the strongest, long-term effective outcomes for the patient.  

Several studies have shown that integrating medical and mental health care in the primary care setting tends to improve depression outcomes. 

Telehealth for Behavioral and Mental Health Services

If the COVID-19 pandemic could possibly have any positives associated with it, it would have to be the movement of healthcare services out of the office and into the virtual world. The pandemic reduced access to in-person care, which forced many practitioners to seek out new ways to keep in touch with their patients. Thus, the age of telehealth was born, and from all indications, it’s here to stay. Beyond initial contact with a PCP or primary health practitioner, it is critical that patients in need of mental health services have quick access to a specialist in the field.  

Telehealth in the field of mental and behavioral health is known as telepsychiatry. Telepsychiatry is a subset of telemedicine that delivers psychiatric assessment and care through telecommunication technology, usually via video conferencing. Recent studies have demonstrated that telepsychiatry is an effective tool for helping those with depression, bipolar disorder, post-traumatic stress disorder (PTSD), and many other behavior and mental health conditions.  

A recent study conducted in 24 rural Federally Qualified Health Centers (FQHCs) that screened patients for depression, bipolar disorder, and/or PTSD and subsequently created care management plans centering on telepsychiatry helped improve their patients’ overall quality of life. 

The five-year trial, called The Study to Promote Innovation in Rural Integrated Telepsychiatry, or SPIRIT, compared two approaches in delivering telepsychiatry. First, the patient received a referral to a psychiatrist or licensed clinical psychologist via telemedicine. Second, the telepsychiatrist and a care manager were involved in the patient’s visits with a PCP to ensure additional support and specific mental health services. The two approaches were equally effective in treating the patients. 

“The results of our trial showed that if you give access to high-quality care for patients who are underserved, they improve their quality of life,” said lead researcher John Fortney, Ph.D., in a University of Michigan news release. The study also reported that patients experienced decreased mental health symptoms and medication side effects and increased their perceived access to care. Thanks to the FQHCs that coordinated telepsychiatry, the patients were able to get the mental help they needed regardless of their race, insurance status, or ability to pay.  

In this particular case, researchers pointed out that many of the patients in the study would have likely gone without care due to a lack of access to specialists. In a typical year, only about a third of patients with bipolar disorder and PTSD receive specialty care, they pointed out, and only about 10 percent receive adequate care in a primary care setting. 

FQHCs: Value-Based Care at Work

FQHCs serve as PCPs in low-income areas. As such, the American Psychiatric Association recommends that behavioral health practitioners embrace a collaborative approach with PCPs, — including FHQCs — in treating mental health problems to make it easier for all patients to have access to quality, affordable mental health care. This starts with involving their mental health practice in a value-based care reimbursement model. 

Many FQHCs offer mental health care, but only about 10 percent of staff are licensed clinical psychologists or psychiatrists. To address the workforce shortage and to address areas where mental health services are limited, FQHC PCPs can connect their patients to mental health services through telehealth quickly and without a lengthy wait for a referral process. Telepsychiatry also removed travel burdens and the stigma of being seen entering a mental health facility. It is therefore possible that FQHCs or primary care clinics can successfully integrate mental health care into routine health screenings using a collaborative care model and telepsychiatry without needing an onsite psychiatrist. 

HealthEC Conquers Complexities of Value-Based Care for Mental and Behavioral Health

A HealthEC© client — a clinically integrated behavioral health network that was created to improve the integration of behavioral and physical healthcare by serving Medicaid beneficiaries in collaboration with payers — initially faced complex challenges compiling health data from siloed sources to create a comprehensive longitudinal record for each patient to facilitate coordination of care. However, implementing HealthEC’s Population Health Management platform, including our CareConnect™ Pro and 3D Analytics™ modules, helped the independent practice association (IPA) integrate care and health data from assessments and multiple physician and community-based organizations to drive care management and analytics activities. HealthEC’s platform streamlined the entire care management processes for over 200 IPA practices, resulting in increased collaboration among care teams and improved access to mental and behavioral care for patients using telepsychiatry as well as onsite visits. Ultimately, the evolution and transition to behavioral health value-based contracting was an initiative that proved rewarding for the IPA providers and patients.

To learn more about how HealthEC© can help your organization make the transition to value-based care reimbursement, please contact us.