Payer-Provider Partners Tap Telehealth for Behavioral Health Access

October 06, 2020 - The coronavirus pandemic saw a huge rise in the need for behavioral health services.

In June alone, 40 percent of adults in the United States reported struggling with mental health or substance abuse, according to the Centers for Disease Control and Prevention. This isn’t exactly a new problem, although the pandemic certainly has exacerbated mental and behavioral health issues in this country.

Behavioral health is not insular, as many behavioral health conditions impact an individual’s physical health too. At Community Health Plan of Washington (CHPW), it was important to support behavioral health efforts in its provider network to ensure whole-person care for its members throughout the pandemic and after.

“Behavioral health is really your mental state and the health of your mind and interacting with the health of your body to reflect your overall state,” Paul Sherman, MD, chief medical officer of Community Health Plan of Washington told HealthPayerIntelligence.

For example, individuals with depression are at an increased risk of cardiovascular disease, diabetes, stroke, and Alzheimer’s disease, according to the National Institute of Mental Health.

READ MORE: 4 Ways Payers Can Invest In Mental and Behavioral Healthcare

Therein lies the rub; although behavioral and physical health are intrinsically linked, the healthcare industry is seeing very little integration between the two.

Addressing behavioral health conditions is critically important to an individual’s overall health. But throughout the COVID-19 pandemic, this was a challenge. Clinic volumes declined and patients were hesitant to seek care.

“In light of the pandemic, we very quickly realized many of our behavioral health providers were at risk of going out of business with zero patient volume practically overnight,” Sherman explained. “We quickly advanced $4 million to providers to ensure they could still take care of members in their communities.”

Being a local plan, CHPW was able to react quickly and funnel resources to primary care providers. One of the provider groups that benefited from these resources was Compass Health, a community-based healthcare organization that integrates behavioral health services and traditional medical care.

“During the pandemic, Community Health Plan of Washing was able to find a way to support us as the number of services we provided and the amount of time on those services declined,” Tom Sebastian, president and CEO at Compass Health said. “The fact that we could have an open dialogue with a payer who considers us as a partner and not just a commodity is critical. This demonstrated their sense of value as a payer of services that we provide in behavioral health.”

READ MORE: Virtual Behavioral Health Visits Improve Care Access

Lockdown orders, social distancing guidelines, and patient fear of contracting COVID-19 decreased patient volumes. So CHPW and Compass partnered to think creatively about the sustainability of reimbursement.

“We see clearly isolation can be a trigger for behavioral health challenges. Substance use disorder experiences are spiking. And we’re working hard to figure out how to respond to that new demand,” Sebastian continued. “Some of that may be making sure patients have good access to the care we provide.”

To encourage care and maintain patient and provider safety throughout the COVID-19 pandemic, CHPW supported their providers in leveraging solutions that emphasize full-person care.

“We really pushed and promoted more free cell phones and an increased number of minutes,” Sherman explained. “Behavioral health visits typically take up a lot of minutes, so we wanted to make sure our patients could access telehealth that way.”

These virtual care initiatives helped decrease no-show rates.

READ MORE: How Payers Can Help Reform Behavioral, Mental Health Parity

“Technology has proven to be an amazing tool to provide broader access to care. It has also helped those that we are serving experience a higher rate of access to their ongoing services,” Sebastian said.

With telehealth options, patients do not have to worry about transportation to an appointment, finding childcare, or any of the other challenges to maintaining in-person care appointment. In fact, telehealth often eliminates access to care barriers.

“Getting on the phone is not as big of a hurdle for someone who is depressed as getting up, getting dressed, and getting to an office,” Sherman furthered. “There can be more care connections.”

In eliminating access to care barriers, behavioral health telehealth solutions have also helped promote further equity.  

“Telehealth can be a very powerful tool, not only in response to the pandemic but also in response to equity and access to care. We see those things moving forward in the future,” Sebastian emphasized. “As a community provider, we really need to think deeply about access to care to disenfranchised community members whether that’s due to race or heritage, sexual orientation, food insecurity, or housing insecurity.”

But to address equity, frontline clinicians need support from their partners.   

“Most things we think of as behavioral health aren’t actually seen by behavioral health providers. The biggest providers of behavioral health services are actually not behavioral health providers,” Sherman highlighted. “It’s actually our primary care clinics, providers, and staff.”

Building up primary care’s ability to support behavioral health services is critical to supporting patients with behavioral health needs. But this does not mean insularly focusing on behavioral health solutions. Treating the whole patient is a critical aspect of these strategies.

“We really focus on full person care, so mind, body, and spirit in the context of our community,” Sherman continued. “We all need to realize it’s normal for us to be experiencing these issues and to need help. The healthcare system needs to support people and reach out to each other.”

Telehealth solutions have allowed behavioral healthcare to continue during a time when patient volume was at an all-time low. Maintaining these services as patients return to healthcare clinics will require a recognition and practice of whole-person care and destigmatizing behavioral health needs.

“It’s not personal failing or whatever else one might conjure up that creates a sense of stigma or embarrassment. But these are really legitimate conditions,” Sebastian pointed out.

A holistic care approach will impact not just a patient’s behavioral health needs but overall health outcomes.

“It’s a win-win in that we can use a whole person care approach for those we serve and payers,” Sebastian said. “It’s a great opportunity to break down the traditional silos that separated mental health and substance use disorder treatments from pure medical care and actually begin moving forward with whole person care approaches where we’re working together in tandem.”

Payers and provider should continue promoting conversations around destigmatizing and supporting behavioral healthcare and building partnerships that promote whole-person care.