The behavioral health landscape is fragmented. Patients receive care from multiple providers across settings, data sharing across stakeholders is murky at best, and reimbursement is confusing and often inadequate. The result? A system that doesn't work for most of the individuals it aims to serve. This is a complex challenge that requires cross functional collaboration across various stakeholders to solve.
That's why we convened a roundtable of 21 behavioral health leaders from health plans, provider organizations, and life sciences companies to problem-solve for the most intractable challenges spanning the care journey.
Here are our main takeaways from the conversation.
1. Behavioral health challenges cannot be solved by one stakeholder alone.
The consensus from this session was best summed up by a payer leader who said, to unanimous agreement: "We have to work together—none of us can solve this alone." Our team was frankly surprised by how undisputed this sentiment was for these leaders.
2. There are (or should be) more players involved in the behavioral health journey than we traditionally consider
In that spirit, attendees agreed that they need to think creatively about which individuals and organizations—beyond traditional stakeholders—they should work with to improve care and reduce fragmentation in behavioral health.
To expand the care team beyond PCPs and specialists, attendees proposed:
- Upskilling non-clinical care team members. For example, training front office, helpline, and customer service staff to recognize when a patient is in crisis and escalate the call accordingly.
- Introducing enhanced ancillary support. For example, hiring specialized behavioral health navigators, designating care coordinators or community health workers to serve patients/members with behavioral health conditions, or partnering to access specialized navigation.
To engage stakeholders beyond health plans and provider offices, attendees identified two types of groups as potential partners:
- Community-based organizations/employers. Individuals may first seek support from settings that are familiar and trustworthy to them, like a religious organization, school, local non-profit, or employee assistance program. Others may receive services through the criminal justice system. Partnerships with these types of organizations may prevent patients from falling through the cracks.
- Life sciences companies. Advisory Board research shows that 86% of PCPs find behavioral health medication prescribing assistance helpful, but only 44% report receiving it. Partnerships with life sciences companies may help educate or upskill prescribers without taxing already-overburdened pharmacy and psychiatry staff.
3. Cross functional stakeholder communication and collaboration need to be built into workflows
With so many players involved in the behavioral health care journey, it's not surprising that individuals are confused about where, when, and from whom to seek care—they shouldn't have to serve as the connecting points across stakeholders. But for stakeholder-led coordination to work at scale, the roundtable agreed it must be baked into the way they do business. They pointed to a few emerging opportunities that give them hope:
- Direct scheduling to reduce unfilled referrals, ensure timely access, and match individuals to the "right" providers (i.e., by acuity level, preferred demographics, etc.). This requires shared use of technology platforms that enable PCPs or health plans to directly schedule a patient with a behavioral health specialist.
- Disease registries to enable proactive patient/member outreach and engagement. This requires accurate documentation of patients' medical information and secure information sharing across provider networks, plans, and other care management partners.
- Health information exchanges (HIEs) to enable medical, pharmacy, and outcomes data sharing across providers and plans. This requires that entities set aside the time and resources required to comply with and actively participate in local HIEs.
One thing that struck our team is that two of these "emerging" ideas are well-established practices for physical health. But operational and regulatory challenges around documentation and data sharing, coupled with the legacy separation of behavioral and physical health have left behavioral health care behind the curve on these best practices.
4. To be effective, behavioral health care strategies have to account for social determinants of health
Social determinants of health (SDOH) often exacerbate and/or are exacerbated by an individuals' behavioral health conditions. Providers, payers, and life sciences leaders alike emphasized the need for health care organizations to consider SDOH when designing any behavioral health strategy. Two examples they pointed to included:
- Ensuring existing access points account for SDOH. The group was quick to celebrate telehealth as a way to improve access to behavioral health care—and equally quick to raise the risks of digital inequity. They mentioned leaning on state waivers and corporate partnerships to subsidize internet access for patients/members as ways mitigate that risk.
- Finding new ways to integrate care from the first step in the patient journey. The roundtable proposed integrating screening for behavioral health and SDOH needs. This would require consensus among providers and plans on a standard screening tool that is clinically effective and easy to implement, use, and input into an EMR. Our team was energized by the roundtable's shared enthusiasm around—and willingness to work together toward—the concept.
We'll admit—we expected this conversation to be more difficult—or even contentious—than it was. As it turned out, the hard part wasn't getting the roundtable to agree that they need to work hand in hand with cross-industry peers, nor was it coming up with ideas for how to improve behavioral health care.
The hard part is what comes next: figuring out the nuts and bolts of putting these collaborative ideas into action and seeing them through. And keep in mind, as the roundtable highlighted, any next steps you take must also address health equity to prevent further exacerbating disparities in care and outcomes.