The nation's economically disadvantaged suffer from behavioral health conditions at a much higher rate than the general population. Rising unemployment is driving greater numbers of people toward Medicaid and government-subsidized health plans. Such economic problems can also add to, and are themselves, psychosocial issues that contribute to higher health care costs. Additionally, as the baby-boom generation reaches retirement age, a growing percentage of the U.S. population is joining the Medicare ranks. As a result, more and more government and not-for-profit plans will bear an increasing share of the healthcare burden to treat America's elderly and lower-income individuals and families.
For those with even the best health insurance, access to mental health services is often worse than access to physical health services. For those who are uninsured or covered by Medicaid, Medicare or other health coverage programs, access can be especially difficult. Without proper integration of a behavioral health management strategy, members and participating physicians of public health plans will most likely experience challenges in accessing and coordinating care, causing delays in treatment or disconnects between the member's primary care approach and mental health management. There are workable solutions to overcome these challenges.
Engage Primary Care Physicians
L.A. Care Health Plan, the largest public health plan in the United States, has recently partnered with Health Integrated to implement a new behavioral health management pilot program to strengthen services for primary care physicians who provide care to members with behavioral health conditions enrolled in L.A. Care's Medi-Cal, Healthy Families, Healthy Kids and Medicare Advantage Special Needs Plan. This 18-month pilot program will help L.A. Care evaluate the effectiveness of integrated physical and behavioral health care in a primary-care setting.
For L.A. Care members, mental health services are carved out to a specialty mental health vendor or to the County Department of Mental Health, depending on the program. In focus groups and surveys, L.A. Care providers have identified the gap between the primary care services they provide and specialty mental health services as one of the biggest sources of dissatisfaction with participation in Medi-Cal managed care.
Primary care physicians (PCPs) may not be ideally equipped to treat patients struggling with behavioral health barriers. PCPs are not always trained to recognize many of these conditions, and may not be aware of the latest pharmacological options. To bolster its support of PCPs, L.A. Care is using Health Integrated's behavioral health management strategies.
Health Integrated works within the PCP's treatment approach to better provide the support those physicians need to most effectively treat patients with medical and psychosocial issues. Through the program, L.A. Care's PCPs now have hotline access to board-certified Health Integrated behavioral health specialists for consultation on diagnosis, patient management, medication regimens and referral assistance to behavioral health specialists when necessary. This peer-to-peer interaction is key to success, as PCPs will be able to leverage a proactive and credible resource to discuss treatment approaches, appropriate drug regimens and other important patient management issues, as well as referrals, as appropriate, to California's Department of Mental Health or the PacifiCare Behavioral Health Network.
For those with even the best health insurance, access to mental health services is often worse than access to physical health services.
By mining important administrative, clinical and patient data, Health Integrated also identifies opportunities for PCPs to improve diagnoses of behavioral health conditions, enhance treatment plans, or provide additional clinical resources in managing the member holistically.
Closing the Gaps: L.A. Care Program Components
In addition to a toll-free provider telephone line and email availability for provider behavioral healthcare consultation and assistance, Health Integrated will provide L.A. Care PCPs with several other means of support, including:
analysis of administrative data to identify and reach out to providers who could benefit from assistance with management of members with behavioral health conditions.
assistance with identification of behavioral health conditions and treatments.
assistance with medication management.
assistance with the design of treatment plans.
identification of gaps in care.
assistance with access/referrals to behavioral health specialists.
provision of basic care management, if requested by the PCP, or if the need for care management is identified by Health Integrated. This includes member outreach, education and medication compliance.
participation in educational seminars and availability for in-office visits by Health Integrated clinicians.
incorporation of nationally accepted behavioral health diagnostic screening tools and educational materials for various behavioral health conditions, as needed.
While the 18-month L.A. Care program is still early in its implementation, according to Elaine Batchlor, MD, Chief Medical Officer of L.A. Care, the program “gives doctors the support they need to strengthen the integration of physical and behavioral health care in a primary care setting.”
Knowledge is Power
A behavioral health management integration strategy offers many benefits to the PCP, including:
access to information regarding other medical and social services accessed by the member