At Dr . Gibson ’ s recommendation , Baptist settled on a form of integrated behavioral health known as collaborative co-management ( CoCM ), which offers mental health services in a virtual environment .
managers that initially talk to patients referred by the providers ,” explained Dr . Tyler . The care managers gather patient information and send it to a psychiatrist for an evaluation , who then provides diagnostic and therapy recommendations and agrees with or tweaks what the PCP has prescribed or diagnosed . “ Physicians use that information in the management and treatment of patients . Because it ’ s virtual , we can scale up and cover all of our clinics .”
As Baptist implements the virtual system through a company called Mindoula , it also has been able to retain four embedded therapists who cover six of its clinics and two counselors working centrally for its Population Health Services Organization . Dr . Tyler explained , “ These take referrals from care coordinators and providers and then reach out to patients mostly by phone to do some long-term case management .”
WORKING ON PAYMENT BARRIERS
As grants and federal initiatives end , payment and reimbursement challenges grow . “ Some payors are trying to figure out how to make the change , but it ’ s a puzzle ,” said Dr . Gibson , who mentioned the need to identify gaps in the current payment system ( such as value-based payment , codes , reimbursement , credentialing , copays , visit limitations ). “ We need insurance payors ( Medicare , Medicaid , private insurers ) to willingly pay for integrated behavioral health . It sounds logical that they would , but the system is set up mostly for mental health care in ‘ mental health ’ settings . Practices need payors to pay for mental health care in a ‘ medical setting ’ so that PCPs can have trained people to help in their clinics .”
“ Payor systems are now appreciating the collective cost to the system if behavioral health is not done ,” offered Arkansas BlueCross BlueShield ’ s Mark Jansen , MD , of the current payment situation . Currently the vice president and chief medical officer for AR BCBS , Dr . Jansen is a former primary-care physician who has long been a proponent of integrated behavioral health . “ I have appreciated , both on a personal and academic level , the impact of behavioral health .
“ BCBS recognizes the impact of behavioral health in Arkansas , as evidenced by its $ 5.29 million in grants announced last year for certain behavioral health programs in Arkansas and its investment , early on , in the formation of the nonprofit ABHIN . We helped get it running , then removed ourselves from governance of that to avoid any conflict .”
Noting a substantial change in the last few years , Dr . Jansen said , “ Early in the pandemic , we removed the requirement that the patient be seen in-person first before telehealth visits could commence . When I look statistically for telehealth visits for traditional medical care visits as the pandemic has calmed down a little bit , the slope of that line has dropped to the negative , but I have not seen much decrease in telebehavioral health . One thing about virtual care is it ’ s removed the stigma of proximity to the provider ( e . g ., your car in the parking lot ). You can access it in a confidential way . It ’ s been a silver lining that ’ s come out of the pandemic .
“ Curtis Barnett , Arkansas BCBS president and CEO , has made behavioral health his top priority . We know that having the mental health embedded in the clinic is going to give the patient the best access to care .”
But can independent clinics afford to do this ? Can they embed behavioral professionals in their clinic and use those specialists to offer the best access to care for their patients in a way that is financially sustainable and supported by third-party payors for both their clinic and the patients ?
Asked for his thoughts , Jansen said of AR BCBS , “ We are emphasizing the enhancement of the delivery of behavioral health in the state of Arkansas – not just for people who have our insurance , but for all Arkansans . I can ’ t give you all the answers , but I can tell you , we clearly understand the question and we ’ re deploying significant effort and resource to answer in an appropriate way .”
The Journal thanks the many sources consulted for this article . Physicians interested in learning more about behavorial health integration or associated training may email patty . gibson @ abhinetwork . org .
Reference :
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“ A growing psychiatrist shortage and an enormous demand for mental health services ,” By Stacy Weiner , Senior Staff Writer August 9 , 2022 https :// www . aamc . org / news-insights / growingpsychiatrist-shortageenormous-demandmental-health-services ■
FALL 2022 | VOLUME 119 | NUMBER 2 41