Behavioral health, which comprises mental health and substance use disorders (SUD), has long been a burning issue in the U.S. Before COVID-19, several key behavioral health indicators — suicide deaths, fatal overdoses, and levels of burnout among behavioral health clinicians — were heading in the right direction. The pandemic reversed these encouraging trends, and we're now witnessing upticks in depression, anxiety, and acute mental health episodes.
In response, providers , health plans , and policymakers alike have called for a renewed focus on integrated care, which embeds behavioral health services in physical healthcare delivery. Continuing a decades-long trend, these recent calls to action have largely centered on primary care, which the Institute of Medicine identified as a "critical interface" for mental health more than 25 years ago.
To be sure, expanding access to behavioral health services in primary care — where mental health and substance use concerns often surface for the first time — remains critically important. However, integrated primary care is just one piece of the puzzle.
To meet the current behavioral health challenges in the U.S. head-on, healthcare leaders need to think bigger and explore new ways of integrating behavioral care across the full continuum of healthcare experiences and interactions. As a healthcare services company serving a diversity of patients and partners across the healthcare system, that means advancing behavioral health integration in three key areas: care delivery, pharmacy, and data and analytics.
Thinking about care delivery differently
At Carelon, we've seen firsthand the impact that integrated primary care can have on clinical outcomes and costs. Carelon's care delivery business (originally known as CareMore Health) has been providing integrated value-based care in outpatient clinics since the 1990s. This capability, which offers behavioral health services alongside primary care, disease management programs, nutrition guidance, and wellness classes, has proven successful at reducing avoidable ER visits and hospitalizations.
For many patients, however, especially those who have a chronic illness or face social and economic barriers to accessing care, even behavioral health services available in their local doctor's office may be out of reach. Addressing behavioral health among these patients with complex high needs — who account for a disproportionate share of healthcare costs — requires looking beyond the clinic and bringing complex care into the patient's home. Integrated at-home care has a host of advantages. When multidisciplinary care teams meet patients where they live, it not only removes logistical barriers to care, but it also builds trust and enables providers to pick up on subtle social, emotional, and environmental factors that impact whole health.
Read more: Creating a connected care future: 3 key approaches
Reimagining pharmacy care’s role
Pharmacy is an often overlooked but increasingly important area of behavioral health integration. Many people with a mental health condition or SUD also have chronic medical conditions, such as diabetes, that require medication. This offers pharmacists — and pharmacy benefits managers — a unique opportunity to close gaps in care and help patients manage their health holistically. Pharmacy benefits managers that integrate behavioral health benefits with medical and pharmacy benefits enable personalized, whole-person care . Blending these benefits can lower costs and produce better clinical outcomes by improving medication adherence and the member experience.
This whole-health approach requires reimagining the role of pharmacists. Though they have not historically had a leading role in behavioral health, pharmacists and pharmacy technicians are essential to whole health and have become critical first responders in addressing mental health and SUD.
When pharmacists and pharmacy technicians have access to holistic patient data, they can engage members in deeper conversations about their medical, physical, and mental health needs. If the member raises a mental health concern, the pharmacist can connect the patient to a behavioral health case manager at the health plan. A routine medication review becomes an opportunity to close gaps in care and improve care coordination.
Read more: CarelonRx: Dispensing knowledge, compassion, and access to care
Combining whole-health data with predictive analytics
Integrating medical, pharmacy, and behavioral health data is essential to helping individuals achieve whole health. Integrated data gives clinicians a fuller picture of a patient's health. It also creates new opportunities to identify signals and patterns that provide a deeper understanding of behavioral health risk factors. When predictive analytics are added to the mix, providers can mine these large datasets to identify high-risk individuals and populations.
The Connecticut Behavioral Health Partnership (CBHP) is a prime example of predictive models in action. The partnership is a consortium of providers and state social-service agencies that manage behavioral health for Medicaid beneficiaries. To identify members at risk for acute mental episodes, it’s building a shared database with more than 100 variables spanning demographics, utilization, and cost of care broken out by medical, behavioral health, dental, and pharmacy.
Predictive analytics are empowering providers and health plans to be proactive, creating the possibility of getting ahead of the mental health crisis rather than just responding to it.
Read more: Digital platforms: Agility to meet the needs of an evolving healthcare landscape
Up for the challenge
Reversing the current behavioral health trends is a big challenge, but healthcare leaders have reason to be optimistic. Collectively, we have the vision, knowledge, data, and technology to set a new trajectory for not only behavioral health, but also whole health.