Behavioral health integration: Where can it make a real impact?
Behavioral health integration offers healthcare leaders hope at a critical time: 23.1% of adults and 49.5% of adolescents in the U.S. are facing mental health challenges, and the national crisis number, 988, has received 16.5 million contacts since its launch in July 2022. Forward-thinking leaders are addressing the challenge by integrating behavioral health in three areas.
Behavioral health, which comprises mental health and substance use disorders (SUD), has long been a challenge in the U.S. Before COVID-19, several key behavioral health indicators — suicides, 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, stakeholders across the healthcare system, including care providers and health plans , have called for a renewed focus on integrated care, which includes embedded 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. However, integrated primary care is just one piece of the puzzle.
The current behavioral health challenges require inventive thinking about new dimensions of behavioral health integration, specifically in three key areas: palliative care, pharmacy, and data and analytics.
Adding more support to palliative care
For many patients being treated for advanced illness, behavioral health comorbidities, like anxiety and depression, are common. In fact, one study in BMC Palliative Care found that 44% of those with cancer were battling symptoms of depression, 26% were struggling with anxiety, and 53% had symptoms of both. Often, these symptoms can go untreated or undiagnosed -- and not only among individuals with cancer. They affect those with other chronic, complex conditions, like heart failure .
Yet helping members address behavioral health challenges is pivotal in improving their overall health outcomes. One proven model for doing so is integrating behavioral health services within palliative care. As described in the journal Palliative and Supportive Care , behavioral health integration is "the next frontier in providing holistic care to individuals living with serious illness...It's a low-hanging fruit for the alleviation of suffering and improvement of quality of life."
In an integrated palliative care model, patients receive care from a physician-led interdisciplinary team that includes a behavioral health professional, such as a licensed clinical social worker (LCSW). In models like this, the LCSW can diagnose behavioral health concerns -- including depression or anxiety -- that may occur during the patient’s treatment. The LCSW can also provide care, including therapy. This integration within palliative care, along with identifying and alleviating other social drivers of health, can help improve the patient’s whole health, as well as reduce hospitalization rates and avoidable ER visits.
Reimagining pharmacy care’s role in whole health
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 thinking differently about 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 physical and behavioral 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.
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.
Two programs reflect the promise of this practice.
The Connecticut Behavioral Health 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.
Resilience through Intervention, Support, and Education, or RISE , offers another example of predictive analytics’ potential. RISE is a substance use disorder (SUD) treatment program that helps manage and mitigate risks associated with the disorder. The program uses advanced algorithms to identify and support individuals at risk of developing severe alcohol or opioid-related health outcomes within the next 12 months. The program has helped prevent disorder progression and outcomes, including reducing inpatient admissions and emergency department visits; it has also led to $6M in gross savings (when compared to a control group).
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.
Up for the challenge
Reversing the current behavioral health trends is a complex challenge, but healthcare leaders have reason to be optimistic. Collectively, the healthcare system has the vision, knowledge, data, and technology to set a new trajectory for not only behavioral health, but whole health.
