Integrating Behavioural Health Management into Primary Care

What is Behavioural Health Management?

Behavioural Health Management (BHM) involves the use of behavioral health measurement data to help guide and inform the treatment of individual patients among the population. Health data management is a part of clinical management for behavioral health services.

Why BHM?

According to a 2009 AHRQ brief, behavioral health conditions affect nearly one of five Americans, leading to healthcare costs of $57 billion a year, which is on par with cancer.

Approximately 5% of the population accounts for 50% of healthcare costs. This fact essentially drives the need for population health management.

What do regulators say?

Regulatory agencies such as the Mental Health Parity and Addiction Equity Act (MHPAEA), with the Affordable Care Act (ACA), are putting pressure on insurers to actively participate in addressing the mounting issue of behavioral health in the U.S.

In U.S, approximately 18% of the population suffers from mental health issues, while 9.8% have addiction issues. The Federal Substance Abuse and Mental Health Services Administration (FSAMHSA) provides some mental health information and statistics in this regard., in 2016, the FSAMHSA notes that nearly $228 billion will be spent on behavioral health and substance abuse treatment in the U.S. By 2020, this number will rise to $280 billion.

How does it make a difference to existing primary care practice?

Health management information systems have come a long in way in providing health data/information management and behavioral health solutions/integrations, including global payment initiatives and health data management. Use of routine measurement data in accessing behavioral health is proving to be indispensable in assisting primary care physicians/providers to deliver better quality care.

Integrating BHM into primary care assists in developing more accurate clinical assessments, devising an individualized treatment plan and evidence-based practices, identifying high-risk and high-cost patients, preventing hospitalization and reducing ER use, as well as improving health care outcomes.

With Medicaid reforms, most of the insurance payers in the U.S are shifting towards value-based payments to focus on outcomes. Going forward, outcomes will progressively dictate income, leading providers to re-think their approach to patient care.

Behavioral Health Landscape:

Challenges to the Success of Behavioural Health Management:

To have successful Behavioural Health Management, providers should have seamless access to patient data that can be utilized to trace an individual’s medication history and compliance to prescriptions. With different provider organizations using different EMR/EHR products, data exchange among providers remains a massive challenge.

Other challenges in implementing Behavioral Health Management by a provider organization are:

• Lack of accountability (for managing care to cost of care)
• Prevailing payment method still pay per unit of service
• Volume orientation of executives and physicians
• High fixed costs, so hospitals keep utilization of capital equipment high
• Inadequate data and systems
• No payment for managing, maintaining and improving patient’s health
• Little coordination of care

What can we do?

To achieve the effective implementation of Behavioural Health Management we need to witness certain changes such as:

• A cultural transformation from treating illness to managing health
• An economic model that rewards providers, patients for keeping people OUT of inpatient care
• Extensive integration of clinicians into hospitals and health systems
• Robust data and analytical tools to allow managers and clinicians to better manage the health of people they serve
• Improved communication and coordination among care providers
• Better alignment of executive, physician, and staff compensation with behavioral health goals

Role of IT:

Healthcare IT organizations are leveraging technology to develop applications that aid in Behavioral Health Management. They do this by aggregating patient data by population and sub-population using data integration and data analytics against defined quality indicators. These products integrate with provider EMR/EHR for a data feed and provide a deeper insight of individual patient medical history, health status and a patient’s contribution towards their own health. Most products do offer data exchange using HIE, thus maintaining confidentiality and privacy while complying with regulatory standards like HIPAA

Summary….

In 2010, there were no ACOs. Today, there are 700 + ACOs existing across the U.S. Similarly, although BHM is resisted by most of the providers, in the future these evidence based treatments will be an integral part of healthcare providers.

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