- The healthcare industry should do more to improve behavioral healthcare access and substance abuse disorder treatment, says an op-ed published in the Journal of the American Medical Association, in order to account for the growing patient population dealing with those conditions.
“Despite the availability of effective care models, identifying and engaging patients in primary care with behavioral health problems has proven difficult,” wrote article authors James Knickman, PhD, Ranga Krishnan, MB, ChB, and Harold Pincus, MD.
“Moreover, the United States needs to solve the problem of providing access and building the capacity to meet the needs of even those who are already engaged in care,” the trio continued. “At the same time, individuals with severe mental health and substance use disorders have difficulty accessing effective primary and preventive care for chronic medical conditions.”
The key to driving treatment access is in boosting care coordination, the authors argued. The healthcare industry is too fragmented to support the kind of comprehensive care behavioral health and substance abuse disorder patients need.
Because these patients often present with multiple conditions, such as physical ailments in addition to their mental health or substance abuse issues, it is important they receive coordinated primary care alongside mental healthcare.
In order to foster collaboration between different providers, industry leaders should continue to push alternative payment models, the authors say. Care models such as patient-centered medical homes and accountable care organizations (ACOs) provide financial incentives to coordinate care between clinicians.
“Currently, a fee-for-service system is the dominant payment mechanism for behavioral health services,” the authors stated. “But given the importance of integration across care providers and of working in teams, payment approaches need to focus on shared accountability across behavioral and medical systems to achieve good outcomes and to manage the broad care needs each individual requires.”
Alternative payment models may also be conducive to improving treatment access for patients. Going forward, industry leaders should look at new ways to improve upon these structures to apply directly to behavioral healthcare and substance abuse disorder treatment.
“Encourage and invest in improvements in know-how for building better care models, clinical and organizational strategies, and accountability mechanisms to enable attainment of better outcomes,” the authors suggested. “Standards that are measurable must be created to implement incentives to diffuse tested organizational models and establish a culture of shared accountability to integrate the delivery of services.”
Industry leaders must also ensure that the workforce is robust enough to care for more behavioral health and substance abuse disorder patients.
Currently, there are too few psychiatrists, psychologists, social workers, and substance abuse counselors to serve this population. When there aren’t enough clinicians, patients cannot access care.
The authors suggest industry leaders cultivate a larger workforce, ensuring that more future clinicians are qualified to serve this patient population. Additionally, it may be useful for health IT developers to create more tools to allow patients to access alternative treatment methods.
The industry is already seeing improvements in this area, the authors said.
More mHealth apps are allowing patients to work on their mental health and substance abuse concerns on their own between doctor’s appointments, and the burgeoning telehealth market offers new opportunities for patients to access therapists at their own convenience.
Ultimately, improving healthcare for patients struggling with mental health and substance abuse disorders will be a multi-pronged effort involving multiple different stakeholders, the authors said.
“It will take the energy and commitment of many parts of US society to improve outcomes for people who have mental health and substance use disorders, especially in the presence of other medical problems,” the authors concluded.
“Supportive families, supportive workplaces, supportive health care professionals, and supportive communities are needed. Public policy at the federal level also can play a role in leading progress in this social challenge.”