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Innovative Approaches In Expanding Access To Behavioral Health Care

Multiple factors continue to drive health plans, health care providers, and other stakeholders to find innovative ways to expand access to behavioral health, inclusive of substance use disorder treatment services. In 2016, nearly 1 in 5 Americans lived with a mental illness and suicide was the 10^th leading cause of death within the U.S. Individuals with mental illness continue to experience higher early mortality rates than the individuals without mental illness. A 2016 Kaiser Family Foundation health tracking poll found that 1 in 5 Americans reported that they or a family member did not receive needed mental health care. Drug overdoses have claimed the lives of 70,237 Americans in 2017. The prevalence of autism continues to grow. According to the Centers for Disease Control and Prevention (CDC), the rate of autism was 1 in 59 children in 2014. To date, roughly 10% of individuals with substance use disorders receive specialty care.

Other factors are also creating demand for treatment services. New funding resulting from state and federal legislative action, such as the Patient Protection and Affordable Care Act and Medicaid expansion, has provided individuals with a mechanism to access care that was previously unattainable due to cost. The 21^st Century Cures Act and other federal funding initiatives have provided states with additional funding to cover opioid treatment. Mental health parity has ensured that health plans cover behavioral health services.

New care delivery models, new health plan and provider partnerships, new network designs, and new use of technology to improve access to care are being driven to development through several factors:

1. Unmet need
2. New funding
3. Historically geographical disparities related to behavioral health care
4. Efforts to reduce stigma
5. The growing acknowledgement of the impact of untreated mental illness on everything from workplace productivity to use of expensive health care services

The Second Edition of Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing & Delivery System (The Guide), which contains insights and strategies collected from surveys from over 1,200 health plans and interviews with numerous health plan executives, highlights how health plans are looking towards technology to address growing demand for behavioral health services. Additionally, the Guide outlines how plans are responding to demands for greater member convenience and ease of access through technology and new partnerships to support on-demand access to behavioral health care. Ninety-nine percent of all health plans surveyed for the Guide have incorporated technology-enabled care such as telemental health, asynchronous texting- based therapy and e-CBT to help meet access demands. Studies of telehealth interventions have demonstrated that therapy services delivered telephonically or via video are comparable to face-to-face treatment.Consumer attitudes are also favorable for these types of interventions. These interventions are widely acknowledged as having some of the greatest potential to help reduce geographical disparities related to behavioral health care access.

The following are some examples of innovative approaches and partnerships to expand access to behavioral health care:

Talkspace: Talkspace provides access to online therapy through a combination of asynchronous text messaging, audio messaging and real-time video chat. The service is available for adults, couples and teens. After a brief assessment, individuals are matched with a therapist who is available 5 days a week. Therapists will respond to text messages at least twice per day and video chat sessions can be scheduled with the individual’s therapist. Individuals pay a monthly fee which allows for unlimited text messaging and weekly video chat. Video chat access varies based on monthly subscription. Health plans have begun partnering with Talkspace allowing the service to be delivered as part of a health benefit. In November 2017, Magellan announced a partnership with Talkspace in which the service will be offered under Magellan’s comprehensive Employee Assistance Program (EAP). In 2018, new Directions Behavioral Health announced a similar partnership providing access to Talkspace through their EAP. More recently, UnitedHealth Group’s Optum announced plans to make Talkspace available to its 2 million customers.

AbleTo: AbleTo provides individuals with access to professional therapists and coaches via phone or video chat. AbleTo uses licensed therapists and coaches to deliver short-term treatment that is based on Cognitive Behavioral Therapy. Sessions are time limited and provided to individuals twice per week for 45 minutes. In addition to providing services to address common behavioral health issues, AbleTo offers specialized programming to help individuals address the stress, anxiety, and depression associated with comorbid and chronic illness as well as chronic pain. All sessions are scheduled and delivered at the individual’s convenience. As with Talkspace, the service eliminates the need to travel to receive treatment services. In July 2018, Harvard Pilgrim Health Care announced it was providing their members with access to AbleTo.¹¹

Walmart Mental Health Clinics: In November 2018, Walmart partnered with Beacon Health Options to open a mental health clinic in one of its Texas stores to promote access to care for individuals experiencing mild behavioral health issues. The selected location is in an area that has a shortage of behavioral health care service providers. The clinic provides walk-in access to counseling services with licensed behavioral health clinicians. Beacon clinicians are also available via Skype to provide video sessions at the clinic when an on-site clinician is not readily available. The clinic provides a sliding-fee schedule for patients without insurance and has planned to enroll in the state’s Medicaid program.

Optum Express Access Network: Optum has created a high-performance network within their overall network focused on creating more rapid access to behavioral health care for their members. Providers participating within the Express Access Network are monitored on their ability to provide routine appointments within 5 days of a referrals. Express Access providers are identified in Optum online provider directories that are used by members and Optum Care Advocates to help find and match individuals with available therapists.

Shatterproof: Shatterproof is a national non-profit organization dedicated to ending the devastation addiction causes families. While not a treatment provider, much like the National Alliance on Mental Health (NAMI), they have been involved in considerable advocacy work to expand access to evidence-based treatment and reduce stigma. Shatterproof’s primary focus is substance use disorder treatment. In addition to releasing the National Principles of Care guidelines aimed at improving the state of addictions treatment access and quality, their advocacy efforts are positively impacting access to care. They have successfully advocated for state policy changes, such as the removal of prior authorization requirements and lifetime limits on medications used in the treatment of substance use disorders, in 16 states.

Behavioral Health Urgent Care Centers: Alliance Health, a regional behavioral health managed care organization in North Carolina partnered with two comprehensive behavioral health provider organizations within their network, Carolina Outreach and Monarch, to create outpatient behavioral health urgent care centers. These programs were developed to bridge a gap in access to care for individuals experiencing significant behavioral health distress, but not at the level that would require care from a behavioral health crisis center or emergency department. This service functions similarly to a traditional medical urgent care center. Individuals can walk-in and received needed treatment, including an assessment, brief counseling and leave with a prescription if needed. The center also links individuals back to their routine source of behavioral health care or connects individuals who are not treatment-connected to a local behavior care provider. The centers screen for unmet social determinants of health and make referrals to community-based organizations who can help address these needs.

Additional information about access challenges to behavioral health and substance use disorder treatment services and how states, payers, and providers are addressing these challenges can be found in Second Edition of Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing & Delivery System.

About The Guide

The Second Edition of Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing & Delivery System (The Guide) provides information and insights into the multi-layered United States behavioral health system. The Guide includes an in-depth view of current statistics, prevailing issues, and emerging trends in order to inform the discussions, debates and decision-making of policy-makers, payers, providers, advocates and consumers. The Guide addresses current behavioral health care trends topics, including:

• A look at the national policy that is shaping the U.S. health and human services market
• A view of the state behavioral health delivery systems that were created by a combination of historical practices, federal and state policy, and market factors over recent years
• An examination of the practices of 1,265 health plans that manage both physical and behavioral health care for the vast majority of the U.S. population
• A deep-dive into behavioral health care access and delivery of care from the consumer perspective