简而言之: Establishing trust between payers and providers is the first step in resolving the behavioral health crisis.
The pandemic pushed the US healthcare system to its limits, 长期存在的问题——劳动力短缺和医护人员的职业倦怠是其中最主要的问题——随着临床bet8网站备用和医院工作人员努力跟上人满为患的急诊室,这些问题达到了沸点.
但公平地说,没有什么专业比行为健康受到的影响更独特.
Amid a climate of social isolation, 经济压力, 健康问题, 悲伤和失落, hospitals saw double-digit increases in mental health emergency visits in 2020. The pandemic exposed access issues as demand soared.
围绕COVID-19的突发公共卫生事件已经结束,但行为健康危机仍然存在.
- 55% of US counties do not have a single practicing psychiatrist.
- 1 in 5 youths aged 13 to 18 live with a serious mental illness.
- 精神和行为健康索赔现在占全国所有索赔的12%,高于2015年的5%.
But is there cause for optimism?
The toll that the pandemic took on people’s mental health shouldn’t be downplayed, 但2020年的事件也有助于将行为卫生保健纳入全国对话. 更重要的是, 行为健康突然发现自己处于不断发展的技术和不断变化的观念的联系之中. “我认为,这次大流行让人们意识到,除了面对面,还有其他选择, 面对面的护理,汤姆·福利说, a senior manager in 心电图’s Managed Care Division. “Before the pandemic, telehealth was nice to have. Now it’s a must have, and it’s here to stay.”
随着新的护理模式的出现,人们对精神疾病的理解也在不断发展. “十年前, people didn’t really talk about their behavioral health struggles,” notes Katy Shropshire, a senior consultant with 心电图. “At least in the younger population, it’s almost trendy to have a therapist [today]. I’m excited to see that continued acceptance and progression.”
Meanwhile, there are tangible examples that demonstrate the potential of an organizational commitment to behavioral health care. And recently enacted legislation is poised to expand increase the behavioral workforce and expand access to mental health care for Medicare beneficiaries.
这是鼓舞人心的, but until the gulf between payers and behavioral health providers can be bridged, progress will remain elusive. 在最近的 survey conducted by the American Hospital Association, 78% of hospitals said their relationships with payers are getting worse. Reimbursement for mental health care has historically been 不充分的, 而且,这个空间的碎片性使得创建有凝聚力的行为健康网络的努力变得复杂. Clearly, there’s work to be done.
心电图’s Behavioral Health 团队 Adds Payer Expertise
Tom Foley和Katy Shropshire为心电图的行为健康管理护理团队带来了付款人的心态. Tom拥有30年的付款人经验,在加入心电图之前,他曾担任马萨诸塞州蓝十字蓝盾的辅助和行为健康合同主管. Katy was previously a senior network contract manager with Optum Behavioral Health, where she led network contracting and reimbursement initiatives across the western US.
在这里,他们谈论了他们为什么来心电图,以及他们认为支付者和心理健康提供者如何找到共同点.
Strength in Numbers
从历史上看,心理健康bet8娱乐的报销一直很低,汤姆对此没有异议. “当你把行为健康专业网络作为一个整体和独立的行为健康提供者设施来看时, I would say [reimbursement is low], 特别是如果你没有持续尝试重新协商合同,或者你是一个新的市场进入者,与付款人的历史利用率有限,他说.
当然,行为健康提供者不可能空手出现在谈判桌上. “在行为健康领域,现在有很多人都在谈论需要与有数据的付款人进行对话,凯蒂解释道. “提供者需要向付款人证明他们的结果是可衡量的,符合付款人的要求,以便获得更高的报销率.”
But behavioral health providers, especially individual providers, 经常难以获取和解释可以提高他们在价格谈判中的地位的数据. “To get that data, there has to be an investment in technology,” Katy says. “但目前的报销几乎无法支撑临床bet8网站备用,更不用说对技术的投资了. 当纳税人考虑利率时,他们并不总是把这个考虑在内.”
更大的实体更有能力投资于这些能力,汤姆看到了这一点. “You’re starting to see formation of professional groups across multiple states. 你需要它,这样你就可以与付款人共享数据,并将其提升到一个新的水平,”他说.
Pathway to Partnership
解决行为健康问题需要付款人、提供者和社区之间的协调努力. Tom believes providers are willing to make that effort. 他说:“我认为行为健康提供者正在寻求与付款人建立伙伴关系。.
But are payers willing to be partners?
“Step one is building trust in the payer-provider relationship,汤姆说, while acknowledging that that’s “easier said than done.他还建议,付款人应该注意到越来越多的心理健康bet8娱乐团体. “They should be targeting provider organizations that they feel they can partner with, organizations that will use that increased investment in technology, like Katy mentioned.”
如果供应商愿意投资技术来帮助他们获取有关结果和访问的数据, payers need to establish solid goalposts. “纳税人 need to be able to clearly define what they’re looking for,” Katy says.
付款人还需要对行为卫生保健bet8娱乐的创新方法持开放态度,并尽可能简化流程.
初级护理
Furnishing behavioral health care in primary care offices, whether through medication management or by embedding therapists, is increasingly being viewed by health systems, CMS, 付款人作为一种选择,在提供低成本医疗bet8娱乐的同时扩大可及性. “There’s growing momentum toward that model,凯蒂承认, “but from a payment perspective, it’s very complicated.“在初级保健领域管理行为健康索赔的行政困难正在减缓该模式的采用. But if payers are willing to collaborate with providers to make it work, 他们也许能够避免病人不必要地去急诊室寻求治疗.
家庭护理
Tom emphasizes the growing trend of care moving outside of traditional settings. ”I think there will be more care in the home in general,他说. “我还看到了一种趋势,即报销不仅仅是基于‘传统bet8娱乐’,这将成为行业标准,’ but also nontraditional services. Peer coaching is something that’s being looked at for substance use disorder. It doesn’t sound very innovative, 但这是非常重要的,因为有些人可能没有能力去看bet8网站备用,或者无法使用笔记本电脑.”
没有任何迹象表明这很容易——在非传统情况下批准医疗报销涉及在复杂的政策环境中运作, 规定, 政治, 和惯性. But telehealth preceded the pandemic by decades, 它的采用同样受到管理复杂性以及付款人和提供者的怀疑的阻碍. A public health emergency changed that, 现在,支付者和提供者需要以同样的紧迫感来处理行为健康危机.
Moving Forward Together
Fostering that sense of collaboration is what brought Tom to 心电图. And he feels like his extensive payer experience will help. “我认为我们的行为健康管理护理团队有能力为客户提供专业知识和反馈,以优化他们与付款人的关系,他说. 汤姆对这一点有第一手的了解,因为他在谈判桌上遇到了心电图的团队. “I had direct experience working with 心电图, and it was really a partnership. That’s what I was interested in.”
Katy strikes a hopeful note as well. “我选择在行为健康领域工作,因为现在有太多的能量和创新, and that makes it a really exciting space to work in.”
Let’s see if payers and providers can convert that energy into change.
Learn how recently enacted legislation will expand the behavioral health workforce.