Behavioral health documentation is often the communication tool used by and between professionals. Records not properly documented with all relevant and important facts can prevent the next practitioner from furnishing sufficient services. The outcome can cause unintended complications.
Behavioral healthcare cuts both ways for payers and providers. Shortages of qualified expertise makes filling positions difficult to impossible, while the need for services grows on many fronts and in many populations. The Daily Briefing How 2 health systems are rethinking mental health care for a value-based world, from the Advisory Board, reinforces the connections between behavioral and physical health. This identifies tangible targets, like reducing behavioral health readmissions, for improving patient care and institutional financial health.
Payers and providers spend significant energy recruiting and retaining all levels of behavioral health professionals. The access to psychiatrists acts as the 'canary in a coal mine' signalling the impending challenges. Lacking mental health expertise hits organizations at a time of increasing use spurred on by value-based care.
Massachusetts bill (H 1070/S 1093) adds to the definition of “medically necessary services” and challenges the notion of who decides medical necessity. Medical necessity criteria sits at the center of case and claim determinations. Laws, policies, and procedures evolve through time and the various administrations both locally and nationally.
The greatest need for mental health professionals are found in the more populated east coast and remote northern states. Large populations and rural settings significantly impact behavioral health staff shortages. The Health Resources and Services Administration (HRSA) released the most current data. The table shows the 10 states with the worst behavioral health professions clinical coverage, the national average, and the 10 states with the best BH coverage.
The National Council for Behavioral Health and the National Council Medical Director Institute released a far-reaching report this month: The Psychiatric Shortage: Causes and Solutions. As a recognized leader in behavioral health reviews, this BHM Healthcare Insider Blog brings selections from the executive summary focusing on the behavioral healthcare shortages and solutions.
Managing behavioral health costs challenges the US healthcare system. The issues encompass many of the legacy processes and structures needing to be overhauled. Some interesting recently posted examples may show the way for the entire healthcare system. These come from both payers and providers.
Providers are beginning to bridge the gap between medical and mental care, forming partnerships aimed at improving patients’ physical and mental health, and reducing costs at the same time. Such holistic projects are underway in numerous states, including California, New York, Washington, and Florida.
While clinical settings struggle and shortages raise expenses, how can payers hope to effectively handle the expected flood of behavioral health claims?
“Overnight we became responsible for all outpatient mental health services for our entire patient population,” said Peter Currie, a psychologist and clinical director of behavioral health at the plan. Heading the wrong direction? Here is the unasked question. How will payers and providers build internal behavioral health capacity to meet care demand when there are barely enough to cover the actual care?