Payers Can Support Behavioral and Physical Health Integration with Proven Insights

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Mental health symbol Puzzle and head brain concept as a human face profile made from crumpled white paper with a jigsaw piece cut out on a rustic old double page spread horizontal wood background.

By Dr. Indira Paharia, Chief Operating Officer, Behavioral Health, Centene Corporation

The connection between physical and mental health is widely known throughout the healthcare community. Yet there’s fragmentation in delivering integrated care; which in addition to the financial impact also results in countless lives lost each year. Up to $68 billion annually in healthcare could be saved by integrating care for individuals who manage both physical and mental health conditions. As a leading healthcare insurer, Centene focuses on the whole health of its members and leads the industry in progressing the integration of behavioral and physical health to improve the health of communities.

With 70 percent of behavioral health concerns treated in a primary care office, it is vital that primary care physicians have the tools to identify, treat and refer members to specialty care, as needed, if a mental health or substance use concern is present. The Collaborative Care Model is a proven means of integration, having demonstrated its ability to control costs, improve access and clinical outcomes, and increase patient satisfaction. While the Model requires significant investment, payers can support providers by reimbursing for collaborative care billing codes, as well as through value-based contracting using alternate payment models. 

There is a lack of integrated care training models for the next generation of medical and behavioral healthcare professionals, an area that payers can augment through training programs that teach interdisciplinary providers how to most effectively collaborate using evidence-based practices for diagnoses, treatment, and consultation.  For instance, payers can offer trainings to medical providers that enhance their abilities to recognize and address common behavioral health symptoms.  Specialized curricula tailored to both medical and behavioral providers can also be offered that addresses vulnerable populations at greatest risk for comorbid conditions. 

Centene has created programs and partnerships that specialize in co-occurrences of physical and mental health conditions. Examples include Centene’s OpiEnd™, an evidence-based program using predictive modeling to identify members at risk of developing opioid addiction and treat those already diagnosed to prevent worsening of symptoms. The program helps members effectively manage pain and prevent opioid misuse through integrated care management and member education, pharmacy policies, provider engagement, and community outreach interventions. The coordination of these integrated services minimizes inappropriate and excessive use of opioids to prevent the occurrence or exacerbation of opioid use disorder.

Start Smart for Your Baby® and Strong Beginnings™ address specific needs of pregnant members and newborns. The programs improve obstetrical and pediatric care services including post-partum and reduce pregnancy-related complications, premature deliveries, low birth weight deliveries, infant disease, and neonatal abstinence syndrome. Through enhanced member outreach, the programs provide pregnant members intensive care management support, and utilize screenings and assessments to identify risks and establish appropriate, safe treatment to promote a healthy pregnancy. 

Payers and policy makers should consider investments in policies that address integration efforts, while balancing the impact to providers, members, and healthcare costs. For example, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires payers to ensure medical and behavioral health services are provided equally, eliminating historical inequities that served as a barrier to people with mental health and substance use conditions from accessing care. MHPAEA ensures that benefit structures and access of those benefits for behavioral health conditions are on par with medical conditions, serving as a foundation for achieving integrated care.  Further, the Medicaid Managed Care update includes amendments that allow for improved health information sharing, which is a critical component to integrated care models.

Payers play a significant role in helping individuals achieve whole health. Integrated care offers greater opportunities for primary care providers, medical specialists, and behavioral health providers to work together to reduce the impact of mental and physical health comorbidities, improve overall health outcomes, and lower healthcare costs.

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