AMA/Manatt Health Report Envisions Broad Behavioral Health Integration
Could the adoption of digital health tools—among them, telehealth—dramatically improve the integration of behavioral healthcare into the rest of the healthcare delivery system? That’s what a new report, sponsored by the Chicago-based American Medical Association (AMA) and the Manatt Health Strategies division of the Los Angeles-based Manatt consulting firm (which on its website describes itself as “a multidisciplinary, integrated national professional services firm”), concludes.
As a press release posted to the AMA’s website on Monday, Feb. 21 stated, “With the nation’s decades-long behavioral health crisis worsened by the COVID-19 pandemic, a collaboration between the American Medical Association (AMA), Manatt Health Strategies and a group of health care experts has identified solutions to increase access to behavioral health services through the adoption of digital technologies. Released today in a new report, the stakeholder-specific solutions promote the incorporation of technology, such as telehealth and other digital tools, that can enhance the patient-physician relationship and increase the overall effectiveness of behavioral health integration (BHI). The accelerated adoption of BHI is essential to reaching more individuals in need of behavioral health treatment and solving the nation’s growing behavioral health crisis, according to the report.”
The press release quoted AMA president Gerald Harmon, M.D., as stating that “The demand for behavioral health services is significant and rising, but so is the potential for digital technology to support the integrated delivery of physical and behavioral health services. The AMA is committed to accessible and equitable treatment for behavioral and physical health needs, and appropriate use of digital health technology can drive behavioral health integration, particularly at time of increased psychological distress and trauma,” Dr. Harmon said.
The press release went on to state that, “To further drive adoption of digitally enabled BHI, the report emphasizes the importance of demonstrating the value generated by these digital tools for providers, patients, and society at large. The value framework described in the AMA’s Return on Health report is a useful tool that can be used to achieve this aim. The new report builds on the AMA’s ongoing commitment to accelerating BHI adoption in primary care practices by working alongside the members of the BHI Collaborative to provide enhanced support and evidence-based resources. Physician practices and health systems can also access additional guidance on optimizing and sustaining telehealth at their organizations through AMA’s Telehealth Immersion Program.”
What’s more, it said, “To ensure the solutions outlined in the report are adopted, the AMA will continue to engage payers, policy makers, patients, and other key stakeholders to overcome critical barriers to care and help combat the nation’s growing behavioral health crisis. This includes efforts on Capitol Hill to identify solutions for improving access to behavioral health care for patients.”
The report states that “Stakeholders across the health care ecosystem have a role to play in advancing the adoption and sustainability of digitally enabled BHI. This report, which was informed by a diverse working group convened by the AMA and Manatt Health, proposes a set of practical solutions that stakeholders—physician practices and health systems, health plans and coverage programs, federal and state policymakers, employers, and private or publicly-traded behavioral health companies—can pursue in order to accelerate the widespread adoption of sustainable BHI.”
The report defines behavioral health integration as “the integrated delivery of comprehensive physical and behavioral health services within the primary care practice setting.” And it notes that “The ability to demonstrate the comprehensive value that digitally enabled BHI generates for providers, patients and society at large could further drive adoption among primary care specialists. The value framework described in the AMA’s Return on Health report is a useful tool that can be used to achieve this aim. There are commonly used measures associated with each value stream within the Return on Health Framework—clinical outcomes; quality and safety; access to care; patient, family member and caregiver experience; financial and operational impact; and health equity—that can be standardized to assess the value of digitally enabled BHI models. For example, diagnostic screening and assessment tools, such as Patient Health Questionnaire-2 (PHQ-2)/PHQ-9 and Alcohol Use Disorders Identification Test-Concise (AUDIT-C), can be used to measure clinical outcomes, quality of care and safety. Referral completion percentages can be used to assess access to care for patients. There is ample evidence that BHI, specifically the Collaborative Care Model, produces superior patient outcomes, improves patient experience and access to care, and can generate cost savings. Incorporating technology into BHI models has the potential to accelerate BHI adoption and impact. All stakeholders have a critical role to play in making it easy for primary care specialists and behavioral health providers to adopt BHI in their practices, as doing so will significantly impact the trajectory of our nation’s behavioral health crisis.”
The report offers three sets of recommendations for five sets of stakeholders: “physician practices and health systems,” “health plans and coverage programs,” “federal and state policymakers,” “employers,” and “private or publicly-traded behavioral health companies.” With regard to what “physicians and health systems can do, the report advises the following:
Ø Increase behavioral health diagnosis and treatment rates by incorporating evidence-based digital health solutions and enabling technology into standard workflows.
Ø Address the siloed delivery of care by primary care specialists and behavioral health providers by implementing technologies that facilitate care coordination and enable highly collaborative care.
Ø Raise provision of evidence-based treatment to best practice standards by adopting and integrating standard measurement tools into provider and patient-facing technologies and by promoting data-driven continuous quality improvement.
Ø Increase BHI training for primary care specialists and behavioral health providers by incorporating digitally enabled BHI into standard curricula.
With regard to technology, the report states that “A person’s behavioral health condition(s) can impact other medical conditions and their overall health. Most people with a behavioral health condition are first diagnosed in the primary care setting or an emergency room. Primary care teams are often best positioned to screen for and address common behavioral health conditions, such as depression, anxiety and substance abuse, with as many as 70% of primary care visits stemming from psychosocial issues. To that end, behavioral health integration (BHI), or the integrated delivery of both behavioral and physical health care, is essential to reaching more individuals in need of behavioral health treatment and solving the nation’s growing behavioral health crisis.”
Broadly speaking, the report cites several limiting factors around the adoption of behavioral healthcare integration, which are:
Ø A national shortage of behavioral health providers and primary care specialists
Ø Provider payment inadequate to cover the costs associated with implementing and delivering behavioral healthcare integration
Ø The siloed nature and inherent cultural differences between behavioral health and non-behavioral health providers with respect to length of visit time and communication style
Ø Federal and state regulations that make it difficult to share patient information across care team members
Per that last issue, the report states that, “While not a panacea, the incorporation of technology into BHI care models (i.e., digitally enabled BHI), such as telehealth and other digital tools, could enhance the effectiveness and accelerate the adoption of BHI.”
The report’s authors conclude that “There is ample evidence that BHI, specifically the Collaborative Care Model, produces superior patient outcomes, improves patient experience and access to care, and can generate cost savings. The evolution toward digitally enabled BHI models that incorporate the use of technology has the potential to accelerate BHI adoption and impact; however, technology is only one part of the solution needed to meaningfully drive adoption of sustainable BHI. All stakeholders have a critical role to play in making accessible and equitable treatment that addresses peoples’ behavioral and physical health needs a more standard practice within primary care,” the report concludes. “It is essential that all stakeholders act now to ensure that primary care specialists receive dedicated support to operationalize digitally enabled BHI, and that BHI is paid for with a margin in both fee-for-service and value-based payment models in order to achieve widespread adoption.”
The “report project team” is listed as the following: from Manatt Health Strategies, Jared Augenstein, M.P.H., director; and Jacqueline Marks, M.S.P.H., senior manager; from the AMA, Carol Vargo, M.H.S., director of physician practice sustainability; Chris Botts, care delivery and payment manager, physician practice sustainability; Meg Barron, vice president of digital health strategy; Vimal Mishra, M.D., director of digital health strategy; Stacy Lloyd, M.P.H., director, digital health and operations; Samantha Lewin-Smith, M.P.H., program administrator, physician practice sustainability; and Kathleen Blake, M.D., M.P.H., senior advisor.
