Maureen Bonatch

Value-Based Care and Behavioral Health Treatment

For value-based care to provide truly holistic, coordinated care to patients, it must incorporate behavioral health treatment. This can result in improving the quality of health care for your employees, especially those with chronic medical conditions. Despite the benefits of integrating behavioral health treatment into value-based care, physical and behavioral medicine too often remain siloed in our health care systems — even under value-based care arrangements.

The Need for Inclusive Treatment

Comprehensive primary care has begun to seek ways to integrate behavioral health treatment to improve outcomes and cost-effectiveness. Behavioral health conditions frequently co-occur with chronic diseases, but these symptoms may be overlooked. Depression symptoms, for example, may be masked by other medical conditions. Patients with diabetes often receive mental health education along with diabetes education, since anxiety and depression are frequently associated with this diagnosis. If left untreated or overlooked, people with behavioral health issues can end up in the ER or experience increased physical complications.

Many mental health conditions can affect a person’s overall quality of life, including their ability to maintain employment. And a behavioral health diagnosis can still carry a stigma. Your employees may be uncomfortable with or even unaware of their need for mental health treatment. This may be why 74% of patients go to their primary care doctor first to seek help for depression, according to Mental Health America. But primary care physicians may not be able to address mental health issues due to time constraints, limited knowledge or discomfort discussing behavioral health, and a diagnosis of depression is missed 50% of the time in the primary care setting. Warning signs may go unnoticed or be mistaken for a normal response when a patient is struggling with a serious health condition.

Value-Based Care and Behavioral Health Challenges

Value-based care encourages provider collaboration; taking advantage of this momentum to incorporate behavioral health providers within patients’ provider networks could improve the overall quality of care. A multidisciplinary solution may help determine whether anxiety and depression could be contributing to pain, for example, or help the patient prepare for their procedure and recovery. A behavioral health evaluation may even determine that a different treatment is more appropriate.

The 2017 Centers for Medicare and Medicaid Services Medicare Physician Fee Scale added codes supporting the integration of behavioral health care. But incorporating behavioral health care in value-based care can be difficult. Value-based care focuses on measuring outcomes and quality through the evaluation of standardized data, and the implementation of standardized data and opportunities for cost savings are not as well-established for behavioral health as they are for other medical conditions. Behavioral health professionals may not have access to these tools, or they may utilize different sets of data that make it difficult to share data between providers. If the impact of mental health and its outcomes on chronic conditions are better recognized, it may reduce the separation of mental health treatment from overall care.

Working Toward Changes to Behavioral Health Care

Comprehensive primary care has begun to address behavioral health issues. Some providers will evaluate for mental health and substance use disorders or psychological symptoms, including screening for depression with the Patient Health Questionnaire (PHQ-9). This integration is beneficial, although appropriate mental health care often requires the expertise of behavioral health professionals who aren’t always part of the primary care network.

The coordination of care with behavioral health professionals can assist with directing treatment and improving outcomes. The psychiatric Collaborative Care Model has begun to demonstrate how more effective care integration can help control costs and increase patient satisfaction.

Integrating behavioral health into value-based care may be beneficial for providing more holistic care for your employees. This process has faced some challenges, but ongoing changes in implementing behavioral health treatment are improving the quality of health care.