Accelerating and Enhancing Behavioral Health Integration Through Digitally Enabled Care

Editor’s Note: The American Medical Association (AMA) and Manatt Health gathered a diverse working group of stakeholders representing physician practices and health systems, large employers, health plans, and patient advocates to meet twice during the fall of 2021 and inform the development of a new report on advancing the adoption of behavioral health integration (BHI) through digitally enabled care. Jointly developed by the AMA and Manatt Health, the report, summarized below, shares the working group’s proceedings. It builds on the AMA’s ongoing efforts to advance effective and sustainable BHI, including the BHI Collaborative and the AMA Return on Health framework for measuring the comprehensive value of virtual care. Click here to download a free copy of the full report.

The United States is in the midst of a decades-long behavioral health crisis that has been exacerbated by the COVID-19 pandemic. The number of American adults reporting symptoms of anxiety and/or depressive disorder grew from 1 in 10 in 2019 to 4 in 10 by early 2021.^{1, 2} In 2018, deaths due to drug overdose were four times higher than in 1999.³ The prevalence and severity of mental health conditions among children and teens have also increased sharply during this time, with suicide now the second-leading cause of death among individuals between the ages of 10 and 24.⁴ Stakeholders across the health care system have committed to addressing this crisis; however, the long-standing shortage of behavioral health providers has limited timely access to treatment.

Behavioral health integration (BHI), or the integrated delivery of both behavioral and physical health care, is essential to reaching more individuals who need behavioral health treatment and solving the nation’s growing behavioral health crisis. Experts agree that behavioral health is a core component of primary care; however, BHI adoption among primary care practices remains low due to persistent workforce, financial, information and cultural barriers.⁵

The current shift within the U.S. health care system toward digitally enabled care models presents a unique opportunity to enhance the overall effectiveness of BHI. Appropriately applied, the incorporation of technology—including digital tools for screening and intake, clinical decision support, and telehealth care delivery—can support current BHI models by helping engage more people in behavioral health treatment and possibly encouraging broader adoption by providers. It is important to note, however, that the adoption of technology-based solutions can augment but cannot replace interactions between providers and their patients. In addition, persistence of disparities in access to technology, such as broadband internet or smartphone-enabled devices, may impede equitable adoption of digitally enabled BHI.

Stakeholders across the health care ecosystem have a role to play in advancing the adoption and sustainability of digitally enabled BHI. The AMA’s and Manatt Health’s joint report proposes a set of practical solutions that stakeholders—physician practices and health systems, health plans and coverage programs, federal and state policymakers, employers, and venture-backed behavioral health companies—can pursue in order to accelerate the widespread adoption of sustainable BHI.

Summary of Practical Solutions to Advance Digitally Enabled BHI

Conclusion

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.^{6, 7, 8, 9} 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 people’s behavioral and physical health needs a more standard practice within primary care. 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.

_{¹ Panchal N, et al. The implications of COVID-19 for mental health and substance use. Kaiser Family Foundation, February 2021. Available here.}

_{² Kaiser Family Foundation. Adults reporting symptoms of anxiety or depressive disorder during COVID-19 pandemic. Available here.}

_{³ Panchal N, et al. The implications of COVID-19 for mental health and substance use. Kaiser Family Foundation, February 2021. Available here.}

_{⁴ Centers for Disease Control and Prevention. WISQARS data visualization. 2020. Retrieved from https://wisqars.cdc.gov/data/lcd/home.}

_{⁵ Malâtre-Lansac A, Engel CC, Xenakis L, Carlasare L, Blake K, Vargo C, Botts C, Chen PG, Friedberg MW. Factors influencing physician practices’ adoption of behavioral health integration in the United States: A qualitative study. Ann Intern Med. Jul 21, 2020;173(2):92–99. doi: 10.7326/M20-0132. Epub Jun 2, 2020. PMID: 32479169.}

_{⁶ American Hospital Association. The value initiative—Issue brief: Integrated behavioral health is high-value care. December 2019. Available here.}

_{⁷ Balasubramanian BA, Cohen DJ, Jetelina KK, Dickinson LM, Davis M, Gunn R, Gowen K, DeGruy III FV, Miller BF, Green LA. Outcomes of integrated behavioral health with primary care. J Am Board Fam Med. March–April 2017;30(2):130–139. doi: 10.3122/jabfm.2017.02.160234. PMID: 28379819.}

_{⁸ Unutzer J, Katon WJ, Fan MY, et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care. 2008;14(2):95–100.}

_{⁹ Barton T, et al. Tackling America’s mental health and addiction crisis through primary care integration. Bipartisan Policy Center. March 2021. Available here.}