Behavioral health plays a critical role in overall health and vitality.
Thought leaders from around the health care industry gathered this month in Portland, Oregon, for the AHIP 2023 conference. Discussions went deep into health care’s biggest challenges, opportunities, and innovations. Behavioral health care, of course, was a main topic.
Among the key takeaways: The health care system must do a better job of working together to provide people with the right resources at the right time, with measurable outcomes. In fact, experts see a tremendous opportunity to connect more people to mental health support earlier and more often, but that will require collaboration, innovation, and partnership.
Below we look at some of the most meaningful behavioral health insights we heard throughout the three days of this in-person event.
Spotlight on adolescent behavioral health: access and barriers to care
Of the many complex challenges discussed at this year’s conference, improving access and removing barriers to mental health care for adolescents was front and center. In an age of digital, young people need access to behavioral care more than ever before. The U.S. surgeon general recently issued a warning that young people are at risk for devastating behavioral effects due to a range of factors, including disruptions to social interactions, subsequent isolation, loneliness, bullying, and an atmosphere of fear and anxiety. And amid the backdrop of a troubling rise in suicide rates among young people during the pandemic, these risks are compounded by a shortage and uneven distribution of behavioral health professionals across the country.
During a panel on the health insurance payer’s role in addressing adolescent mental health, Eva Borden, president of behavioral care at Evernorth, spotlighted the urgent need to improve access to behavioral care for young people. Speaking from her professional experience, but also her personal perspective as a parent trying to navigate the system for a child with escalating mental health challenges, she spotlighted the importance of having a resource to help people navigate their options and, crucially, the importance of guiding those young people who are willing to get care. “We’ve seen some surveys that show 45% of all young people with a mental health condition are willing to engage and get care,” she said. “The important question is, how do we connect them to the care that they need?” That’s where measurement-based care comes into the equation, Borden said.
Eva Borden, second from right, addresses the importance of improving behavioral care access for adolescents.
The role of measurement-based care in earlier detection and intervention
Measurement-based care has become an increasingly central part of the behavioral care conversation, Borden said, adding that too often the behavioral field has been allowed to ignore true evidence-based approaches — something that isn’t tolerated in the medical field.
“When I think about measurement-based care and where we need to go, this is exciting from a technology point of view, because technology is enabling more and more ways for us to really be able to see and understand what’s going on,” she said. She described some of the opportunities, such as leveraging technology in therapy sessions to consistently collect information and measure the change in how someone is responding to behavioral care.
When it comes to partnerships, Borden shared an example of a collaboration that she believes is one of the most important — an innovation in the applied behavioral analysis (ABA) space. ABA is a type of interpersonal therapy often used to treat children with autism spectrum disorder. She explained that ABA is difficult to measure — determining whether, and how, the therapy is making a difference.
Innovating the approach to ABA with a measurement-based focus, going beyond collecting data, provides an opportunity to better understand treatment protocols and overall efficacy. (See what Evernorth is doing in this space.)
Defragmenting the behavioral care system
One of the key questions in behavioral care, according to Borden, is identifying ways to defragment the system. For those willing to seek care, the first point of contact is usually their primary care provider, who frequently will prescribe drugs to treat their needs — this is especially true for young men. About 35% of boys age 13-17 stop their behavioral care journey at that point. The question, she said, is why they aren’t seeking other forms of care, such as therapy.
Borden clarified that drugs alone may be the most appropriate protocol and treatment in some situations. However, she challenged the system’s model of operating in silos and described an opportunity to better connect the system, especially for young people already willing to seek care. (See Evernorth’s latest research on this topic.)
“If we have the information, we must work together across the system to arm parents and caregivers with the right map to navigate care — and also ensure that whatever care we provide is actually relevant,” Borden said.
Embedding health equity in value-based behavioral care
Alternative, value-based care models for behavioral care also were a topic of conversation at AHIP 2023. Dr. Doug Nemecek, chief medical officer for behavioral health at Evernorth, shared his insights while moderating a panel focused on those models.
Dr. Nemecek highlighted the opportunity for innovation. “There is a real excitement and need for alternative reimbursement models — and better alignment between payers and clinicians on how we improve care, improve quality, and improve the outcomes for everybody who needs and deserves high quality behavioral health care,” he said.
Dr. Doug Nemecek, right, moderates a panel focused on value-based care models for behavioral care.
Alternative value-based models reward behavioral providers based on improved outcomes, affordability, and the experiences they achieve – rather than just the amount of services they provide. Throughout the conversation, the panel examined the power of taking this model further — embedding health equity outcomes into value-based relationships and financially rewarding those who proactively screen for, and create programs to address, social determinants of health such as housing insecurity, food insecurity, and lack of transportation.
As with many topics in behavioral health, value-based care is complex. The group explored challenges related to how to collect, understand, and react to social determinants data — which will require new ways of thinking and collaboration across all levels of the health care system. The group also highlighted the importance of designing and developing any value-based alternative payment models alongside providers, to ensure everyone is brought in, empowered, and buys into the arrangement. Ultimately, value-based behavioral care is a way to incentivize accountability and deepen relationships with providers and members.
“We share the same goals,” Dr. Nemecek said. “In terms of reducing health disparities, it’s all about improving outcomes and quality of life, and using the contract and the reimbursement as a way to align us with the providers and the clinicians on those goals.”
Tremendous opportunities for collaboration and innovation across the system
Reflecting on the topics, ideas, and solutions discussed at AHIP 2023 revealed that every session shared a common thread. A spirit of collaboration, partnership, and innovation was present in every conversation, across all levels of the health care system. One thing is clear: Much work needs to be done to help connect people to the mental health care they need. Evernorth will continue to collaborate and innovate with our partners across the health care system to reduce barriers to care. There is a tremendous opportunity to connect more individuals to support earlier and more often, which will lead to better overall health and vitality.
