Editor’s Note: This content has been excerpted from “Changing Behaviors,” Healthcare Executive, July/August 2023.
Healthcare CEOs who responded to ACHE’s 2022 Top Issues survey ranked behavioral health and addiction third on a list of 11 concerns, behind only workforce challenges and financial pressures. That’s ahead of such perennial and still very pressing issues as patient safety and quality, governmental mandates, access to care, and patient satisfaction.
The survey indicated that behavioral health and addiction are perhaps intertwined with the two issues that outranked them. Among the most common reasons respondents gave for their degree of concern were “lack of appropriate facilities/programs in the community” (78%), “lack of funding for addressing behavioral health/addiction issues” (77%) and “insufficient reimbursement specifically for behavioral health/addiction services” (70%).
Societal events of the past few years have at least partly driven the need. The proportion of adults with symptoms of anxiety or depression rose from 36.4% in August 2020 to 41.5% in February 2021, according to the U.S. Centers for Disease Control and Prevention. Meanwhile, the proportion of mental health-related ED visits rose 24% for children aged 5 to 11 and 31% for adolescents aged 12 to 17 between comparable periods in 2019 and 2020.
These spikes touched all ages, races and income brackets, leaving patients with months-long waits in some cases due to a lack of available providers or resources in their areas. Behavioral health providers and experts agree fervently that improvements are imperative, and they offer up a bevy of ideas on what needs to be done.
“The crisis is not new,” says Stephen Merz, FACHE, COO, Sheppard Pratt Solutions, a recently formed consulting division of Sheppard Pratt, one of the nation’s oldest psychiatric hospitals, founded in 1853. “There are not enough leaders who know how to successfully manage this vulnerable population, and for many years, we have lacked enough team members to provide care at a scale and magnitude that’s needed.” The demand-side challenges have grown both substantially and qualitatively, “exacerbated by the COVID experience,” he added.
J.R. Greene, FACHE, CEO, Psychiatric Medical Care, Nashville, Tenn., points to the paucity and ambiguity of funding sources.
“The funding has not universally been at a rate that would motivate many practitioners to become behavioral health experts compared to other specialties,” he says. And payers don’t have the same hard data about the costs of behavioral health treatment as they would, say, for a hip replacement. “We don’t know the exact costs associated with treating various mental disorders,” he adds. “As an example, we can’t tell someone with adult bipolar illness that they will need a certain type of treatment for a very strict amount of time, at a set industry cost. [That] ambiguity of behavioral health treatment disrupts the funding mechanisms. Insurance providers want to see consistent data to know their realistic estimated cost by treatment. Behavioral doesn’t have this near perfect sophisticated capability—yet.”
Terrie Andrews, PhD, vice president, behavioral health, Baptist Health and Wolfson Children’s Hospital, Jacksonville, Fla., agrees. She cites data from the U.S. Substance Abuse and Mental Health Services Administration showing that the percentage of people experiencing a mental health crisis has risen from 1 in 5 before the pandemic to 1 in 3 today.
“There’s going to be a three-fold increase in the need for outpatient behavioral health services and addiction treatment over the next couple of years,” Andrews says, pointing to estimates from healthcare and hospital system consultant Sg2. Data from the Florida Hospital Association show that “there’s still not enough beds, and reimbursement is extremely low from insurance.” She says insurers need to reimburse at appropriate levels so patients can not only get care when they need it but also so hospitals can provide it at a sustainable level.
Read the full story in the July/August 2023 issue of Healthcare Executive.
Ed Finkel is a freelance writer based in the Chicago area.