简而言之: 在支付方之间建立信任 而提供者是解决行为健康危机的第一步.
大流行将美国的医疗体系推向了极限, bringing long-standing problems—a workforce shortage and provider burnout chief among them—to a boiling point as clinicians and hospital staff struggled to keep up with overcrowded emergency rooms.
But it’s fair to say that no specialty was more uniquely affected than behavioral health.
在社会孤立的气氛中, 经济压力, 健康问题, 悲伤和失落, 2020年,医院的精神卫生急诊人数出现了两位数的增长. 随着需求飙升,大流行暴露了获取问题.
The public health emergency around COVID-19 has ended, but a crisis in behavioral health persists.
- 美国55%的县没有一名执业精神科云顶集团40011官网.
- 13至18岁的青少年中有五分之一患有严重的精神疾病.
- Mental and behavioral health claims now make up 12% of all claims nationally—up from 5% in 2015.
但我们有理由乐观吗?
这场大流行对人们精神健康造成的损失不应被低估, but the events of 2020 also helped bring behavioral health care into the national conversation. 更重要的是, behavioral health suddenly found itself situated at the nexus of evolving technology and changing perceptions. “I think the pandemic opened people’s eyes to the fact that there are alternatives to in-person, 面对面的护理,汤姆·福利说, 他是心电图管理护理部门的高级经理. “在大流行之前,远程医疗很好. 现在它是必备的,而且会一直存在下去.”
And along with new modes of care delivery came an evolving understanding of mental illness. “十年前, 人们并没有真正谈论他们的行为健康问题,凯蒂·什罗普希尔说, 心电图高级顾问. “至少在年轻人中,(今天)找心理云顶集团40011官网几乎是一种潮流。”. 我很高兴看到这种持续的接受和进步.”
与此同时,也有一些具体的例子证明了人工智能的潜力 对行为保健的组织承诺. 最近颁布的立法准备扩大 增加行为劳动力 扩大医疗保险受益人获得精神卫生保健的机会.
这是鼓舞人心的, 但在付款人和行为健康提供者之间的鸿沟能够弥合之前, 进展仍难以捉摸. 在最近的 美国医院协会进行的一项调查在美国,78%的医院表示,他们与付款人的关系正在恶化. 精神保健的报销历来是 不充分的, and the fragmented nature of the space has complicated efforts to create cohesive behavioral health networks. 显然,还有很多工作要做.
心电图的行为健康团队增加了付款专业知识
Tom Foley and Katy Shropshire bring a payer’s mindset to 心电图’s behavioral health managed care team. Tom has 30 years of payer experience and served as the director of ancillary and behavioral health contracting at Blue Cross Blue Shield of Massachusetts before joining 心电图. Katy之前是Optum Behavioral Health的高级网络合同经理, 在那里她领导了整个美国西部的网络合同和报销计划.
Here they talk about why they came to 心电图 and how they think payers and mental health providers can find common ground.
人多力量大
Reimbursement for mental health services has historically been low, a notion Tom doesn’t dispute. “When you look at the behavioral health professional network as a whole and the freestanding behavioral health provider facilities, 我会说[报销很低], especially if you haven’t consistently attempted to renegotiate your contracts or if you’re a new market entrant with limited historical utilization with payers,他说.
Of course, behavioral health providers can’t show up to the negotiating table empty handed. “There’s a lot of talk right now in the behavioral health space about needing to show up to conversations with payers with data,凯蒂解释道. “Providers need to demonstrate to payers that their outcomes are measurable and in line with what payers want to see to in order to get higher reimbursement rates.”
但是行为健康提供者, 尤其是个人供应商, often struggle to capture and interpret the data that can improve their standing in a rate negotiation. “为了获得这些数据,必须对技术进行投资,”凯蒂说. “But current reimbursement barely supports the clinicians, let alone an investment in technology. 纳税人 don’t always include that in their calculations when they’re when looking at rates.”
Larger entities are better positioned to invest in those capabilities, and Tom sees that happening. “你开始看到在多个州形成专业团体. You need that so you can share data with a payer and take it to the next level,他说.
伙伴关系之路
Fixing behavioral health will require a coordinated effort among payers, providers, and communities. 汤姆相信医疗云顶集团提供者愿意付出这样的努力. “I think behavioral health providers are looking to have partnerships with payers,他说.
但纳税人愿意成为合作伙伴吗?
“第一步是在付款人和提供者之间建立信任关系,汤姆说, 同时也承认这“说起来容易做起来难”.” He also suggests that payers should take note of the growing numbers of mental health provider groups. “他们应该瞄准那些他们认为可以合作的供应商组织, 组织将使用增加的技术投资, 就像凯蒂说的.”
And if providers are willing to invest in technology to help them capture data about outcomes and access, 付费方需要建立稳固的门柱. “付费用户需要能够清楚地定义他们在寻找什么,”凯蒂说.
纳税人 also need to be open to innovative approaches to behavioral health care delivery—and simplifying processes wherever possible.
初级护理
在初级保健办公室提供行为保健, 无论是通过药物管理还是嵌入治疗师, 是否日益受到云顶集团40011官网的关注, CMS, and payers as an option for expanding access while providing care in a lower-cost setting. “这种模式的势头正在增长,凯蒂承认, 而是从支付的角度来看, 这很复杂.” The administrative difficulty of managing behavioral health claims in the primary care space is slowing adoption of the model. 但如果付款人愿意与供应商合作,使其发挥作用, they may be able to keep patients from turning unnecessarily to emergency rooms for care.
家庭护理
汤姆强调了传统环境之外的护理日益增长的趋势. 他说:“我认为,总的来说,人们会在家里得到更多的照顾。. “I also see a movement afoot where it becomes industry standard that reimbursement is based not just on ‘traditional services,还有非传统云顶集团. 同伴指导是一种被用来治疗药物使用障碍的方法. 这听起来不怎么创新, but it’s very important because someone may not have the ability to get to a medical appointment or have access to a laptop.”
There’s nothing to suggest any of this is easy—approving reimbursement for care under nontraditional circumstances involves operating within a complex environment of policies, 规定, 政治, 和惯性. 但远程医疗比大流行早了几十年, and its adoption was similarly stymied by administrative complexity as well as payer and provider skepticism. 一场突发公共卫生事件改变了这一点, and now payers and providers need to approach the behavioral health crisis with the same sense of urgency.
共同前进
培养这种合作意识是汤姆来到心电图的原因. 他觉得自己丰富的付费经验会有所帮助. “I think our behavioral health managed care team is positioned to provide the expertise and feedback for clients to optimize their relationship with their payers,他说. Tom knows that firsthand, having encountered 心电图’s team from the other side of the negotiating table. “我有直接与心电图合作的经验,这真的是一种合作关系. 这就是我感兴趣的.”
凯蒂也发出了充满希望的声音. “I chose to work in the behavioral health space because there’s so much energy and innovation right now, 这使它成为一个非常令人兴奋的工作空间.”
让我们看看支付者和提供者是否可以 把能量转化为改变.
了解最近颁布的立法将如何扩大行为健康工作队伍.
2023年5月10日出版