AMA/Manatt health report envisions broad integration of behavioral health

Could the adoption of digital health tools, including telehealth, significantly improve the integration of behavioral health care into the rest of the health care delivery system? That’s what a new report, sponsored by the Chicago-based American Medical Association (AMA) and the Manatt Health Strategies division of Los Angeles-based consulting firm Manatt (which on its website describes itself as “a national enterprise of integrated and multidisciplinary professional services”), concludes.

As a press release posted on the AMA’s website on Monday, February 21 stated, “With the country’s decades-long behavioral health crisis compounded by the COVID-19 pandemic, a collaboration between the American Medical Association (AMA), Manatt Health Strategies and a group of healthcare experts has identified solutions to increase access to behavioral health services through the adoption of digital technologies. Released today in a new report, the stakeholder-specific solutions promote the integration of technologies, such as telehealth and other digital tools, that can improve the patient-physician relationship and increase overall hospital efficiency. Behavioral Health Integration (BHI). Accelerated adoption of BHI is key to reaching more people in need of behavioral health treatment and solving the growing behavioral health crisis in the country, according to the report.

The press release quotes AMA President Gerald Harmon, MD, as saying, “The demand for behavioral health services is significant and growing, but so is the potential for digital technology to support the delivery integrated physical and behavioral health services. The AMA is committed to providing accessible and equitable treatment for behavioral and physical health needs, and the appropriate use of digital health technology can support the integration of behavioral health, especially in times of distress. heightened psychological and trauma,” Dr. Harmon said.

The press release went on to state that “to drive adoption of digital BHI, the report highlights the importance of demonstrating the value generated by these digital tools for providers, patients and society as a whole. The values ​​framework described in the AMA’s Return on Health report is a useful tool that can be used to achieve this goal. The new report builds on the AMA’s continued commitment to accelerating the adoption of BHI in primary care practices by working alongside members of the BHI Collaboration to provide enhanced support and evidence-based resources. Medical practices and healthcare systems can also access additional guidance on optimizing and sustaining telehealth in their organizations through the AMA’s Telehealth Immersion Program.

Additionally, he said, “To ensure adoption of the solutions outlined in the report, the AMA will continue to engage payers, policymakers, patients and other key stakeholders to address critical barriers to care. and help tackle the nation’s growing behavioral health crisis. . This includes efforts on Capitol Hill to identify solutions to improve access to behavioral health care for patients.

The report states, “Stakeholders in the healthcare ecosystem have a role to play in advancing the adoption and sustainability of digital BHI. This report, which was informed by a diverse task force convened by the AMA and Manatt Health, offers a set of practical solutions that stakeholders – medical practices and health systems, health plans and coverage programs, federal policymakers and state, employers and private or privately-listed behavioral health companies – can sue to accelerate the widespread adoption of BHI Sustainable.

The report defines behavioral health integration as “the integrated delivery of comprehensive physical and behavioral health services within primary care practice.” And he notes that “the ability to demonstrate the overall value that digitally-enabled BHI generates for providers, patients, and society as a whole could drive adoption by primary care specialists. The values ​​framework described in the AMA’s Return on Health report is a useful tool that can be used to achieve this goal. There are commonly used metrics associated with each value stream within the framework of health return—clinical outcomes; quality and safety; Health care access; the experience of patients, family members and caregivers; financial and operational impact; and health equity – which can be normalized to assess the value of numerical BHI models. For example, diagnostic screening and assessment tools, such as Patient Health Questionnaire-2 (PHQ-2)/PHQ-9 and Alcohol Use Disorders Identification Test-Concise (AUDIT-C), can be used to measure outcomes clinics, quality of care and safety. The benchmark completion percentages can be used to assess access to care for patients. There is ample evidence that BHI, particularly the collaborative care model, produces superior patient outcomes, improves patient experience and access to care, and can generate cost savings. Integrating technology into BHI models has the potential to accelerate the adoption and impact of BHI. All stakeholders have a critical role to play in facilitating the adoption of BHI by primary care specialists and behavioral health providers into their practices, as this will have a significant impact on the trajectory of the behavioral health crisis. of our country.

The report offers three sets of recommendations for five sets of stakeholders: “physician practices and health systems”, “health plans and coverage programs”, “federal and state policy makers”, “employers” and “private or publicly traded behavioral health companies. .” Regarding what “physicians and health systems can do, the report advises the following:

Ø Increase behavioral health diagnosis and treatment rates by incorporating evidence-based digital health solutions and enabling technology into standard workflows.

Ø Address siled delivery of care by primary care specialists and behavioral health care providers by implementing technologies that facilitate care coordination and enable highly collaborative care.

Ø Increase the delivery of evidence-based treatments to best practice standards by adopting and integrating standard measurement tools into technologies for providers and patients and promoting data-driven continuous quality improvement.

Ø Increase BHI training for primary care specialists and behavioral health care providers by incorporating digitally enabled BHI into standard curricula.

With respect to technology, the report states that “a person’s behavioral health issues can impact other health issues and their overall health. Most people with a behavioral health problem are first diagnosed in primary care or an emergency room. Primary care teams are often best placed to identify and treat common behavioral health issues, such as depression, anxiety and substance abuse, with up to 70% of primary care visits stemming from psychosocial issues. To this end, behavioral health integration (BHI), or the integrated delivery of behavioral and physical health care, is key to reaching more people in need of behavioral health treatment and solving the behavioral health crisis. growing in the country.

Broadly speaking, the report cites several limiting factors around the adoption of behavioral healthcare integration, which are:

Ø A national shortage of behavioral health care providers and primary care specialists

Ø Insufficient provider payment to cover costs associated with implementing and delivering behavioral health care integration

Ø The siled nature and inherent cultural differences between behavioral and non-behavioral health providers with respect to length of visit and style of communication

Ø Federal and state regulations that make it difficult for care team members to share patient information

According to this latest issue, the report states that “while not a panacea, integrating technology into BHI models of care (i.e., BHI digitally enabled), such as telehealth and other digital tools, could improve efficiency and accelerate adoption of BHI. .”

The report authors conclude that “there is ample evidence that BHI, in particular the collaborative care model, produces superior patient outcomes, improves patient experience and access to care, and can generate cost savings. of costs. The move towards digital BHI models that incorporate the use of technology has the potential to accelerate the adoption and impact of BHI; however, technology is only part of the solution needed to significantly drive the adoption of a sustainable BHI. All stakeholders have a critical role to play in ensuring that accessible and equitable treatments that meet people’s behavioral and physical health needs become more common practice in primary care,” the report concludes. “It is essential that all stakeholders act now to ensure that primary care specialists receive dedicated support to operationalize the digitally enabled BHI, and that the BHI is paid with a markup in the fee-for-service and fee-based models. on value in order to achieve widespread adoption.”

The “Report Project Team” is listed as follows: from Manatt Health Strategies, Jared Augenstein, MPH, Director; and Jacqueline Marks, MSPH, senior manager; from the AMA, Carol Vargo, MHS, director of medical practice sustainability; Chris Botts, Head of Care Delivery and Payments, Medical Practice Sustainability; Meg Barron, vice president of digital health strategy; Vimal Mishra, MD, director of digital health strategy; Stacy Lloyd, MPH, director, digital health and operations; Samantha Lewin-Smith, MPH, program administrator, sustainability of medical practice; and Kathleen Blake, MD, MPH, Senior Advisor.

The full report can be accessed here.

About Michael G. Walter

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