March 23, 2019, marked the ninth anniversary of The Patient Protection and Affordable Care Act (ACA) being signed into law. These past nine years have been a continuing debate regarding the various aspects of health insurance reform contained in the ACA.
The most fundamental of reforms arose out of the simple definition of “essential health benefits.” For the first time in our nation’s history, health insurance plans were obligated to include “mental health and substance use disorder services, including behavioral health treatment” as covered benefits in their policies.
Behavioral health (BH) providers, who previously had very little exposure prior to the ACA, have been on a sharp learning curve when it comes to dealing with commercial payers.
However, much to the surprise of the BH community, payers are running toward alternative payment models that have been commonly utilized in BH for decades. Capitation and risk arrangements are a way of life for BH providers. Capitalizing on this knowledge is critical for any primary care physician (PCP) looking to integrate BH into his/her practice.
Beyond gaining a working knowledge of managing a patient under alternative payment models, what makes the case for integration? Simply put, BH conditions generally go undiagnosed and untreated.
The following list of statistics published by the Patient-Centered Primary Care Collaborative demonstrate precisely why outcomes can be so dramatically improved among patient populations when BH is integrated into primary care. They further demonstrate why integration of BH is the secret to bending the cost curve:
- 80 percent of individuals with a BH disorder will visit a PCP at least once a year.
- 50 percent of all BH disorders are treated in primary care.
- 67 percent of those with a BH disorder do not get BH treatment.
- As much as 50 percent of referrals to BH outpatient do not make their first appointment.
If the above statistics are not enough to convince your practice that the real opportunity for population health improvement lies with BH integration, consider these financial benefits, also published by the Patient-Centered Primary Care Collaborative:
- Utilization of healthcare services decreases by 16 percent for those receiving BH treatment.
- Depression treatment in primary care lowers total patient spending by $3,300 over 48 months.
- Depression is the number one driver of cost.