Why Mental Health Should be Included as Part of a Whole Health Approach
The notion of taking care of our physical health is ingrained in us. Many of us follow the recommendations from our primary care physician to eat healthy and exercise, while also getting plenty of rest and water. But what about taking the time to see a mental health professional to examine one’s extreme anxiety about life? Or dedicating energy to tackle a looming substance abuse issue?
I personally wake up every morning and make the time to exercise and pack my salad for lunch, but to find the time to tackle some family issues and take care of my general mental well-being? Nope – and it’s mostly because I don’t know where to start, nor do I even know how to access it easily through my insurance program. Yet, discussing this topic seems more acceptable than ever before since the stigma of mental health has steadily been softening thanks to educational programs on the importance of having good mental health as well as celebrities sharing their stories (thank you Demi Lovato and Michael Phelps).
Leading the educational charge is the National Institute of Mental Health (NIMH), who recently reported that 18.9% of Americans experienced some form of mental illness (not including substance abuse disorders) in 2017, but only 42.6% of adults with any mental illness and 64.8% with a serious mental illness reported receiving treatment within that past year. These statistics are powerful and point not only to the prevalence of mental health disorders, but also to the shortcomings in services available to serve people suffering from these disorders.
Why Should We Care About Mental Health Anyway?First, as mentioned earlier, people aren’t aware of how common mental health problems are. More importantly, people with depression or other mental health disorders are at higher risk for suicide. According to the CDC, suicide is the tenth leading cause of death in the U.S. and for every death by suicide, there are 25 attempts that go along with it. With that said, we all have a role to play in not only the prevention of suicide, but in identifying those with potential mental health problems to deliver them the appropriate care and resources.
Three Roadblocks to Optimal Care
In addition to the social stigma, political and regulatory stigmas within healthcare still exist, creating additional roadblocks to those looking to receive treatment and mental health professionals looking to deliver care.
One of the first roadblocks is patient lack of coverage and adequate insurance reimbursements. Many mental health diagnoses are not supported by insurance providers. For example, a mental health provider may recommend four months of treatment, but insurance payers may only approve for one month of the recommended four months of treatment. That leaves two sub-optimal solutions for a patient to consider: 1) “I can pay for three months out of pocket, leaving me financially strained” or 2) “I can forego treatment altogether” , which hurts not only the practice’s income but the patient’s cumulative mental health in the long run. This is an all-to-familiar scenario that happens on a frequent basis. A report published by the American Hospital Association (AHA) also revealed some astounding statistics:
- Based on an online survey conducted by the National Alliance on Mental Illness (NAMI), Patients seeking mental health care are twice as likely to be denied care based on “medical necessity” – also stating that insurance plans limit treatments or have extremely strict requirements for behavioral health providers over medical and surgical care.
- Behavioral health providers are still reimbursed less than primary care providers by approximately 20%- simply because these types of services are undervalued.
- State mental health agencies are significantly underfunded.
The second roadblock is the mental health market is faced with a double-edged sword. As the stigma around mental health services and solicitation of treatment sheds, there is an unprecedented demand for such services driving an all overall workforce shortage. Much of the shortage is fueled by the gap between newly trained mental health providers entering the workforce to meet the demand for these services. In the same AHA report, a 2017 analysis found that in the United States alone, we’ve only fulfilled 33% of our need for mental health professionals. Case in point - some mental health practices have a wait list three to six months out!
And finally, care coordination and regulatory impediments are creating delays in delivering mental health services. There is a lack of physical and behavioral health care coordination along with health record integration that creates a barrier to delivering comprehensive care to a patient. An example of this is a substance use disorder treatment where separate confidentially standards for medical records impede responsible sharing of the patients’ records between mental and physical healthcare providers. To top it off, Health Information Technology (HIT) adoption has historically been low among mental health providers for several reasons- likely the upfront costs, system maintenance and privacy/consent required to share records.
Creating Access to Mental Health Care
At Kareo, we believe that medical software companies have a significant role to play in ensuring mental health gets as much focus as physical health. We are in a unique position to be advocates for providers by ensuring mental health workflows and market barriers are at the forefront of product design decisions, while also providing the necessary support to navigate the complex ins and outs of our current regulatory environment. In addition, medical software companies can relieve the burden of care coordination with software platforms that drive streamlined workflows from the time a new patient is created throughout each phase of treatment (which is extremely important because most mental health services are continual). Through this, the market barriers will lessen over time and mental health can become a highly efficient care delivery machine.
Let’s focus on some ways medical software companies can play a role in mental health:
- Mental health practices should look for a company that offers a true end-to-end platform -not just a ‘great EHR’. It all goes back to ensuring that mental health providers have streamlined solutions that enable them to meet the extreme demand they face on a day-to-day basis.
- The technology should ensure that the features offered are mental-health focused, including customizable treatment plans and clinical note templates, same-as-last-time (SALT) shortcuts, ePrescribing capabilities with medication histories, mobile functionality, and HIPPA compliance.
- A software platform should offer appointment reminders. Appointment reminders are key, as many mental health customers state that one of their biggest challenges is ensuring their clients get to their appointments. As is common with this type of client persona, getting out of bed or simply remembering an appointment can create additional stress on top the other emotional and behavioral hurdles they are currently facing.
How Technology is Helping Mental Health Practices During COVID-19 CrisisI would be remiss if we didn’t at least touch upon the COVID-19 pandemic facing all communities today. This epidemic has accelerated the need for providers to be able to connect with patients anywhere, at any time, which is why it’s vital to consider a vendor with telemedicine capabilities. Technology, in the form of telemedicine, is a great way to connect with patients intimately and within a setting that’s comfortable to them, like their own home. It is best if a telemedicine solution is integrated directly with your EHR and clinical documentation for that patient. And don’t forget billing - if your mental health practice is looking for helpful tips on coding and billing related to telehealth and COVID-19, check out our latest guide for helpful advice.
Mental health practices already face many reimbursement and patient collection issues more than their medical and surgical peers. Ensuring that the billing features are closely linked with the patient’s medical records is key to having a simplified and transparent workflow from start to finish. Mental health billing software should include some basic features such as: eligibility checks, patient billing, reauthorizations, claims management, patient payments, secure messaging and compliance. As a bonus – look for a technology platform that offers billing analytics and reporting tools that help efficiently monitor practice performance to help stay ahead of the reimbursement curve.
Since it is already a hassle for patients to find a mental health practice, make sure your practice stands out with patient engagement tools for online scheduling, appointment reminders, communications and surveys, which help reduce no-shows and overall experience. In addition to managing a solid online presence, it’s key that mental health intake is stress-free. Look for a vendor that offers online patient intake that captures critical information prior to the patient’s appointment where they can fill out necessary screening forms, like GAD-7 or PHQ-9 in the comfort of their own home. Being able to digitally collect patient screenings during and in-between appointments not only improve communication with patients, but enables improved clinical decision making in between appointments to ensure treatments are on track.
And lastly, if using HIT software is still a relatively new venture and requirement for your practice, then consider a vendor that’s fluent in regulations. The fourth year of the Quality Payment Program (QPP) is well underway for 2020 and companies like Kareo are available to help, providing clients with handy checklists of items, actions and progress report guidance. Specifically for telehealth updates related to COVID-19, we believe in creating helpful lists for our mental health customer base as healthcare rapidly shifts these days.
At Kareo, mental health services are close to our heart and is a core focus of our business. Because of its importance, we’ve formed focus groups of small, mid-size and large mental health practices to help drive and shape our product roadmap so that together, we can break down the mental health roadblocks one step at a time. Click to learn more about Kareo Mental Health software.