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    Thirty years ago, epidemiologists branded primary care as the “de facto U.S. mental and addictive disorders service system.” In the past decade, several experts have worked to define the competencies needed for provider and practice success as integrated behavioral health in primary care has gained traction across the industry. 

    Now, as the public health emergency declaration around the COVID-19 pandemic has ended, the future of how healthcare provider organizations respond to elevated demand for care is being determined today. 

    A Sept. 12, 2023, MGMA Stat poll finds that just under three in 10 (29%) of medical groups plan to add or integrate behavioral health services in the next year, while the majority (59%) do not, and another 12% responded “not applicable.” The N/A responses frequently noted that, while the groups may not be adding behavioral care in the year ahead, many of them already have some form of integrated behavioral care providers in their ranks. The poll had 421 responses. 

    These results echo a similar MGMA Stat poll from September 2022, which found about 30% of organizations planned to add behavioral health services in the past year. 

    Among medical group leaders that are expanding existing behavioral health services, many told MGMA that they clearly recognize a need for it in their communities. As one practice leader said, the common steps reported to MGMA included: 

    • The addition of more behavioral health therapists, clinical psychologists, licensed counselors and psych nurse practitioners 
    • Hiring licensed clinical social workers (LCSWs) to help patients cope with illness and address positive PHQ9 results 
    • Expanding virtual behavioral counseling and virtual medication management 
    • Plans to expand individual and group therapy options 
    • Broadening access to coping skills education, ADHD education, and testing for anxiety, depression and autism. 

    While several practice leaders who responded “no” told MGMA that they did not see a need for integrating or adding behavioral health in their specific specialty, several respondents outside of primary care said their organizational philosophy has evolved to see a need for behavioral health access for certain specialty patients, such as cardiology. 

    Another barrier to additions or expansions cited by several poll respondents was either a lack of capital to invest in it or payment issues that make services unsustainable. “We had behavioral health, and insurance companies just do not pay well for these services,” one respondent said. “We were actually losing money in our office by offering these services.” 

    More on behavioral health services 

    Assessing the need 

    As of February 2023, about one-third of all adults reported symptoms of anxiety and/or depressive disorder during the pandemic, per a KFF analysis of U.S. Census Bureau surveys. While this is down from nearly 40% reported in February 2021, the latest figure represents a slight uptick from February 2022, demonstrating that the relative return to pre-pandemic normalcy in many areas of society hasn’t meant that the need for mental health has significantly subsided.  

    More than four in 10 (46%) of Americans will meet the criteria for a diagnosable mental health condition in their lifetimes, and half of those people develop conditions by the age of 14. More than half of adults (55%) with a mental illness receive no treatment, according to nonprofit Mental Health America

    Learn more at Leaders 2023 

    The 2022 MGMA Harwick Innovation Award recipient Natalia Szczgiel, MSHA, CMPE, OMC, will co-present alongside Malissa Becksvoort, a fellow director of operations at Corewell Health, on the topic of “Behavioral Health Screening in Healthcare and Beyond” at the 2023 Leaders Conference, October 22-25 in Nashville, Tenn.   

    Their case study will explore building a standardized behavioral health screening infrastructure across 14 hospitals and more than 200 ambulatory sites for patients and employees. The infrastructure emphasizes a “whole-person healing approach” that incorporates behavioral health screening and early interventions into a medical system that can be adapted for wider community use.  

    Corewell Health adapted suicidality protocols for the health setting to support workplace mental health using an employee peer-to-peer model, and then adapted their toolkit further to train staff and faculty at middle and high schools on life-saving suicide prevention procedures for students in crisis. Participants of this session will hear all the details on making these expansions work across communities. Becksvoort and Szczygiel will also highlight using standard work, change management and a system dashboard to set expectations for team members and periodic auditing for continued improvement and compliance during the planning stages. 

    Join MGMA Stat   

    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat — by texting “STAT” to 33550 or visiting mgma.com/stat — and make your voice heard in our weekly polls. Polls will be sent to your phone via text message.  

    Additional resources 

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