As of March 2023, 160 million Americans live in areas with mental health professional shortages, with over 8,000 more professionals needed to ensure an adequate supply. In order to address this shortage, long-term legislative opportunities are necessary but will not provide immediate relief to the millions of Americans in need of care. Digital tools overcome many of the barriers to traditional mental health care; however, they present their own challenges concerning federal regulation and public and private insurance coverage. In order to start implementing near-term solutions, The Commonwealth Fund and the Meadows Institute have begun focusing on existing authorities that have not yet been applied to the behavioral health sphere.
The Commonwealth Fund is a private U.S. foundation dedicated to promoting a high-performing healthcare system that can provide society's most vulnerable, including low-income people, the uninsured, and people of color, with better access to care. In 2021, The Commonwealth Fund launched their focus on behavioral health and dedicated efforts towards helping policymakers on federal and state levels. The fund was able to track trends in mental health care demand and compared state to state and the US to other countries to isolate which populations are most underserved and why. They found that youth populations of color were most at risk for mental health professional shortages and began analyzing how they could target this population. One of the main factors that prevent patients from connecting with service providers, in addition to the workforce shortage, is that Medicaid is not accepted by many care providers, which only further isolates disadvantaged populations.
The Meadows Institute works to utilize public and private partnerships to advance innovative funding models for mental health care and services. As digital mental health technology is not FDA regulated, both clinicians and consumers struggle to determine which tools are safe and effective. Additionally, unregulated providers have no incentive to protect the privacy of their patients, and their data security is unmonitored. Once a consumer has identified a digital mental health tool (DMHT) they would like to use, there are a myriad of complications with insurance. As DMHTs are both a service and a device, which are usually disparate categories for insurance purposes, it is difficult to quickly and easily reimburse consumers. Additionally, DMHTs are constantly updated, but the research that reviews these technologies is much slower and struggles to effectively ensure that all information is accurate for insurance claims. These difficulties are particularly complicated for Medicaid at the state and federal levels. All of these barriers discourage providers from exploring options with tools and technologies that may never get approved; meanwhile, the population of Americans without mental health care only grows.
However, there are many opportunities for near-term solutions. The creation of clear definitions and standards can go a long way in ensuring that consumers have safe and effective care that does not put their privacy or data at risk. With regard to reimbursement, clinicians and staff should be paid for their time spent using an online resource and the time taken to educate patients on it. Providers can explore enhanced payment possibilities, such as increasing the rate for the same service, as DMHTs are part of supplies and should be factored into the calculation of cost. Underlying all of these solutions is the need to target vulnerable populations when crafting policies to ensure these solutions are aiding all people seeking care.
Medicaid programs can encourage the adoption of DMHTs and universal screenings, as well as focus on youth mental health, by making it a part of the request for proposal process with managed care organizations (MCOs). Looking towards exemplary states, such as Louisiana and Washington, to model evidence coverage determination processes can aid Medicaid providers in the process. Medicaid MCOs could also incorporate DMHTs into their own request for proposal processes by offering it under “value-added services.” There are many short-term proposals that can help mitigate the effects of the mental health professional shortage while longer-term legislative processes work towards fixing the core issues that resulted in this crisis.
Just because digital mental health tools are new and ever-changing does not mean we should not incorporate them into our notions of what constitutes behavioral health care. These tools can streamline the lives of many providers and patients as they overcome many of the traditional barriers to providing care and can address the need for 8,000 additional mental health professionals.
To download the full report, please visit Meadows Mental Health Policy Institute’s website here.