There are more mental health and substance use point solutions than ever, so how are health plans, employers, and, most importantly, patients to know which solution they should use to forge a path to meaningful behavioral health outcomes? We brought together health plans, providers, investors, and more at HLTH 2023 to learn how the healthcare ecosystem can better bridge the supply-demand conundrum in behavioral health while prioritizing affordability, access, and seamless patient experiences.
Deb Adler, CEO at Navigator Healthcare Inc., discussed what employers and health plans are doing to address addiction in the workplace with Salma Sparklin, MPH, Business Strategy and Transformation Manager at CareFirst BlueCross BlueShield, Dr. Stuart Lustig, MD, MPH, National Medical Executive for Provider Partnerships at Evernorth Behavioral Health, and Manny Arisso, Chief Network Officer and President of the Employer Division at Carelon Behavioral Health. This was the only panel at HLTH that revolved around substance abuse this year.
Read highlights from their conversation below. The following has been edited for length and clarity.
There are a lot of reasons somebody might not be able to complete treatment and stay in treatment—and though cost is not the only barrier to care, it's a major one. CareFirst BlueCross BlueShield's program is the gold standard for intensive outpatient care for substance use disorders. There may be a financial barrier to that care for some of our members, so we created a cost-sharing waiver that goes with the program. For members who have plans that are eligible for this, if they start their care for substance use disorder at the IOP level, their outpatient costs are waived. It's helped keep members in that level of care. Even though intensive outpatient care is a huge time commitment, they can still remain within their work and home environments, allowing them to marry what they're learning in treatment with their actual life and sustain what they got from the program.
People are more aware of substance use disorder and opiate use disorder now, but people are still resistant to entering care. Yet demand for care has gone up, as there are more people who need care. When we partner with employers, we first help them come to the realization that you can't treat every employee the same way. It's about helping them understand their benefits and creating pathways for employees to get into clinical care. Getting people into care early is especially important, so we use predictive models to help with early identification. Our models use not just healthcare data but also zip codes and social drivers of health – as we know different areas and communities have varying prevalences of substance use disorder. Using data this way allows us to be proactive and work with partners to address gaps in care.
You have to meet people where they're at, and you especially have to meet kids where they're at. You need to be there when people with substance use disorders call in or when they call in for someone else – their kids, spouse, or friend. We're there for our clients (small and large employers) 24/7, 365 days. We have to be willing to talk to people anytime – day, night, Christmas Day, whatever it is. We see that as our opportunity to help people get the proper care. When dealing with something as complicated as behavioral health and dealing with something as terrifying as substance use, you absolutely need to be there the moment they need you, whether digitally or in person.
We always try to create and maintain an ecosystem of care around the person needing support. In some cases, we’ll have an employee side by side with their employer and a behavioral health clinician who has expertise in substance use disorder. The clinician is equipped to have a conversation with both of them to understand what's happening, ask the right questions so they get the information they need, and respond with empathy and compassion and without judgment. Once they understand what's happening, the employer and employee can discuss their care options, benefits, any barriers to care, and whether virtual or in-person care is most appropriate for them based on the employee’s clinical acuity or where they are on the recovery journey. The clinician can also help find specific providers and make an appointment, helping ensure the employee shows up for it.
It's a collaborative effort. PCPs are often the front door for a lot of people with substance use disorder, but they should certainly have adequate support and backup as well. The silver lining in the pandemic is that about 50% of our patients are getting here virtually—before, it was about 1.5%, so this is a massive shift. In my 20 years as a psychiatrist and thinking about some of the advancements we've seen, this is big. Because people are coming in virtually, they are more likely to get in treatment earlier and are more likely to stay in treatment. These are all good shifts that we're seeing, and more good things are to come – but we still have a lot of work to do.
We’re developing strategic alliances that focus on early engagement. There’s an opportunity to make things easier, right? People don't know where to go or what to do for substance abuse disorder, so how do we make it simple from a navigation perspective? In our case, we work with partners like yourself, Navigator Healthcare, and with unique providers specializing in substance abuse disorder treatment so that the pathway to care for members is easy, seamless, and effective.
The Behavioral Health Tech Conference in November will continue to shine a light on ideas and solutions that improve access to mental and behavioral health care, pulling in perspectives from health plans, employers, behavioral health providers, digital health companies, investors, policymakers, and more so that we can continue making progress for people in need of care.
We’re looking forward to more discussions like this one, and we hope you’ll join us either in person or online. Register today!