Over the past few years we have seen a tremendous increase in the amount of investment (both private and government-funded) in behavioral health solutions and services. Yet, despite all this investment, the mental health crisis continues. Gaining access to quality mental healthcare is still extremely difficult for many in the U.S. and we haven’t made a significant impact in addressing members’ mental health needs.
We believe that a big part of the problem we are facing in the U.S. is that the behavioral health ecosystem is out of alignment.
There are two sides to the behavioral health ecosystem: Demand, driven by patients’ need for mental health care, and supply, which refers to available, accessible delivery of care. To be in equilibrium, demand and supply need to be in balance and the flow between supply and demand needs to be frictionless, unhindered and efficient. This is not happening in behavioral health. Demand is increasing at an unprecedented rate. Despite the explosion of behavioral health startups and point solutions, supply remains fragmented and dispersed. The systems don’t exist to seamlessly coordinate, at a macro level, the influx of members’ needs with the output of care.
The departments at health plans responsible for managing member behavioral health needs have limited real-time visibility into their provider networks to ensure adequate access. As a result of relying on lagging data, they don’t have the ability to effectively connect members to care. Instead, the onus is often on the member to identify their mental health needs, look up a list of covered providers and resources, then cold-call providers to find an available appointment. Members often must figure out for themselves if they need medication, therapy or some other approach; digital or in-person treatment; a young male or an older female provider. Even where health plans have expanded their solution set, members are not connecting the dots between these point solutions, and struggle to find the right provider or solution to treat their needs in a timely fashion.
The lack of alignment across BH member demand and provider supply is compromising our ability to get out of the crisis phase in mental health. Members either don’t get treatment, or they pick the first treatment available rather than the right treatment that will appropriately address their concerns. Not having the right treatment can exacerbate symptoms and cause loss of functioning. Members then need to restart their search for care, delaying health resolution and driving up cost. Providers, in turn, are frustrated and dissatisfied, because they’re not proactively managing their patient pool to drive positive outcomes. The quality of care and outcomes go down, and the upward ripple effect on the total cost of healthcare continues.
Health plans need a central ‘switchboard’ that aligns supply with demand and optimizes the flow of care. Optimization means making effective use of a situation or resource. In behavioral health, it means that members have the most direct path to finding the right treatment for their needs, when they need it. It means that providers are managing the profile and number of patients they treat, leading to a higher likelihood of positive outcomes and immediate visibility into those outcomes.
People with deep domain expertise who can screen and triage members, personally navigate them to the right care, and provide the necessary case management and ongoing support.
Technology with real-time operational capabilities in pooling across all types of providers (independent, small group, large group, aggregator, point solution and specialty) to centrally manage appointment scheduling, outcomes measurement and care management.
Real-Time Insights to understand the interplay across demand and supply for better matching of members to care, capacity planning and network management.
Health plans can clinically assess all members needing BH care–from the mildest to the most complex–and direct them to care quickly. Some point solutions or provider networks do this, but there’s no consolidated ‘front door’ for all health plan members.
Plans can match and connect members to the most clinically appropriate and immediately available treatment solutions based on their level of acuity and clinical profile. With consolidated visibility into overall provider capacity and provider-level appointment availability, they can directly schedule appointments in pockets of time when providers are available.
Using standardized measurement-based care tools, the patient profile, provider profile and outcomes data, health plans can fine-tune assessment, triaging and matching of members to care. They have real-time insight into macro demand and supply trends, which they can use to dynamically expand or contract their provider networks to be responsive to member needs.
Lucet is building an optimization infrastructure to align the flow of behavioral health services across health plans and provider networks, and allow for timely access to high-quality, value-driven mental healthcare for all who need it. In our work supporting health plans’ efforts to optimize their behavioral health systems, we’ve uncovered 44% additional provider capacity without adding a single additional provider and connected 55% more people to care. By improving the connection to behavioral healthcare, we’ve saved a prominent health plan client over $90 per member per month (PMPM) in total cost of care for each connected member, with savings sustained over three years. For each person in care, we’ve improved their mental health scores by 40%. Plus, we’ve connected members to their first therapy appointments in an average of five days, and as little as one day, using our scheduling platform.
Most health plans’ behavioral health systems are running inefficiently. By simply aligning and coordinating the way member demand and provider supply work together, health plans can unlock significant levels of potential value waiting to be utilized. Find out what that opportunity and value is in your health plan. To learn more, contact us here.
Article written by Sarah Reilly, SVP of Product, Strategy & Innovation of Lucet.