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Technology can scale to offer Medicare Advantage plans the support they need in integrating behavioral and physical care management for their large member populations. Dr. Tom Zaubler, MD, MPH, Chief Medical Officer at NeuroFlow shares more.

If providers agree that integrating physical and behavioral health delivers better outcomes, why isn’t every health plan doing so? One of the main reasons is: Their resources are stretched too thin. Suppose care managers had the resources to screen at-risk members and improve care coordination. In that case, they could more effectively guide members to appropriate resources, help identify co-morbid conditions sooner, and preempt emergency room visits.

Fortunately, technology can help with this. Technology can scale to offer care managers support for a larger member population and provide the insights Medicare Advantage plans need to identify risks and prevent behavioral health crises. Dr. Tom Zaubler, MD, MPH, Chief Medical Officer at NeuroFlow, shares more about the challenges faced by Medicare Advantage plans and how technology can help integrate behavioral and physical care management.

What barriers have prevented Medicare Advantage plans from delivering on promises of better clinical and business outcomes?

Many Medicare Advantage plans fail to deliver on improved outcomes due to their outdated and siloed approach to care. Providers agree that integrated care, assessing and treating physical and behavioral health together, delivers better outcomes, but many plans are still managing their members’ health needs separately. Many members with chronic conditions have underlying behavioral health needs that can prevent or hinder recovery. In fact, over one-third of individuals with chronic conditions also struggle with behavioral health conditions. Managing these health needs separately is not only inefficient; it’s ineffective.

Care management is also reactive. Many Medicare Advantage plans provide care management to their members based primarily on claims data. That means members have already submitted a claim for an emergency room visit, for example, before they receive support from their Medicare Advantage plan. A preventative approach can lower utilization, helping plans meet their cost savings goals and improve clinical outcomes. Preventative measures like regular behavioral health screening and providing access to relevant behavioral health resources are critical components of this effort.

Medicare Advantage plans have another unique challenge that calls for urgent preventative measures. Older populations are at a higher risk for suicide than many age groups. In fact, men over 65 years old face the highest overall rate of suicide. It’s especially important in these instances to manage physical and behavioral health needs together and proactively screen populations to mitigate behavioral health crises.

How can integrating physical and behavioral health help Medicare Advantage plans overcome these issues?

Delivering improved outcomes and lowered costs isn’t achievable if physical and behavioral health aren’t managed in tandem. For example, someone with diabetes is two to three times more likely to have depression than someone without diabetes, according to the CDC. Depression can lead to unhealthy habits like not checking blood sugar or skipping critical doctor’s appointments. It’s clear that overlooking the underlying behavioral health needs of a diabetes patient prevents physical recovery.

If care managers can integrate the physical and behavioral health data of their members into a single view, they can more effectively guide those members to appropriate benefits and resources that can support their recovery. Screening Medicare Advantage populations more regularly can also help identify co-morbid conditions sooner and preempt an emergency room visit or suicide attempt.

How can technology enable care management integration at scale?

One of the main reasons care managers aren’t proactively screening at-risk members or improving coordination across physical and behavioral health care management is that their resources are stretched thin. Calling large volumes of Medicare Advantage members simply isn’t feasible, and many care management platforms don’t connect physical and behavioral health data. Technology can offer the scale care managers need to support a larger member population, prioritize outreach to their highest-risk members, and unify physical and behavioral health data.

For example, NeuroFlow screens members enrolled on its platform at a regular, monthly cadence. The digital engagement platform delivers clinically-validated assessments to screen for depression, anxiety, substance use disorder, and more. AI technology analyzes these assessments, along with other user signals, to inform a proprietary Severity Score. Depending on the severity of an individual’s behavioral health needs, NeuroFlow will either direct that person to relevant self-care resources or flag the member as at-risk to their care manager, prompting further outreach. Connecting members to self-care resources or care management can have major upstream impacts on clinical outcomes and costs of care.

Technology infrastructure can streamline integration by making it easier to identify and manage co-occuring conditions and enhance efficiency. To make a meaningful impact on clinical and business outcomes, care managers need a comprehensive and proactive approach to member wellness. Rather than waiting for worsening symptoms or for members to seek help, technology can provide the insight Medicare Advantage plans need to identify risk and prevent behavioral health crises.

To learn more about how technology can improve and scale integrated care management, visit NeuroFlow.

Dr. Tom Zaubler MD, MPH is the Chief Medical Officer at NeuroFlow, the leading SaaS solution for integrated behavioral health. He is also the Founder & Medical Director, Pegasus Psychiatry Associates. Prior to joining NeuroFlow, he was the Chair and Medical Director of the Department of Psychiatry at Morristown Medical Center for 21 years.