With COVID-19 cases rising, health plan members are facing new stressors. Such challenges are exacerbating existing health issues—and in some cases, triggering new ones. Health insurance providers must prepare for an increase in mental health and substance use disorder needs and guide members to necessary behavioral health support.
Easier said than done. Although an integrated physical-behavioral health structure has long been the ideal model for cost-effective, holistic care, in practice many plans operate more in parallel than as interwoven teams—a legacy of an industry shift toward specialization that came at the cost of holistic care approaches.
To serve our members amid the pandemic and beyond, we need pathways that reconnect the head and body.
Our Integration Story: True Health New Mexico
At True Health New Mexico, a physician-led health insurance provider, mental health has always been a high priority: New Mexico has a suicide rate 59% higher than the U.S. average and has ranked among the bottom three states for alcohol-related deaths since 1981.
Working with Evolent Health, we established four integrated care approaches: remove barriers, leverage a fully integrated medical management team, implement comprehensive and holistic assessments, and partner with community behavioral health (BH) providers.
To realize this path, we made several changes, including:
- Benefit design: We implemented free BH generic medications, primary care provider visits and outpatient BH visits.
- Care management staffing: We ensured that 75% of case management staff had prior experience in a BH clinical setting and that 100% of medical management staff had worked with members affected by BH issues.
- BH provider network: We formed an alliance with the largest BH provider independent physician association (IPA) and held regular planning meetings with behavioral IPA business and clinical leaders.
- Comprehensive assessments: We included evaluations for depression, anxiety, and substance abuse in all health assessments.
Our performance metrics point to the value of this approach. For example, we increased antidepressant medication adherence to 79% for acute-phase treatment, compared to the national average of 67%. We also credit BH integration in part for our low emergency department visits among members—34% less than the national average.
Breaking Down Industry-Built Silos
The challenge of reconnecting mental and physical health is an industry-wide problem because it was borne out of the trend toward specialization. Clinical care advanced at the specialty level, yet it became more difficult for physicians to spot and address BH conditions. Mental health carve-outs of the 1970s exacerbated the issue.
Preserving necessary specialization while integrating begins with addressing the structures that created these silos. At True Health New Mexico, we found that integrated clinical teams ensure that treatment approaches address the whole patient, foster collaboration, improve efficiency, reduce administrative burden, and increase treatment adherence.
The benefits of turning away from an increasingly disjointed path cannot be understated. Early and highly integrated intervention can positively disrupt disease courses that would otherwise become worse with unmanaged BH conditions, saving considerable long-term physical and monetary costs.