New approaches are required to improve outcomes, access, and financial sustainability amid record rates of depression, suicide, PTSD, and mental illness
More than two dozen health systems met this week to launch a new effort to transform the country’s behavioral health resources – particularly in underserved communities. Beginning in 2019, the health systems will adopt and drive the widespread use of new solutions targeted at a spectrum of dire concerns, including untreated depression, teen suicide, and post-traumatic stress disorder (PTSD). The work is part of a national initiative announced last year called the Medicaid Transformation Project, a collaborative effort to transform healthcare and related social needs for the nearly 75 million Americans who rely on Medicaid.
Communities face an expanding crisis:
- 44.7 million American adults – including 10 million adults covered by Medicaid – experienced a mental health illness as of 2016, a number that is likely underestimated due to issues of stigma1
- Approximately 35 percent of adults with a serious mental illness are not receiving mental health treatment2
- More than 25 percent of teens are impacted by at least mild symptoms of depression.3 Untreated depression puts teens at a higher risk to die from suicide, misuse drugs or alcohol, do poorly in school, or run away
- Beyond issues of care, there are challenges of cost: serious mental illness leads to $193 billion in lost earnings in the United States annually and spending on Medicaid beneficiaries with mental health needs is nearly four times greater than for peer beneficiaries4
To improve behavioral health access and outcomes – and to manage financial impact – health systems must now assess and build comprehensive behavioral health strategies that incorporate innovative digital tools and clinical best practices. Doing so creates tighter links between patients, providers, and community organizations and enables faster, more informed care decisions. The Medicaid Transformation Project’s Behavioral Health Initiative propels this work forward, as 28 participating health systems evaluate and implement solutions that dramatically improve areas like crisis intervention, school-based health services, and care management.
"As jarring as the national behavioral health statistics are, they only serve as the tip of the iceberg for the long-term consequences that we risk if we don’t take wide-reaching, decisive action to address this crisis today,” says Andy Slavitt, Chair for the Medicaid Transformation Project, former Acting Administrator of CMS, and general partner at Town Hall Ventures. “Twenty-eight healthcare organizations have stepped up to proclaim with a singular, unmistakable voice that enough is enough. Within the next year, I expect dozens of new positive initiatives to launch. Within five to seven years, we could spark the transformation the country needs.”
Recent policy changes also point to this being the moment for bold action. With expanded incentives for behavioral health integration, new collaborative care, and solutions focused on addictions, policy tailwinds offer an additional springboard for health systems looking to take on mental health challenges. Leading national policy experts Vikki Wachino, former head of the Center for Medicaid and CHIP Services at CMS, and Molly Coye, former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, as well as Slavitt, are directly involved in shaping this initiative and guiding its efforts.
Launching the initiative with action
The Project’s Behavioral Health Initiative kicked off on April 23 with an Action Forum that included many of the nation’s most innovative health systems. Co-hosted by Project Member Baylor Scott & White, the launch signifies the start of a multi-month sprint for participating health systems to identify, select, implement, and scale solutions that create meaningful improvement for the people most affected by the behavioral health crisis.
At the Behavioral Health Action Forum, more than 100 leaders from each of the participating 28 health systems took steps toward expanding the capabilities necessary to build a comprehensive behavioral health strategy and address some of the most common questions that persist in behavioral health:
- How do you provide the ability to conduct depression and anxiety screenings at more sites of care, including primary care settings?
- How can you use available data to identify high-risk patients more quickly and effectively, enabling you to intervene with the right care at the right time?
- How do you help patients and providers understand the specific type of behavioral healthcare required by specific patients … as well as where and how patients can receive it?
The Project has analyzed more than 150 digital innovations in behavioral healthcare to create a shortlist of 11 solutions and current best practices that were demonstrated at the Action Forum. The Project’s rigorous solution selection methodology and guidance enables health systems to tailor decisions to their individual organizations’ needs, accelerate their decision making, and ultimately achieve enduring impact for patients.
Building on success in community-based care innovation
The Project was launched in summer 2018 by AVIA and Andy Slavitt to move the needle on health outcomes for vulnerable populations – while also reducing costs – through the adoption of digitally enabled care models. The Project has already realized early success in creating a national mandate for change and action:
- Since the Project was announced, 11 additional health systems have signed on to solve the most pressing issues facing Medicaid populations and those that care for them
- In just five months, participating health systems accelerated the development of 35 unique capabilities that will enhance community care and reduce unnecessary emergency department visits
- This points directly to the Project’s ultimate goal of catalyzing action that turns ideas into reality. Adoptions are underway, with more results to be included in a year-end annual report
Following the Behavioral Health Action Forum, participating health systems will proceed with further evaluation, selection, contracting, and implementation of specific solutions. Thereafter, the Project will initiate its next phase focused on maternal and infant care, followed by substance and opioid use. The Project expects to see the following over the next three years:
- Broad adoption and solution uptake
- Scaling, measurement, and solution optimization
- Sharing of best practices to inspire further action
“The response we’ve seen from not only providers, but also payors and other interconnected entities since launching the Medicaid Transformation Project only a few months ago has been tremendous,” said Linda Finkel, President of AVIA. “Healthcare is something that touches every single person in this country, but access and quality of care have not been equitable, historically. It’s inspiring to see so many diverse health systems collaborate in earnest to provide better care at lower costs, and we truly believe that this unique approach will be the catalyst that will make measurable transformation a reality – it’s already working.”
About the Medicaid Transformation Project
The Medicaid Transformation Project is a national effort to transform healthcare and address related social needs for the most vulnerable. Health systems will implement innovative solutions that address challenges like behavioral health and substance use disorder. This will create long-term systemic impact with the goal of improving the health of 75 million Americans.
AVIA leads a network of health systems working together to innovate and transform. AVIA Innovator Network Members solve pressing challenges with digital solutions that deliver financial and clinical results. AVIA provides strategic focus and a collaborative approach to accelerate innovation. Learn more at aviahealthinnovation.com. Follow us on LinkedIn and Twitter.
1 Ahrnsbrak R. et al. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2017. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm (accessed October 2017).
2 Kaiser Family Foundation analysis of data from SAMHSA 2015 NSDUH (Accessed on July 27, 2017) Get the data PNG
3 Any Disorder Among Children. In National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml (accessed September 2016).
4 Mental Health in America. In https://www.nami.org/learn-more/mental-health-by-the-numbers; National Alliance on Mental Health: Medicaid and Mental Health. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Public-Policy/National-Policy-Priorities/Medicaid-and-Mental-Health; Medicaid’s Role in Behavioral Health. (2017, May 8). Retrieved from https://www.kff.org/infographic/medicaids-role-in-behavioral-health/