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| December 12, 2019
In recent decades, the stigma around behavioral health issues like depression, anxiety, and substance use has markedly decreased. Today, 76% of Americans believe mental health is just as important as physical health, and 56% are seeking or want to seek mental health services either for themselves or for a loved one, according to a report by the Cohen Veterans Network. That’s the good news. The bad news is that there are still significant barriers to getting quality mental health care. Supply and demand is a growing issue, especially for children, teens, and low-income populations. Cost and inconvenience also keep people from getting the services they need.
Tufts Health Plan is working to expand behavioral health care choice and access by seeking out new and innovative approaches, collaborating closely with providers, and adopting practices and principles designed to improve outcomes. “Behavioral health is an area of focus for the entire organization,” says Emily Bailey, LICSW, vice president for behavioral health at Tufts Health Plan. “There are steps being taken to help ensure that we are staying at the top of the curve in our behavioral health, not only through our offerings, but our thinking, our innovation, and our understanding of what’s happening in the market.”
How technology is driving innovation in behavioral health care
Nearly half of American adults have had to travel more than an hour roundtrip to get to their most recent mental health care appointment or know someone who has. For people in remote areas or without easy access to transportation, or whose schedules prevent them from getting care during business hours, access is a significant obstacle to care. Others may be hesitant to seek care in the same communities where they live and work.
Thanks to technology, however, alternative options are becoming available. “There’s been a big increase in HIPAA-compliant technologies and providers in the marketplace who have been able to offer alternative modalities,” Bailey says. “We’re continuously looking at and evaluating how we can leverage those new emerging technologies to support access and choice.”
One of those technologies, which many health plans, including Tufts Health Plan, offer to their members, is telehealth. Telehealth allows patients to “meet” with behavioral health care providers via a video call on their mobile device or computer, making it an appealing choice for people who can’t easily get to a provider’s office, or who want greater privacy. Since providers and patients don’t have to be in the same geographic area, and because there’s greater flexibility in scheduling, telehealth is also a solution to the supply and demand issue.
Another innovation showing promise is Digital Cognitive Behavioral Therapy, or DCBT—online and app-based programs that incorporate proven behavioral techniques to help users address issues like anxiety, phobias, insomnia, and substance use disorder. Like traditional cognitive behavioral therapy, DCBT focuses on helping users develop skills and find new ways to behave by changing their thought patterns. DCBT programs can be done on their own or in combination with therapy and/or medication, and include elements such as educational modules, exercises, day-by-day coaching, and behavior and mood tracking. Some programs also incorporate live messaging with behavioral health professionals.
Pursuing evidence-based approaches in substance use disorder treatment
One of the most pressing behavioral health needs today is substance use disorder treatment. More than 21 million Americans suffer from a substance use disorder, and overdose has now surpassed car accidents as the number one cause of accidental death in the U.S. The current opioid epidemic has generated an urgent demand for treatment, but care remains out of reach for many people due to cost or availability. The quality and efficacy of available treatment, meanwhile, varies widely, with many treatment programs using outdated, non-evidence-based approaches.
Tufts Health Plan recently joined a national movement, spearheaded by the nonprofit Shatterproof, to adopt the 8 National Principles of Care for the treatment of addiction, which are expected to improve results and save lives. These principles, derived from the Surgeon General’s Report on Alcohol, Drugs and Health and backed by three decades of research, include universal screening for substance use disorders across medical care settings; personalized diagnosis, assessment, and treatment planning; and rapid access to appropriate substance use disorder care.
Expanding choice and access also requires rigorously evaluating new, evidence-based treatment approaches. These include in-home treatment, where patients receive medical care and monitored support in their home; ambulatory detox, an outpatient model for detoxification from drugs or alcohol; and recovery support programs, which keep patients engaged in the recovery process through groups and/or one-on-one relationships with peer leaders who have direct experience with addiction and recovery. Recovery support programs have been shown to be effective with other mental health issues as well.
The benefits of a focused, integrated approach
Behavioral health is increasingly viewed as an integral part of people’s overall wellness, both within the medical and behavioral health professions and within our society at large. That view is part of the fabric of Tufts Health Plan: Unlike many health plans, Tufts has an internal behavioral health department rather than an outside vendor. Their medical care managers sit side by side—literally, in some cases—with behavioral health care managers, and regularly screen members for anxiety, depression, and other behavioral health issues.
“There’s a significant benefit in having all services delivered out of the four walls of a health plan,” says Bailey. “We have a network relationship with the whole spectrum of providers. We’re asking our PCPs, nurses, behavioral health providers, and other clinicians to look at chronic and co-occurring conditions, and to have more of a holistic approach to treating members.” Moreover, having in-house behavioral health and pharmacy departments enables Tufts Health Plan to utilize data across behavioral health treatment, physical health treatment, pharmacy, and any ancillary treatment, and use it to identify members with various risk factors so they can intervene appropriately.
Tufts Health Plan is also proactive in helping members access the behavioral health services they need. Making information readily available for all members, including those on public and senior product plans, is just the beginning. With their deep, broad contracted network of facilities, programs, and practitioners, they’re able to do targeted outreach to providers when there are gaps in coverage and identify providers that might be able to offer new programs or treatments. Currently, Tufts Health Plan is working with the provider community to think creatively around how to increase the capacity for psychiatric prescribing, especially for children and teens. They’re also offering support to providers interested in delivering suboxone treatment for opioid dependency and providing education and training around suboxone management.
Everyone deserves access to high quality behavioral health and substance use disorder care that fits their unique needs and circumstances. By embracing innovative, evidence-based modalities, working closely with our provider network, and taking a holistic approach to physical, mental, and emotional health, we believe we can make it possible for more of our members.