Demand for behavioral healthcare services has skyrocketed, reflecting a growing recognition of the importance of mental health. However, access to these essential services remains a challenge. 

Behavioral health conditions affect people of all ages: About one in five people over age 65 lives with a mental health condition such as depression, anxiety, dementia, schizophrenia, and bipolar disorder, and about eight percent of people with Medicare younger than 65, and 2 percent of those 65 and older, have a substance use disorder.

4 Challenges to Accessing Services

Medicare Advantage (MA) and Medicaid health plans often struggle to provide adequate coverage due to complex network requirements, a shortage of qualified providers, and logistical barriers. 

A renewed commitment from CMS to improve access to behavioral health services begins to address some of these issues. These include:

  1. Provider shortage and distribution: One of the primary barriers is the shortage of mental health counselors, addiction medicine specialists, marriage and family therapists, and other behavioral health providers. Many regions, particularly rural areas, face severe provider shortages, making it difficult for people to receive timely care. CMS is allowing more providers to serve under the Outpatient Behavioral Health umbrella which is estimated to make 400,000 mental health providers available to Medicare patients.
  2. Complex network adequacy requirements: Through the Innovation in the Behavioral Health model, CMS has introduced new network adequacy standards to ensure MA enrollees have access to the services they need. These standards require health plans to independently verify provider qualifications and ensure providers meet specific criteria. While these updates aim to improve access, they also add layers of complexity to network management.
  3. Coordination of care: Behavioral health often requires coordination across various types of providers, including outpatient facilities, community mental health centers, and hospitals. Coordinating care can be challenging, potentially leading to fragmented care and poor outcomes.
  4. Telehealth integration: Although telehealth offers a promising solution to improve access, integrating telehealth services into existing networks and ensuring they meet CMS standards can be difficult. For example, health plans must navigate regulatory requirements and ensure telehealth providers are adequately credentialed.

Using Technology to Improve the Process

The right care coordination and network management tools can improve access to behavioral healthcare services. 

…Quickly getting your members the services they need leads to improved outcomes, reduced costs, and a stronger, more compliant network.

“Investing in the right solutions can help you engage a complex set of providers to quickly get your members the services they need,” said Travis Woyner, Dina’s senior vice president of product strategy. “For health plans, this leads to improved member outcomes, reduced costs, and a stronger, more compliant network.”

Here’s what to look for:

  1. Streamlined provider network management: Simplify the process of managing provider networks by using tools that automate the verification and credentialing of providers. This reduces administrative burden and ensures compliance.
  2. Enhanced provider directory and referral systems: An up-to-date directory of qualified providers lets health plans efficiently match patients with appropriate services. Advanced referral systems ensure patients are directed to the right providers, improving access and reducing wait times.
  3. Integrated telehealth solutions: Incorporating telehealth providers into the network is an effective way to expand access to behavioral health services, especially in rural and other underserved areas.
  4. Data-driven care coordination: Leverage data to facilitate care coordination across various providers, manage care plans, and ensure continuity of care.

“Investing in the right care coordination and network management tools can improve access to care, reduce administrative spend, and improve the member experience by getting your people the vital services they need when they need it,” said Woyner. 

Members Expect Quick Activation of Behavioral Health Services. Does Your Plan Deliver?

In under 2 minutes, we’ll show you how easy it is to coordinate behavioral health and home-centered benefits to your members and quickly measure results.

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