Searching for Momentum in Behavioral Healthcare

By Jake Moy, Kellogg School of Management ‘22

There’s no shortage of complex challenges in healthcare, although the U.S.’ behavioral health crisis might just be one of the toughest, most urgent to address.

Well before the COVID-19 pandemic, long-standing challenges such as inadequate reimbursement, inconsistent coverage, related provider shortages, and difficulties in measurement have resulted in steep barriers to access, quality, and affordability in behavioral health services. These challenges come at tremendous cost, both for people and families experiencing mental illness, as well as the broader healthcare system and social safety net. Recent estimates indicate annual spending on behavioral health conditions surpasses $200 billion, exceeding that of any other health condition in the U.S.[1]

As we enter 2021, this existing infrastructure is being further stretched: our nation’s opioid epidemic continues to accelerate, suicide rates are rising, and COVID-19 has increased levels of loneliness and anxiety.[2] Lack of care and rising mental health needs are particularly high among youth and adolescents. Recent data indicate that 60% of youth with major depression do not receive any mental health treatment.[3]

In focusing on this year’s conference theme--“What now?”--it’s worth considering where there has been positive momentum during this time of disruption and how to sustain it. While there is clearly no silver-bullet solution, opportunities have emerged and evolved that could nonetheless help drive positive impact:

Expansion of Technology-Enabled Behavioral Healthcare

2020 saw an unprecedented increase in funding and development of digital behavioral health tools.[4] Adoption has further accelerated, as patients and providers alike have had to shift from in-person to virtual care settings for services like psychotherapy.

 Cognitive Behavioral Therapy (CBT)-based web tools--often consisting of video and audio visits with asynchronous messaging--have shown early promise improving anxiety, depression, and insomnia, providing a remote-based alternative to traditionally in-person therapy.[5] Non-clinician based tools (e.g. text-bots) represent additional mechanisms to further expand care for those with less severe conditions. Companies like Pear Therapeutics are also demonstrating the use case for technology-enabled approaches in treating substance use disorder (SUD), offering “prescription digital therapeutics” that pair software-based CBT tools with medication-assisted treatment (although access to the latter also remains a challenge, particularly for low-income communities and communities of color).[6]

Digital health offerings are by no-means a cure-all and, in more severe cases, may not be appropriate. They may not effectively reach those without a formal entry into the healthcare system, namely the uninsured, nor do they address the highly-fragmented funding, reimbursement, and coverage landscape that has contributed to provider and facility shortages.[7]

However, the continued improvement and adoption of technology-enabled behavioral healthcare does present an opportunity to provide more personal, continuous (rather than episodic) care, lower some of the barriers to seeking treatment, and improve access for groups where provider shortages exist.

Growth of Preventive & Integrated Care Models

Primary-care focused organizations like Oak Street Health, Cityblock, and Iora Health garnered increased attention and funding in 2020 and have shown relative success, despite the need to adapt parts of their care model amidst the changing COVID-19 landscape. These organizations are showing how a heavy focus on primary and preventive care--and, importantly, intentional integration of behavioral health services--can drive better outcomes for the aging and for low-income patients with complex needs.

These organizations’ promising success integrating behavioral health into a whole-person care approach underscores a broader opportunity to adopt and expand more integrated care. Team-based, collaborative care models that integrate mental health and SUD services into primary, secondary, and acute care can increase early screening and detection of behavioral health conditions, as well as provide more effective, “stepped” interventions, where a majority of patients are treated in lower-acuity settings while those with complex needs are connected to more specialized care.[8]

Opportunity exists to continue recent momentum in adopting and evaluating integrated care models and in expanding early screening efforts.

Advances in AI, Data Science, and & Evidence Generation

Artificial intelligence (AI) continues to generate tremendous buzz in healthcare, given its powerful potential to improve diagnoses and patient outcomes across a variety of settings. Applications in mental health are similarly promising, where experts are exploring how deep learning and natural language processing might help identify early indicators of behavioral health conditions like depression.[9] As we look to 2021, recent studies that collect real world data, like Verily’s Project Baseline Mood Study, may represent the start of a new wave of virtual clinical trials and research efforts to understand early indicators of behavioral health conditions and, ultimately, deliver more tailored treatment plans.

Furthermore, the continued extension of data science and technology into behavioral health represents a promising opportunity for advancing continuous learning and improvement. Verily-funded OneFifteen, for example, is testing how data science and leading technology infrastructure can support a comprehensive recovery ecosystem for individuals with SUD, one that not only treats patients’ day-to-day needs but also continually generates insights that help identify optimal treatment pathways and service adjustments to promote sustained recovery. Such efforts could meaningfully shorten and improve the performance feedback loop for behavioral health and SUD services.

In closing, there is no one-size-fits all approach to tackling the current behavioral health crisis. Different groups face different challenges and much of the current crisis is years in the making. Policy, technology, the medical community, and local leaders each have a role to play if we are to successfully stem the rising challenge. In this context, areas of promise and momentum are limited, but they do exist. Expanding on these opportunities is a must as healthcare leaders, policymakers, and communities hopefully take broader steps towards more systematic reform.

ABOUT THE AUTHOR

Jake Moy: Jake Moy is a first-year 2Y MBA. At Kellogg, Jake serves as a board member of a local nonprofit and first-year director of The Good Life, a Kellogg initiative committed to helping students live an intentional, values-based life. He is passionate about driving measurable improvements in people’s health and wellbeing.Prior to Kellogg, Jake worked as a Manager at Third Sector, a social impact consulting firm that works with governments, providers, and their communities to maximize the impact of publicly-funded social programs. In this role, Jake worked directly with state and county behavioral health, human services, workforce, and housing agencies to design outcomes-based contracts and performance management practices that encourage continuous learning. Jake graduated magna cum laude from Georgetown University and is a proud native of Buffalo, NY.

[1] https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1659

[2] https://emergency.cdc.gov/han/2020/han00438.asp

[3] https://mhanational.org/issues/state-mental-health-america

[4] https://rockhealth.com/reports/2020-market-insights-report-chasing-a-new-equilibrium/

[5] https://hbr.org/2020/12/digital-tools-are-revolutionizing-mental-health-care-in-the-u-s

[6] https://nam.edu/improving-access-to-evidence-based-medical-treatment-for-opioid-use-disorder-strategies-to-address-key-barriers-within-the-treatment-system/

[7] https://rockhealth.com/reports/going-digital-to-disrupt-the-addiction-epidemic/

[8] http://whsc.emory.edu/blueridge/publications/archive/Blue%20Ridge%202019-2020-FINAL.pdf

[9] Deep Medicine: How Artificial Intelligence Can Make Health Care Human Again | Aspen Ideas