Primary Care Providers and Behavioral Health

Michael Thompson: One last point I want to bring up on the supply side is around a particular area we talked about before, which is mental health. This is an area in which we have directories full of providers, and apparently it’s kind of hard to get an appointment with a provider, particularly if you’re a new patient. What are you seeing there, and where do we go from here? I mean, this is a big challenge, I think. Pat?

Patricia Haines: I’m thinking this is an area in which telemedicine may have a role—at least in the short term—because you’re right, the access is really hard. I think we use a pretty broad network, and we still hear all the time that there just aren’t the providers there. This is an area in which I think—at least for initial consult, or some intervention, or somebody to talk to—telemedicine might be effective for mental health.

Andrew Crighton, MD: Yeah. I think this is your classic supply and demand. You do not have enough mental health providers. Therefore, they don’t have to be part of the networks. They can be out of a network and thrive and do well, and a lot of times it’s easier on the practice. They don’t have to hire as much administrative staff and deal with all the headaches of having to file claims and things like this.

First of all, there’s not enough. And second, as you said, there may be a list of providers, but they may not be taking any more new patients with this plan. I think we need to get more mental health providers, whether it’s an issue of reimbursement or things like that. But it’s difficult. It’s like primary care—a difficult profession to get providers to go into.

Bruce Sherman, MD: I would completely agree, and I think 1 of the challenges is, are they as providers being appropriately compensated for the services that they provide? They don’t have procedures like a number of other clinical entities. I think to a good extent that creates an incentive or is a limitation that creates an incentive, for those individuals who want to be paid in parity with other individuals in the profession.

Michael Thompson: This also relates to integration of behavioral health into primary care. Most of the prescription drugs that are being offered for a behavioral health issue are coming through primary care, yet our primary care physicians are not trained in behavioral typically, right? There were new codes established just over the last few years, and Medicare is paying for them. When we did our deep dive, we found there are not a lot of claims coming through on that space. How important is it to get that fixed?

Andrew Crighton, MD: I think it’s very important, because as we talk about this in employer groups too, 1 of the solutions to taking care of lack of access to behavioral health professionals is centered on primary care. And you’re already short-staffed there. That’s just not a solution at all. I think for primary care providers, as they add a behavioral health individual into their practice, there’s just such a wealth of support there—not only because somebody may have a mental health condition. Some of the people with chronic illness need that behavioral health counseling to kind of turn the corner. I think it can make a primary care provider’s job much easier too.

Patricia Haines: The ideal primary care office would have behavioral health specialists and a nutritionist all under the same group.

Michael Thompson: There are still a lot of solo practitioners or small practices, and we shouldn’t discount virtual care in this. Virtual care is the way that we can deliver integration even in small practices, but we have to have a will to help make that happen and push that through. I do think, to your point, interestingly what I have heard from providers is that they have gone to integrating behavioral health into their primary care practice, and they will never go back. Once they’ve experienced what it means to serve their patients effectively and comprehensively, they realize it’s better for their patients and better for them—it’s all good.

I think that there’s a lot of work to be done still in the medical-delivery system. I think some of the central themes are, we need to look at payment reform, and we need to look at delivery reform. When you put more emphasis on primary care, the triple aim and quadruple aim still remain there. We need to be able to differentiate on quality. We need to understand what the costs are. We need to move away from fee-for-service and also improve the patient experience and the provider’s experience.

Bruce Sherman, MD: Mike, to your point, I think it comes back to this central theme of patient-centeredness, that we need to meet the patient where they are, simply providing clinical services. Is it going to achieve the success that we want to have?

Andrew Crighton, MD: As we’ve been talking about the patient, you’ve got the physician burnout issue too. It’s the lack of coordination. It’s all these nonpatient-care administrative things—that they have to do—that just makes it less valuable to be a physician.

Michael Thompson: And this is where getting the industry to move together rather than independently would make a difference in everybody’s lives, including getting the outcomes that I think employers are looking for.

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