Ed Jones, Ph.D.’s Post

We should expect our care systems to deliver optimal health outcomes and our health plans to fund them. Poor access to care is a fundamental system failure, and it is the chronic state of behavioral healthcare. It is time we held health plans more accountable for solving this crisis. Part of that solution is reconfiguring the outpatient level of care. A health plan’s responsibilities differ by contract. They fund and manage some contracts and only administer others. Yet, they are ultimately accountable for each one, and access is a vital contractual element. While promising access solutions exist, some need leadership from health plans. One such solution is reconfiguring primary care as the initial setting for behavioral healthcare. Behavioral clinicians have been refining this solution for decades. Behavioral care was developed as an isolated specialty but is more appropriate for many people as a primary care service— brief, continuous, and built on long-term relationships. Behavioral clinicians are now helping primary care patients with diverse behavioral issues in 20-minute visits—i.e., basic outpatient care. Delaying this solution for further research or ROI analyses is unnecessary—payers could fund and implement it today. See more 200-word essays on my website: https://lnkd.in/gcNEznEP  

Behavioral care access and US population health must improve. To make meaningful progress, we must reconfigure the primary care system. Two concepts are critical: HOLISTIC CARE: clinical concept addressing patient comorbidities and mind-body interactions INTEGRATED CARE: structural concept addressing multidisciplinary staffing within primary care Holistic care is common in Medicaid and federally-funded programs but rare in commercial settings. Holistic care thrives in primary care settings configured for integrated care—brief behavioral interventions are commonly used and well-received by patients and PCPs. Care integration may expand in light of widespread, ongoing consolidation in healthcare. Health systems are acquiring behavioral programs and psychotherapists. Redeploying therapists from traditional services to brief primary care interventions would serve two essential goals: 1)     Provide an effective partial solution to the behavioral care access crisis 2)     Address highly prevalent behavioral issues that exceed the focus of holistic care Improved health outcomes must be demonstrated with these changes, so every integrated system should monitor outcomes and report aggregated results using Measurement-Based Care (MBC). As the name suggests, “Integrated Care for All” is a strategy for all consumers. Traditional psychotherapy has its place, but everyone needs easy access to behavioral expertise. See more 200-word essays on my website: https://lnkd.in/gtVGXE6C

Healthcare is evolving toward salaried employment for all clinicians—75% of physicians are already salaried. Psychotherapists will increasingly work in health systems that employ providers from every specialty. Therapists should pursue roles in these companies, especially in primary care, and ensure their compensation is equitable on day one. Pioneering therapists have shown that brief primary care visits can improve patients’ overall health. While a strong business case can be made for this now, it will be more compelling as measurement-based care systems proliferate and generate behavioral outcomes data. The ranks of therapists will grow as healthcare executives recognize this value proposition. Historically, therapists have been inadequately paid. Hourly fees under managed care have been flat, with rate increases limited to network gaps (e.g., psychiatry, rural areas, language needs). Therapist compensation should be comparable to other highly-trained primary care professionals. Consider these parameters: >>  The floor for therapist salaries should be tied to advanced practice providers—i.e., NPs & PAs. >> Incentive compensation, with goals similar to PCPs, should be available. Value (i.e., total healthcare costs and clinical outcomes) will ultimately drive total compensation for key contributors. Therapists should start thinking in these terms. See more 200-word essays on my website: https://lnkd.in/gAyAGHF2

the mental health industry needs to be born before skilled providers can be identified and appropriately compensated. right now most primary mental health patients are being funneled into behavioral health care bc it's whats available. behavioral health is one branch of mental health care. wo standardized industry language that includes things like the word "diagnosis," primary mental health patients have no way to find appropriate care. if we made the data we already collect universally accessible (like diagnosis codes billed by provider), individuals could search by their diagnosis and geography to narrow down appropriately skilled providers. all beds and schedules will be filled and more providers will be needed. revenue will be generated. we need to take this illusion of control out of the hands of healthcare executives and start using common sense as a force to drive change. the mental health industry will be born out of understanding, education and communication; not profits. once a mental health care industry and system exists and individuals can access appropriate care, there will be a measurable reduction in the need for other fields of medicine (ex: SUD prevention will also prevent diabetes/heart disease/stroke/lung disease/etc). professional compensation will shift to follow need.

You know something, the only thing you’re actually advocating here is the destruction of private practices in favor of corporatization. You’re acting like it’s been such a good thing that we destroyed all physicians’ private practices and we now work for a private equity corporation while nobody gets meaningful care. I love how you worded this narrative as “the workforce is evolving” and you’re measuring outcomes. This philosophy is right up there with standardized testing in our schools, which actually has not improved public education. It’s destroyed it. The statement “practice settings detach from physical healthcare” implies that the physician’s or therapist’s office is not a healthcare facility. If the dentist isn’t located inside a hospital, in your view he’s not practicing medicine. What about stand alone eye doctors, are they not practicing medicine either? Why don’t you just write a decent article that says we want to buy up all the private practices and make you work for us. At least that would be an honest narrative.

The behavioral healthcare field is quietly being transformed. Nationwide consolidation in the healthcare industry is the greatest driver. This will reposition behavioral programs and services into comprehensive health systems. Therapists will see big career changes. Consider 7 predictions: 1.     The insurance-based therapy experience requires fundamental restructuring, so health systems will increasingly take responsibility for providing insurance-based care, using salaried therapists to replace the failed network model. 2.     This trend and a proliferation of more affordable “life coaches” in the self-pay market will shrink private practices. 3.     Therapists will continue providing traditional psychotherapy, but many will transition to brief interventions in medical settings, improving behavioral care access. 4.     Medical-behavioral comorbidities are prevalent and expensive, so health systems will increasingly fund brief therapist interventions to improve outcomes and reduce medical costs. 5.     Behavior change is essential for stabilizing high-cost chronic diseases, so health systems will increasingly fund brief therapist interventions in primary care. 6.     Therapists in health systems earn less than clinicians with similar education and responsibilities—e.g., NPs and PAs—so demands for pay equity will escalate. 7.     Therapists with solid business skills will pursue rewarding executive positions in health systems and health plans. All predictions, welcome or not, necessitate planning. See more 200-word essays on my website: https://lnkd.in/gGZidKyY

The behavioral healthcare field has good reason to worry about care integration. The healthcare industry is progressively acquiring and assimilating behavioral programs and services, and the results are uncertain. Also, the clinical models guiding care integration (CoCM and PCBH) are dated, reflecting a hierarchy in which behavioral clinicians primarily support and advise MDs. Pioneers in integrated care found that consulting with PCPs was the main role available in the 1990s, but the environment has changed. Health systems, not PCPs, are today’s decision-makers. Behavioral care access is a top priority. We now need empowered therapists who are partners to PCPs, not consultants. Therapists belong in primary care in their own right. Behavioral issues are pervasive and disabling. Behavioral services have matured clinically and warrant parity with medical care. Given the urgency of the access crisis, this could not be better timed. When our care delivery system is finally grounded in a biopsychosocial orientation with psychosocial parity, the primary care setting will change. A reconfigured setting should include a robust, initial level of care for behavioral health. Brief behavioral interventions can broadly impact population needs, and integrated care without these changes shortchanges consumers. See more 220-word essays on my website: https://lnkd.in/g28me2af

The behavioral field should continuously improve care delivery. Why, then, are many advances routinely rejected?  Private funding pushes niche products forward while more ambitious proposals get discarded for insufficient validation. Demanding more studies (clinical and ROI) is a socially acceptable way of shelving ideas. By obstructing significant change, the status quo is solidified. Consider primary care. Behavioral leaders should be focused on transforming this setting. Behavioral issues in primary care are pervasive but mostly neglected. PCPs acknowledge their limited clinical impact and know more behavioral clinicians would help, but few work there today. Behavioral leaders should take the initiative to collaboratively develop reform plans. Some settings (e.g., FQHCs, military, and academic medical programs) report promising results with richer behavioral staffing and shorter visits. They could be expansion platforms for a new clinical model. Few ideas are as promising for improving primary care. An influx of behavioral clinicians could redefine care integration while improving access to behavioral care. Today’s bias is to limit change to small, incremental improvements, celebrating this preservation of the status quo as empirically driven. Instead, we need nonconformist behavioral leaders to embrace sound, complex ideas to transform care delivery. Read more on my website: https://lnkd.in/g9EWXdXv

Holistic or integrated care inspires passion in many practitioners. While this subspecialty has grown, only a minority of behavioral clinicians work at the intersection of mind and body today. However, it has become increasingly clear that the primary care setting can serve a greater purpose for behavioral healthcare. It can help improve care access. Access to behavioral care is abysmally poor.  The leading causes discussed, too few clinicians and too many consumers, miss a critical factor—psychotherapy is the lowest level of care offered. Traditional therapy does not scale well, and its duration and intensity alienate many. There is a good alternative—less time with a clinician in a familiar setting. Integrated care practitioners have shown us how valuable 20-minute primary care visits can be, and a new way of using this setting now seems obvious. We should prioritize brief visits with therapists to address pervasive and varied behavioral issues. Primary care is ideal for an initial level of behavioral care. Let’s highlight our access crisis with payers and promote this initial level of care as a solution.  Also, let’s leverage consumer anger over access in negotiations with payers. See more 200-word essays on my website: https://lnkd.in/g7Cp5Jai

All consumers should have access to a therapist in primary care. Brief visits can interrupt the development of psychological disorders and drive changes that improve physical health. Healthcare systems should stress the primacy of thoughts, feelings, and behaviors in health. Instead, most systems of care minimize the value therapists bring to prevention. Why? Our healthcare system 1) prefers medication solutions and undervalues psychosocial ones; 2) prioritizes practical lifestyle changes (e.g., related to eating and exercising) as the primary focus for behavioral change; 3) demands that health solutions fit predefined problems and diagnoses vs. therapy’s exploration of idiosyncratic psychological issues.    Our healthcare system’s approach to prevention is wedded to the medical model—e.g., vaccinations for contagious diseases and medicines for chronic ones. Flexible psychosocial interventions are treated with skepticism, so we lose opportunities to change negative behavioral patterns that can vary from being dysfunctional to disabling. Economic forces are at work here—pills generate reliable profits, and therapists do not. However, we can facilitate change without scheduling therapist visits. We can change the environment. Let’s create a culture of behavioral health within every healthcare clinic—let’s nudge people in the direction of behavioral health. See more 200-word essays on my website: https://lnkd.in/gkaTnnMg