Emerging behavioral health product trends

Increase in demand for behavioral health services

 

According to the CDC , approximately one in five U.S. adults currently lives with a behavioral health illness, and one in five individuals aged 13 through 18 have dealt with a debilitating behavioral health diagnosis. Estimates project that a quarter of Americans  will need to access behavioral health treatment by the year 2026.

Several factors led to the sharp increase in demand for treatment. The stress and social isolation due to COVID-19 caused a significant increase in behavioral health diagnoses , such as depression, anxiety, cognitive impairment, and post-traumatic stress disorder. Substance use disorders escalated during the pandemic. Youth behavioral health declined due to the disruption in education, social development, and routines.
 


Current behavioral healthcare challenges


Despite the demand for behavioral health care, obstacles prevent many individuals from receiving the treatment they need; the main barriers being stigma and accessibility.

Many individuals experience stigma as a significant barrier to seeking treatment. They often struggle with feelings of guilt, isolation, and low self-esteem, typically fueled by societal stereotypes and discrimination. As a society, when we understand and normalize mental and behavioral health diagnoses, we reduce their associated stigma. We can then deliver quality preventative and proactive mental health care.

“One of the best ways to reduce stigma around mental and behavioral health is to discuss it openly with inclusive language, encouraging others to do the same,” says James Polo, MD, Chief Medical Officer, Carelon Behavioral Health.

Demand rose during the pandemic due to a rise in behavioral health illness, resulting in accessibility challenges. Provider shortages, limited options, and long waits to see a provider escalated. Demand continues to rise, as the U.S. Health Resources & Services Administration projects a 62% increase in demand for behavioral health services  by 2036 as full-time equivalent healthcare staff declines by 13%. 

According to National Alliance on Behavioral Illness (NAMI) , between 2019 and 2022, 57% of people who sought behavioral healthcare were unable to access care.

Health equity  is also closely linked to behavioral health care access. Racial, economic, and geographic factors influence health care access. Black (39%), Hispanic (36%), and Asian (25%) individuals were less likely than White (52%) individuals  to receive behavioral health services.


Solutions that help meet the demand for behavioral healthcare


Rise of telebehavioral health (TBH)

 

Since the COVID-19 pandemic, TBH utilization has significantly increased. Telebehavioral health care has grown from over 39% in 2019 to 88% in 2022 .

Carelon believes TBH improves access to care , allowing patients to bypass the uneven distribution of providers associated with in-person visits, and that providers often prefer TBH, as the platform can enable providers to treat more patients efficiently without sacrificing quality.

Many individuals also feel reduced stigma when accessing virtual care, as they can access TBH from their homes, which is especially beneficial to those seeking treatment for substance use disorders.

Carelon also believes that TBH helps to foster connections and lessen stigma in marginalized communities, such as LGBTQ+ youth .

 

Risk contracting for value-based care


Carelon believes that value-based care (VBC) provides better health equity, and in turn, improved patient outcomes. By shifting the focus from volume (fee-for-service) to value (the quality of care), VBC incentivizes providers to improve patients' overall well-being rather than solely providing more services, which in turn improves the cost of care. Along with risk-based contracting, this model improves patient health outcomes while reducing unnecessary expenditures. Risk-based contracts typically contain performance metrics tied to quality and cost targets incentivized under a VBC model.

Carelon’s performance-based pricing models fully align incentives with value and results. Under a full risk partnership, clients receive enhanced clinical engagements within clinical teams, improving whole person health and outcomes for patients, along with advanced analytics and reporting to monitor Carelon’s performance.

Key financial benefits include the ability to secure predictable spending through savings and trend guarantees. The capitation rate includes program optimizations and otherwise costly expansions, which eliminates additional implementation expenses. The model removes administrative fees, reallocating funds towards medical costs and reducing the health plan’s Selling, General, and Administrative Expenses (SG&A) expenses.

By transferring risk to Carelon, clients protect their margins from unexpected claims. If Carelon manages medical costs more efficiently than projected, clients can capture additional savings through risk corridors. This approach allows clients to direct resources towards other critical areas since Carelon oversees overall expenditures, including claims payment and network administration.

Carelon believes that full-risk contracts deliver maximum value to clients by providing budget certainty, full organizational alignment, and greater flexibility in downstream provider contracting.

The innovative payment model improves the behavioral health continuum by reducing behavioral health and medical care utilization levels. Carelon includes provider relationship enhancements under a full-risk arrangement.


Integrated behavioral health


The integration of behavioral health services into primary care is a growing trend, helping to facilitate health equity and accessibility. Up to 75% of primary care visits include integrating behavioral health into care to improve health outcomes.

Mental and physical health have a reciprocal relationship. Some studies indicate a link between depression and an increased risk of cardiovascular disease  and diabetes .

“We are seeing evolving trends in healthcare that support the connection of physical and behavioral health. This connection improves health outcomes, supports healthcare efficiency, and helps to reduce healthcare costs and barriers to treatment,” says Dr. Polo. “Primary care that focuses on patients’ physical and behavioral health, telebehavioral health, digital therapeutics, the establishment of prescription drug monitoring programs that increase medications adherence, and the focus on personalized medicine all connect physical and mental health. These connections support patients’ whole health.”

Carelon data indicates that integrated whole-health treatment results in a substantial cost savings:

  • Patients save an average of $3,060 per year, or 16% in total costs from participating in Behavioral Health Case Management (BHCM) comanaged with medical, pharmacy, and disease management.

  • An average inpatient medical savings of $1,152.

  • Integrating whole health and substance use disorder support saves an average $2,493 in medical costs for employees receiving SUD treatment.

In 2022, approximately 15.4 million U.S. adults aged 18 or older experienced SMI . Carelon’s New Comprehensive Care for People with SMI (CCPSMI) is an example of an integrated whole health care model that drives health status and quality of life improvement, while reducing the total cost of care. The multi-modal, hyper-local approach supports patients by providing local resources while identifying and addressing health-related social needs (HRSNs).

CCPSMI targets the highest risk SMI patients (age 18+) with psychotic disorder, bipolar disorder, major depression, delusional disorder, and/or obsessive-compulsive disorder. Early feedback from participants from January-March 2024 in two markets are extremely positive.


Employers prioritizing workforce behavioral health care


Employers understand the need to prioritize employees’ behavioral health care as well as the positive impact of employer mental health initiatives. Research shows that organizations see a return of $4 in improved health and productivity for every dollar they invest into behavioral health treatment .

By increasing employee behavioral health benefits and Employee Assistance Programs (EAPs) focusing on behavioral health , employers can reduce staff missed works days, and increase return to work rates for those employees missing work due to behavioral health issues. Employers can also use EAPs to address their employees’ behavioral health issues early, helping to save on the cost of behavioral health care.

Data from one of Carelon’s customer’s Employee Assistance Programs (EAPs) shows that participants in the program’s integrated, whole-health approach experienced an 80% improvement in their depression assessment.


2024 CMS changes improving behavioral healthcare access


The Centers for Medicare and Medicaid Services (CMS) issued its 2024 Physician Fee Schedule final rule  (Final Rule) for 2024 that help implement some of the most important changes to improve access to behavioral health care in Medicare’s history. These changes further the goals of the CMS Behavioral Health Strategy :

  • Allowing marriage/family therapists and behavioral health counselors to enroll in Medicare Part B and bill for their services
  • The creation of new codes allowing for existing behavioral health codes to be billed by more types of providers

Medicaid Reentry Section 1115 Demonstration Waiver

The new Medicaid Reentry Section 1115 Demonstration Waiver  allows state Medicaid programs to cover selected services for justice-involved individuals meeting specific, qualifying criteria. The services address behavioral health issues and substance use disorders .

The waiver allows states to collect federal Medicaid matching funds to provide a targeted set of services to youth and adults in state prisons, county jails, and youth correctional facilities up to 90 days prior to release.

Carelon’s Justice Connect solution supports U.S. Department of Health and Human Services’ (HHS) state guidance on applying for 1115 Medicaid reentry waivers. HHS’s goals align directly with Carelon’s capabilities and goal for the Justice Connect program, which is to improve outcomes for individuals with behavioral health needs who interact with the justice system.

Carelon’s Justice Connect program emphasizes the following goals:

  • Continuity of care to address behavioral health and substance use concerns
  • Improved discharge planning to increase adherence to follow-up care
  • Successful reintegration into the community
  • Reducing state hospital and correctional facility recidivism rates

 

The future in behavioral health product trends


Carelon continuously assesses behavioral health trends to inform, refine, and develop solutions. As an expert in the field, Carelon understands the importance of evolving to meet these trends and to meet people where they are.

Dr. Polo highlights the emergence of treating the patient’s whole health. “Carelon Behavioral Health centers our care around who the patient is. We attend to the patient’s whole health, which will ensure that the individual stays engaged in both their physical and mental health over the long term. That is the future.”