Primary care has historically been at the heart of value-based care agreements. The growing emphasis on holistic care could leave the door open for more collaborative care models that include both behavioral and physical health.
A key part of that move is more partnerships between primary care operators and mental health providers, industry insiders believe.
“I think the future of this industry … from a value-based care standpoint is partnerships with primary care,” Christopher Brengard, CEO of Mindpath Health, said at Behavioral Health Business’ INVEST event on Wednesday. “There is no doubt patients that are underserved from a mental health standpoint, or [those] having issues that are not being addressed, do poorly physically. And we know that people that are challenged physically are having issues around mental health. It only makes sense to throw those two together.”
Mindpath Health offers outpatient behavioral health services. It has 650 mental health clinicians and serves 97,400 patients annually. The operator has more than 100 locations in California, North Carolina, South Carolina, Florida, Texas, Ohio and Arizona.
That concept especially applies to higher-acuity patients.
Individuals with serious mental illnesses (SMI), including schizophrenia, major depression and bipolar disorder, have a reduced life expectancy compared to the general population of between 10 to 25 years, according to research published in the Annals of General Psychiatry.
Bringing together primary care and behavioral health services could produce better outcomes and save money in the long run.
“We’ve been in a low-cost provider environment for a long time, particularly in the medicated assisted treatment (MAT) area,” David White, CEO of BayMark Health Services, said during the panel. “I think there are real opportunities to save money and provide really good, quality care.”
BayMark Health Services is a behavioral health provider focused on treating substance use disorder. It has more than 400 treatment facilities in 37 states and three Canadian provinces. It claims to be the largest opioid use disorder treatment service in North America.
Not so simple
While there may be synergy between primary and behavioral health providers, parsing out which specialty is responsible for driving cost savings is an uphill battle.
“If you’ve ever worked inside of an ACO [Accountable Care Organization] or with an ACO that is taking full risk and you start saying, ‘The spend on this patient was $10,000 this year compared to $15,000 last year, who was responsible for that savings?’” Brengard said. “You’re going to get 100 hands in the room that said, ‘That was me.’”
At the end of the day, dissecting which provider is responsible for cost savings may be impossible, Brengard said. Instead, he stressed the need for partnership agreements, where it doesn’t matter who gets credit for the savings as long as the providers can treat the patient holistically and get results that cost less.
Beyond the financial complications, some patients, however, aren’t keen on mental health and primary care providers collaborating on their care.
“We have 12 primary care clinics within our addiction treatment centers. When you’re doing it, it’s a lot tougher than it sounds,” White said. “Everyone thinks it should just happen automatically. But the reality is some patients don’t want their primary care for their addiction treatment provider, or vice versa. They want to split that out and not have everyone know what’s in their business.”
The number of primary care providers integrating behavioral health services is on the rise. In fact, a new report found that 45% of providers that used the Center for Medicare & Medicaid Innovation (CMMI)’s Comprehensive Primary Care Plus model (CPC+) were co-locating behavioral health services in their clinics.
A path forward
Outpatient mental health provider Refresh Health was acquired by UnitedHealth Group’s (NYSE: UNH) health services division Optum in March for an undisclosed sum.
This deal with Optum puts Refresh in a unique position to collaborate with other parts of the health care ecosystem, including primary care and payers. Refresh Health has more than 300 locations in 37 states. Its services include treatment for SUD, mental health conditions, eating disorders, couples therapy, psychiatry and more.
“The plan [is] for us to align that primary care capitation model over time. I think that’s really an interesting, innovative field – and one of the reasons for me and our team being really excited to join Optum. This [is an] opportunity to try some of these things out in arrangements where we don’t get burned,” Steve Gold, CEO of Refresh Mental Health Services, said during the panel. “We can try some different things and hopefully [see] that it works and then lower the total cost of care, improve patient experience, improve patient outcomes. That’s what we’re trying to do.”
Apart from Refresh, Optum’s care capabilities include urgent care, specialty care and advanced care. On the primary care side specifically, chronic care management, virtual care, medication refills and connections to speciality services.
Having multiple stakeholders within a larger organization could cut down on competition for resources and lead to a more cohesive model of care.
“I think Steve has an advantage working inside of a larger organization that owns primary care and other specialties,” Brengard said. “You have to put yourself in the position to look at the whole patient and figure out, ‘How do I share that overall savings as a team?’ When you start to split the pie at the end of the year, it’s going to be a dog fight.”
Refresh is in a unique spot, as most providers are not owned by a health care conglomerate with both a payer and service division. But its work in providing a continuum of care for patients could be a model for the future.
“When someone goes into care and fills out the GAD[-7] or whatever it is that they are using to determine mental health status, it would be nice if right there was a therapist because that’s your chance and you may not get that chance again,” Gold said. “There’s plenty of studies that show this would lower the overall cost of care.”