These days, everything appears doom and gloom. I’m tired of reading negative headlines, and I bet you are too. But in behavioral health, it’s hard to ignore:
- Rates of anxiety, depression rising among Americans, especially the young
- What accounts for the rise in suicide rates in the US?
- He wanted to live. After his insurance rejected coverage, he died of a fentanyl overdose
- ‘You kind of feel helpless’: Families face hurdles with accessing mental health care
- Burnout, depression, and diminished well-being among physicians
These headlines were published within a month. Each one tells a unique story, but there’s a unifying theme. Another recent headline sums it up:
Patient Frustration Surges: Americans Struggle with Broken Healthcare System
The mental health crisis isn’t just a headline—it’s a harsh reality.
This crisis is the result of a broken system – one the powers that be don’t seem too keen on fixing. Scrappy healthcare leaders took decisive action by expanding mental health services, adding more clinical providers to insurance panels, and embracing digital and telehealth solutions.
But patients still aren’t getting the care they need, and the grim headlines keep coming. It’s not just media hype, either: nearly 60 million Americans have a mental illness, over half receive no treatment at all, and the country saw a record number of suicides in 2022.
Despite billions invested and millions of lives at stake, one thing is clear: the existing behavioral healthcare system never worked, and it never will.
Here’s where we went wrong:
- Not Tracking Outcomes in Traditional Therapy – Community mental health isn’t currently designed to deliver measurement-based care. Why? Many therapists don’t have access to electronic medical records and fail to measure quantitative outcomes. Patients may not notice what’s happening behind the scenes, but they do notice feeling worse, not better. Requiring further treatment, this creates a bottleneck that worsens access to care for those who desperately need it.
- Relying on Telehealth – COVID-19 thrusted us into the world of telehealth. It helped some patients overcome barriers, but it wasn’t the savior everyone hoped for—it was a stopgap. Telehealth pulled providers away from their patients, created a less engaged therapy model, and reduced overall effectiveness of care. Sure, we increased access to services at a time when people needed it, but the pendulum swung too far and now needs to come back into balance.
- Dividing Payor Arms – Physical and mental health have long been treated separately. Healthcare insurance providers follow a similar model – a “physical health” arm and a “behavioral health” arm. This separation confuses everyone. It frustrates patients trying to understand which services will be covered, and it frustrates providers eager to treat their patients and get properly reimbursed. Payors still don’t fully grasp the need for a whole-health approach, leading to fragmented care and misaligned incentives.
- Propagating Broken Models: Patient acquisition is both competitive and expensive. I don’t begrudge providers chasing money, but the current Fee-for-Service (FFS) payment model incentivizes behaviors that lead to worse outcomes and more frequent visits. Ask yourself: would you rather treat the same patient panel indefinitely or successfully turn them over every few months to help more people? The data clearly shows there aren’t enough behavioral health providers to meet growing demand, but depression, suicidality, and other mental health issues keep rising. So, why are we propagating a model where patients enter the healthcare system without a clear off-ramp to lower levels of care?
- Ignoring Innovative, Outcomes-based Models – Proven solutions that focus on patient outcomes, such as Collaborative Care (CoCM), are celebrated but slowly adopted. These models, which Integrate mental health care into primary care settings, have shown significant improvements but lack the necessary support and funding for widespread adoption.
The frustration is palpable. Yet America continues championing a volume-based healthcare system instead of a value-based system. That’s no accident – it’s by design, one in which people have no choice but to bear the pain and hope for the best.
A history of failure, a future of the same. Let’s fix it.
If we want to break this cycle of inadequate care, worse outcomes, and a never-ending crisis, here are four ways we can build a more effective system:
- Integrate Behavioral Health – We must treat physical and mental health together—not separately. Collaborative care models are proven to be the most effective way to treat the whole patient. It also increases access to care, reduces total healthcare costs for both patients and providers alike, and reduces stigma around seeking help. Since 2017 my company evolvedMD has partnered with leading primary care systems and increased access to care for over one million patients across five states, with more to come.
- Incentivize Delivery and Track Outcomes – On top of integrating behavioral health in primary care, I recommend incentivizing providers to adopt evidence-based practices. Offer additional payments to those who deliver measurement-based care and track quantitative outcomes, not just qualitative. Monetary incentives will ensure treatment is continuously evaluated and adjusted to meet patients’ whole health needs. At evolvedMD, we incentivize each provider to deliver measurement-based care while also tracking outcomes. The results: up to 22% better clinical outcomes than industry average, and long-term clinical and financial viability.
- Focus on In-Person – Despite the telehealth wave, research shows that over 70% of patients prefer in-person care. I think we should incentivize providers and practices that deliver over 70% of their services face-to-face. This can enhance patient engagement, improve outcomes, and ensure people receive personalized care, once again cementing long-term clinical and financial viability. While evolvedMD does offer flexible telehealth options, we render more than 80% of services onsite and in person at each of the primary care practices we serve.
- Payor Reform – Separating physical and behavioral health payor arms negatively impact patients, providers, and practices alike. Consolidating both arms into one entity will streamline processes, improve care coordination, and ensure that patients receive comprehensive coverage. It will also ensure that primary care providers and mental health therapists are properly reimbursed for the full spectrum of services.
How You Can Help Me Fix this Broken System
By embracing these solutions, you’re helping us solve some of the fundamental flaws of U.S. healthcare and creating a system where everyone benefits. If you want to learn more about integrated care and how to achieve measurable, meaningful outcomes, please feel free to reach out at erik.osland@evolvedmd.com.
Collaborating is key to fixing this broken system, and we can’t wait any longer to take action. Let’s get started, and hopefully we’ll start reading headlines like:
A New Lease on Life: Primary Care Clinic’s Mental Health Program Helps Community Heal