Proem Behavioral Health recently hosted "Behavioral Health in 2023: The New Rules and Trends to Know About." This webinar, which is now available as an on-demand recording, brought together behavioral health experts for a discussion about the biggest behavioral health news and trends from 2022 and what they mean for 2023.
The panelists were Troy Di Lello of NVeiUP Telehealth and Clarity Telehealth; Josh Spitalnick, PhD, ABPP, of Anxiety Specialists of Atlanta; and David Purinton, MBA, CM&AA, of VERTESS. The program was moderated by Dr. Tom Young, a board-certified family physician and the chief medical officer and founder of Proem.
The following is an excerpt from the webinar that provides the panelists' responses to the initial questions asked by Dr. Young. It has been edited for length and clarity.
Dr. Tom Young (TY): Let me start things off by asking a simple question: What one word would you each use to describe what transpired in behavioral health in 2022? Looking back for a moment, what's that one word that comes to mind?
Dr. Josh Spitalnick (JS): Accessibility.
Troy Di Lello (TDL): Shortage.
David Purinton (DP): Utilization.
TY: Keeping those in mind, we had some things change in 2022. The U.S. Preventive Services Task Force (USPSTF) added new recommendations for screening, particularly for anxiety in children. How does this affect those three top issues from last year? How does it affect what we're going to be doing in 2023?
JS: Those three words we shared complement each other and conflict with each other. As an anxiety specialist, a psychologist and someone who's in the field providing services in the southeast United States but also in 30 other states as my team does, USPSTF has essentially requested, if not almost mandated, that primary care serve as the leading group — the boots on the ground — to start screening for mental health issues and specifically anxiety. For me, that's wonderful because it increases the potential accessibility of kids getting their needs met, at least through an initial screener. That speaks to my word of "accessibility."
Then we get to Troy's challenge, which was "shortage." You have so many primary care providers increasing awareness to parents and families about the needs of mental health and some basic screeners for anxiety. Now we have the real dilemma, which is how are we going to get these kids who do get flagged for their needs access to good mental health care? That's where the shortage connection kicks in.
Then to David's point of view concerning "utilization." We have to find a way to utilize practitioners out in the field like myself who are not wonderfully integrated with primary care to become more accessible to the field.
The Task Force is critical because it puts mental health on the radar, more so than it has been in previous years. That's a great start. But how do we get primary care to integrate with and connect with behavioral providers like me from screening, to access, to care? That's a real challenge.
TY: I agree that the challenge of integrating behavioral health into primary care is going to be an ongoing concern in 2023. Troy: How does this affect the payers' view? What do we see happening in the commercial and federal payer space and their approach to behavioral health in 2023?
TD: What a huge question. We're not seeing a lot of changes in 2023 in the payer space. When we're talking about integrating primary care with psychiatry and psychology or mental health, there are essentially no codes to support reimbursement for this. I say that because the codes that exist provide minuscule amounts of reimbursement.
As long as that continues, I think we have this obstacle, and we need to figure out how to get over it. How is that time paid for? How do we plan for that? What about reviewing records? What about storing those records? How do we get those records? If you're in an HMO, a group or something similar, or an FQHC (federally qualified health center) where you do primary and behavioral health care, there's an advantage there because you have maybe one EMR. But for a lot of us, we're outpatient, so how are we going to get those records? Who's going to send them? Who's going to fill out the request for information? Who's going to receive it? It's a lot of work. That's something we really have to figure out.
TY: David, where do you sit in that conversation around payers as we move forward into 2023?
DP: I would certainly echo Troy's sentiment. I lost a deal (the sale of an outpatient provider) in 2022 because the charts were initiated at an inpatient hospital. So, the potential buyer of the outpatient provider got into this challenging argument of, "Who actually owns these charts?" The outpatient provider was adding to them and has their own EMR as well. There's a challenge there. We have patients sign ROIs (release of information) on intake, but then what happens after? How much better positioned would the primary care physician be if they have all that information? I love that vein of thought.
I would probably approach [the payer conversation] from a different angle. I'd start with the shareholders of the payers. We're looking at the destigmatization of behavioral health, which has occurred for well over a decade, but since the pandemic, it's been a tidal wave. These are expensive benefits to pay for. I think the payers are looking at the shareholders. In the public markets, they are looking at a six-month time horizon. They are saying, "How am I going to get my EPS (earnings per share)? It's a simple game of addition and subtraction; money in, money out. Though they know, over the long haul, that investing in populations' behavioral health will reduce the total healthcare spend on a patient's lifetime, the public markets work in a six-months' timeframe.
Focusing on the commercial payers, I think that's where some of the challenges will be, and I think that's also where we're sort of seeing some of these payers posture, particularly in 2022. I definitely see that proliferating more in 2023, especially with the movement toward value-based care.
To hear more of this discussion, watch the recording of "Behavioral Health in 2023: The New Rules and Trends to Know About" here.
