A Northwestern University Feinberg School of Medicine professor offers his insights on likely developments in behavioral health this year.
An increased public recognition of the need for behavioral health treatment is one of the top trends in behavioral health care for 2022, an expert says.
Jason Washburn, PhD, MA, is a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine as well as a member of the board of advisors at Owl. His research interests include nonsuicidal self-injury, suicide, and implementation of psychological practices.
HealthLeaders recently asked Washburn about the top behavioral health trends for 2022. The following is a lightly edited transcript of his comments.
1. Public awareness about behavioral health treatment: One of the things that is very clear from 2020 and 2021 is an increased public recognition of the need for behavioral health treatment. We have heard over and over for the past year and a half that increased access is needed for behavioral health services, particularly as a lot of people are struggling with mental health not only in an adjustment to the coronavirus pandemic, but also the ongoing stressors in society.
We certainly have heard quite a bit about the call for access. One thing we need to hear as well, and hopefully we will hear more of it in 2022, is not only increased calls for access to care, such as making telehealth a permanent option for providers and patients, but also to make sure we are providing quality mental healthcare. There is always going to be a marketplace response to the calls for access, but it is one thing to say 'here is more access' and another thing to say 'here is more access to high-quality care' that results in improvement and helps patients to deal with their symptoms.
Whether we see increased calls for quality behavioral health services in 2022 is dependent on many factors, but access by itself is not the solution because accessing care that does not help people get better or is variable in its response to people's needs is not going to be the solution by any stretch of the imagination.
2. Value-base care: There is a broader, longer-term trend that we have seen and will likely pick up in 2022, which is the increasing pivot toward value-based care. This is a long-term issue and when it is exactly going to happen is unclear. What is the tipping point?
We are seeing increasing numbers of payers looking toward the direction of value-based care in behavioral health services. Certainly, providers are looking in that direction. There are many opportunities right now for value-based care. This is a huge area that needs to be taken in full opportunity because we are not there yet in terms of utilizing all that value-based care has to offer.
I doubt that we will see a retreat in value-based care. I expect that we will see more arrangements in that direction. It is a slow process—it is a long-term process. But the providers and payers that can get behind value-based care will see greater benefit, especially for their patients and the value that they are getting.
In the current fee-for-service scenario, I, as a provider, do a service, I bill for that service, and I get reimbursed for that service. Rarely does anyone check to see what value my services provide. There is an incentive to bill as much as I can—I do not have an incentive to make patients better. The incentive is to support the provision of services—not the outcome of services.
A value-based approach would look at things such as whether patients get better and how quickly they get better—are you more efficient in getting patients better. I could be a provider who gets all patients better, but it takes three years to do it. We should be incentivizing providers who get patients better more efficiently than that. There could be patients who do take three years to get better, so we must be careful with a value-based framework to make sure it understands the severity of our cases and understands that patients respond differently to treatment. This is one of the reasons why value-based care is taking so long in behavioral health—it is not easy to do.
3. Measuring outcomes: To provide value and quality in behavioral health, there will be an increasing emphasis on measuring outcomes. Some of the common payer-based outcomes are quite limited in terms of what is currently available. For example, payers will often look at measures such as utilization of emergency room services and the number of behavioral health sessions. Basically, they are looking at how often services are being accessed, and that often is not a true indicator of how people are doing.
Certainly, in terms of improving outcomes, we want to see people's use of emergency rooms going down, but that is a blunt instrument. It does not tell us much about whether symptoms are improving in patients who are not using emergency rooms.
Understanding the severity at the beginning of treatment helps you to understand your case mix. You should expect different outcomes for people with severe depression compared to people with mild depression—you should expect a different amount of time in therapy to get to the same outcome. We also need to develop ways to measure severity over time as a way to capture value. The blunt instruments that are currently available, such as how many times a patient went to the ER or how many sessions a patient got, do not tell the full story. They do not provide the level of precision that is needed to truly understand how well a provider is performing in managing their population. Patient-reported outcomes are critical in assessing mental health services.
4. Spike in anxiety: We are likely to see some immediate escalation of anxiety in response to the omicron coronavirus variant. I recently got a text from my brother, who had just visited a pharmacy. Close to a fight broke out over a new box of COVID-19 test kits; people were yelling and screaming at each other. The amount of anxiety is going to increase dramatically with omicron. It was already a problem over the past 20 months, but omicron is showing that we have increased vulnerabilities, and that is making people very distressed.
If we continue to experience new variants, we as a country are going to have to figure out how we are going to manage the associated mental and behavioral health impacts.
5. Telehealth: I expect that we will see increasing utilization of telehealth in behavioral health services. Telepsychology and telepsychiatry will become part of normal operations for behavioral health organizations. Telehealth is going to be integrated into what we do daily, and it is going to be factored into decisions that health leaders must make. For example, how do you expand services for telehealth versus in-person visits? How do you make sure you are not cutting your in-person access too much? You need to provide enough in-person access for those who need it but also provide telehealth access for those who need it as well.
We are transitioning to a mixed model. Over the past 20 months, mental health services have been provided almost exclusively through telehealth. In 2022, as we transition to much more of a mixed model of telehealth and in-person visits, there are going to be a lot of adjustments. How much space do we need for in-person visits? How do we monitor and control quality of care when a provider is working from home? These issues are going to play out both from a provider and payer perspective. In 2022, the mixed model will give us a glimpse of what care is going to look like for the next five to 10 years.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
The shift from fee-for-service to value-based care in behavioral health is expected to accelerate in 2022.
To provide value and quality in behavioral health, there will be an increasing emphasis on measuring outcomes this year.
In response to the omicron coronavirus variant, there will likely be a sharp increase in anxiety this year.