Reimbursement will be one of the biggest challenges facing behavioral health this year, according to Robert Trestman, MD, PhD, professor and chair of psychiatry at Virginia Tech Carilion School of Medicine.
Despite limited supply, reimbursement rates for psychiatry and behavioral health aren't going up, Dr. Trestman said. At the same time, the behavioral health sector is also confronting new disruptors and higher-need populations.
Dr. Trestman will speak on the panel "Transforming Behavioral Health Delivery in Health Systems and Hospitals" at Becker's Behavioral Health Summit, June 19 in Chicago. Dr. Trestman caught up with Becker's to explain the top challenges facing behavioral health right now:
- A lack of resources and reimbursement is a major challenge facing behavioral health, Dr. Trestman said.
The public sector, where people with serious mental illness are often cared for, is facing an acute shortage of inpatient beds, Dr. Trestman said. Very few states have adequately funded behavioral health systems systems, he added, leading to a "cascade of challenges."
"When people are not provided adequate care in an outpatient setting, they show up in emergency departments," he said. "They get sucked into substance use disorders. They get involved in the criminal justice system."
In private practice, many psychologists and psychiatrists do not accept Medicaid or Medicare, or may not accept any form of insurance, because they can attract enough clients who are able to pay out-of-pocket, Dr. Trestman said.
"There's a significant number of people who are highly trained who are only dealing with the relatively well-off, compromising the workforce's ability to take care of everyone," he said. - New disruptive models in behavioral care, like seeking care online or in a pharmacy, come with their own set of challenges, Dr. Trestman said.
Some of these models are failing quickly, he said, while others have found ways to evolve.
"They come with a real disparity, because some people can afford that kind of out-of-pocket expense, but most cannot," Dr. Trestman said.
These kinds of services are rarely coordinated with the rest of someone's healthcare providers, Dr. Trestman said.
"The kind of interventions that might happen over a telehealth connectivity with a for-profit mental health company, that's not going to be closely coordinated with the rest of your healthcare," he said. "If you are on other medications, that can be problematic." - Behavioral health will have to grapple with how to meet the needs of an aging population and younger people with more acute mental health needs, Dr. Trestman said.
Psychiatry will have a role to play in addressing the rising number of adults with dementia, he said. By 2060, the number of older adults with dementia is expected to double, research published in January found.
"How are we going to provide care, and can we intervene, appropriately, psychiatrically, to keep them healthier longer?" Dr. Trestman said.
Behavioral health providers also have to support young patients, who are dealing with serious anxiety, depression and suicidal thoughts that were more uncommon 20 years ago, he added.
"We are challenged with all of these pressures about real needs, genuine needs," he said. "People need care, but the structure is not appropriately designed to efficiently optimize care delivery."