CVS Health's plan for behavioral health in older Americans

The mental health of older Americans has taken center stage as 20 percent of the population will be 65 years or older by 2030. The COVID-19 pandemic hit this generation hard, and they continue to struggle with mental health challenges.

"There has been an increase in people proactively reaching out and accepting treatment. We see that across all age groups, inclusive of older adults, and a lot of what we see is mild to moderate anxiety and depression," said Taft Parsons III, MD, chief psychiatric officer of CVS Health. "We see a lot of issues related to grief and loss in the older age group."

The pandemic accelerated loss of friends and loved ones, as older Americans were often high- risk individuals for complications related to COVID-19. Older Americans also experienced significant social isolation and lost their support network during the pandemic.

Payers and providers are investing in services and products to address the social determinants of health for older Americans, including loneliness and isolation.

"Having a lot of additional support and services provided to connect people with local community resources makes a difference," said Dr. Parsons. "We do that through our Resources for Living program where our staff connects members with community resources and local organizations for transportation, food programs, caregiver support and more."

CVS Health also offers a service with some Medicare Advantage plans to provide companionship for older Americans, either in person or in a virtual setting. The company found most people accepted virtual healthcare after trying it out with a few modifications, including big text and a simplified user experience.

"After folks had their first experience [during the pandemic], not only would they accept and tolerate it, but a lot of people now prefer it," said Dr. Parsons. "After we've now opened back up for the most part, in the mental health business we're seeing around 40 percent of our enrollees getting their healthcare online. There is a preference for using technology with a good interface."

And there is more good news.

"The industry has seen a greater appreciation of behavioral health challenges," said Dr. Parsons. "Whereas traditionally it may have been looked at as an expense that needed to be treated, you're now seeing an acceptance and encouragement to get the treatment patients need as early and robustly as possible. As we design health plans and administer benefits, we try to get people into the care we already know they need."

There are still access and availability challenges for behavioral healthcare; beneficiaries aren't always able to schedule an appointment with providers in a timely manner. The behavioral healthcare provider shortage in the U.S. has boosted competition between health plans to provide access to beneficiaries. Dr. Parsons said CVS Health is also finding ways to support primary care providers to help patients with mild to moderate anxiety and depression.

There are many great initiatives to address behavioral health challenges, but they are often difficult to scale.

"The collaborative care model works well for folks in the older age group," said Dr. Parsons. "They have chronic conditions and their primary care clinic should have a collaborative care model that integrates behavioral health clinicians and tools to help treat and manage those patients within the primary care clinic. It's effective in improving outcomes and helping people feel better."

From the public health perspective, providers are working on boosting population outcomes, and integrating behavioral health management into the overall strategy. Under value-based care, the care coordination responsibilities often fall on the primary care physicians to take on risk for outcomes instead of fee-for-service.

"We have different levels of value-based arrangements, which moves toward not paying for volume, but quality of care and outcomes instead," said Dr. Parsons. "When we can change the way we contract, collaborative care works well."

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