Physicians are facing a “perfect storm” in behavioral health, with more patients seeking treatment amid limited access and an understaffed workforce, Robert Trestman, MD, PhD, chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine in Roanoke, said at a Dec. 4 HHS-CMS event.
The challenge, he said, lies in how health systems can support large volumes of behavioral health patients while managing limited time, access and resources. For Dr. Trestman, the answer is integration and measurement-based care.
CMS is set to roll out a tech-supported care model for chronic conditions — including behavioral health — that aims to test whether tying recurring payments to health outcomes can accelerate adoption of digital tools. Participants will receive recurring payments to manage patients’ conditions, with payment tied to specific health outcomes.
A majority of Medicare patients present with a comorbidity, whether it be a cardiac, metabolic or orthopedic condition, making patients’ cases more complex when they do access care. He said “improved coordinated care and access to all of the integrated care and coordination among ourselves is critical and lacking in the current system.”
Dr. Trestman said using consistent, standardized tools such as the PHQ-9 and GAD-7 helps support measurement-based care in behavioral health. It is meaningful for patients to see their depression scores trend downward over time, he added.
“It’s not the traditional subjective information,” Dr. Trestman said. “The objective data may not be perfect yet, but it is far superior to anything else.”
He also emphasized the importance of telehealth.
“The reality is particularly for many of us who practice in rural America, [telehealth is] the only way we’re going to be able to leverage our limited abilities to meet the needs of our patients,” Dr. Trestman said.
To support measurement-informed care, physicians can utilize telehealth paired with accurate diagnostic capabilities at the point of care — often through primary care and models such as a collaborative care model, he said.
“The administrative burdens are significant, but the more profound challenges are really the support for decision-making,” he added.
