Where is the robust and comprehensive healthcare system that Americans are paying for?
Despite spending $4.5 trillion per year on healthcare (almost $14,000 per person annually), patients simply aren’t getting any better. They’re getting worse, much worse.
If you think about it, what are patients really paying for? As far as psychiatry and traditional therapy goes, if they can even access care, patients pay for volume—more tests, more visits, and more time living in misery.
It’s a raw deal that’s perpetuating America’s mental health crisis.
Arguably, traditional mental health care is built to keep patients, not heal them.
But stigma and staff shortages don’t tell the whole story. Therapists and psychiatrists in both community settings and private practice rely on personal qualitative judgement when treating their patients. And the current Fee-for-Service model incentivizes providers to keep their patients in the specialty care setting without a clear off-ramp to lower levels of care. Without measurement-based care, patients don’t understand what a good outcome looks like and even worse, neither do providers.
Altogether, this approach achieves three things:
- Therapists and psychiatrists earn fees for each service rendered, regardless of outcomes.
- Since patients never have a measurable treatment goal, services don’t have an end point. Thus, patients stay in services, caseloads remain full, and new patients can’t get an appointment. This proliferates a system that already lacks enough workforce to address the crisis.
- New patients struggle to find providers that accept new patients, the system is complicated to navigate, and over 70% of patients who need services never receive care.
Make no mistake—this is by design.
The current fee-for-service system has perverse incentives that drive therapists and psychiatrists to build patient panels and hold onto them indefinitely. This approach is no longer tenable—nor acceptable. More importantly, it's no longer acceptable for healthcare leaders to think that we can solve the mental health crisis without considering the need to completely redesign the system and change the incentive structure.
We must rethink how we deliver, measure, and incentivize care. Here’s how.
Since launching evolvedMD in 2017, we’ve put intentional work into how we deliver care, measure impact, and incentivize outcomes. It’s how 60,000 unique patients who either did not have access to care or were trapped indefinitely in a broken system started living happier, healthier lives.
Integrate Care, Not Separate It – We must treat physical and mental health care in one setting. In 2022 more than half of the nearly 60 million people living with a mental illness who did receive treatment visited their primary care doctor. But most doctors don’t have the resources, funding, or expertise to treat mental illness. Staffing mental health therapists at their primary care practices is the first step to increasing access to care and improving outcomes. To date, evolvedMD is onsite and in person at over 220 primary care sites across five states (AZ, UT, NM, CO, and FL).
Measure Every Patient, Every Visit – Therapists and psychiatrists can’t afford to treat their patients based on personal judgment alone. They need a quantitative baseline to tailor care to each patient’s specific needs. During routine checkups, PCPs may use clinical screening tools such as the PHQ-9 and the GAD-7 to measure depression and anxiety, respectively. Their scores give on-site therapists and psychiatrists a comparative metric which to begin treatment from. For example, a GAD-7 score of 20 is a meaningful baseline indicating the need for therapeutic interventions to treat anxiety.
Measure Quantitative Outcomes – Therapists and psychiatrists have long documented their clinical impressions and other subjective information: “Patient presents with anxiety about work,” or “Discussed anxiety patient has regarding work.” These are not tangible, measurable, quantifiable, or ultimately helpful. Measuring outcomes at a granular level enables providers to assess whether interventions are working and adjust treatment plans accordingly. Collaborative care settings allow both to take place while using patient registry and an electronic health record (EHR). A provider can screen patients for mental health conditions and log the scores for validated measurement tools into the EHR. Over time, the team of providers at that site (PCP, therapist, psych consultant, nursing staff) can review the patient’s screening scores and adapt as necessary. For example, a patient who initially scores a 20 on the GAD-7 and then an 8 just three visits later shows meaningful, quantifiable progress. This allows both the PCP and therapist to conclude that their patient achieved a 60% reduction from their most recent max assessment score. They are making progress towards targeted care outcomes, this is measurement-based care.
Incentivize Value, Not Volume – While Fee-for-Service models incentivize volume, we believe providers should be incentivized to deliver outcomes. Not only does it ensure we meet patients’ needs, by delivering targeted outcomes, but it also encourages us to proliferate a system that generates ongoing capacity for new patients. At evolvedMD, we incentivize each provider to track and measure outcomes. That’s how we’ve achieved up to 22% better clinical outcomes than industry average during a course of treatment that lasts 4.5 months on average. This approach allows us to deliver high-quality outcomes and then graduate patients off our panels, thus allowing us to see more patients seeking help.
What does this value-based approach ultimately lead to?
Many things:
- Treating physical and mental health together, not separately, leading to whole-person wellness.
- Delivering exceptional patient care now, not later.
- Ensuring treatment is quantitatively, continuously evaluated, not ignored.
- Creating capacity, not bottlenecks and barriers for patients who need care.
From therapy to psychiatry, we can no longer incentivize behaviors that trap struggling patients in a broken system. evolvedMD has proven we can deliver value at scale, creating both capacity and access to care for Americans and their families. Focusing on value, not just volume, by measuring outcomes is the only hope we have for solving the mental health crisis. Integrating physical and mental health within a measurement-based care model is the future, it is now time to cast a broken behavioral health system aside and start anew.
If you want to learn more about delivering measurement-based care, please feel free to reach out at erik.osland@evolvedmd.com.