Earlier this year, Magellan, the last carve-out Behavioral Health company, was sold to Centene Corporation. The official closing of this deal will mark the end of a 50 year era of the Independent Behavioral Health carve-out companies. Mostly started as risk bearing companies that “managed” Behavioral Health at a regional level, eventually these entities were rolled up into ‘Full stack “companies managing all levels of care.
Why this is important
The promise of these full stack solutions fell far short of their goal of improving quality and access to mental care. In fact, navigating individuals to the right mental health resources lags nearly every other condition category in terms of access to quality care.
We need a better understanding of the barriers
Conventional wisdom would have you believe that the de-stigmatization of mental health combined with the Covid-driven acceleration of telehealth services somehow marks a tipping point in achieving this long sought-after democratization of quality mental health access. While these are important barriers to overcome, they get too much oxygen when compared to some of the underlying factors at the root of the dysfunction. Namely:
1. Activation: The system only treats a third of the individuals who have a behavioral condition annually.
2. Engagement: The system tends to only serve the hand-raisers seeking intervention at particularly intense intervals. This translates to serving a small percentage of the population a low percentage of the time.
3. Matching: Finding the right provider is still a game of chance. Front assessments need to improve and lead to better match to digital or in person interventions.
4. General Health Integration; While there is consensus that mental and physical health are intertwined, mental health integration with general healthcare remains elusive.
5. Chronic Illness Integration: While mental health is a prevalent co-morbidity of many chronic conditions, an integrated behavioral and physical care plan is the exception.
6. Outcome Measurement: Mental Health outcomes of individuals and populations have not been well measured.
Do not repeat the mistakes of the past
There is a massive difference between a Digital First Behavioral Health approach and a Digitally Enhanced Behavioral Health approach.
A digital first approach is completely disruptive to the dysfunction described above, namely in its ability to:
1. Lower the barrier to engagement through privacy and accessibility
2. Efficiently triage patients without human intervention
3. Engage individuals with appropriate interventions based on their needs
4. Maintain an ongoing mental health status on an individual based on implicit and explicit data variables
5. Optimize care pathways based on results
6. Maintain evergreen availability
7. Seamless integration between providers, devices and care journeys
Unfortunately, most health systems travel the Digitally Enhanced path. Sure, the surroundings look nicer, but the core product is still abysmal. These systems are just transferring the dysfunctionality from the analog to the digital world. And while apps and telehealth are helpful in reducing stigma and broadening access; it isn’t addressing the fundamental issues that 1) have made it so difficult for individuals to get adequate mental health care and 2) are eminently addressable if you approach mental health from a digital first perspective.
How to take a Digital First Approach
1. Invest in a platform, not just an aggregation of point solutions. The beauty of a platform is that it will engage your populations on an ongoing basis and allow you to introduce the appropriate point solution at the appropriate time of their care journey.
2. Prioritize Activation: To quote the great Wayne Gretzky, “You miss 100% of the shots you don’t take.” The Mental Health equivalent would be that you help 0% of your population that you don’t activate. Solutions that are difficult to discover, access and understand create an artificial ceiling on your organization’s ability to reach and support its population. Market the availability of solutions to help people in need. Make access easy and convenient.
3. Engagement, Engagement, Engagement: Mental Health, like physical, is a lifelong practice. People’s mental health needs will ebb and flow, it is imperative to have both depth and breadth of interventions and services that enable relevant support no matter where they are along their mental health journey.
4. The data you can derive from ongoing Behavioral Health interactions with a population is unique and has the potential to unlock massive value to both individual and organization, alike. Imagine a world where everything from chronic care plans to organizational risk models were informed by an updated mental health profile as opposed to claims data.
As exciting as the technological and care model advancements in Behavioral Health are, we must understand that they are pieces of an overall puzzle that can’t work independently. Only through the connective tissue of a digital first platform can we finally fulfill the mission those Behavioral Health companies started 50 years ago; to truly democratize mental health care.
Click here to download a Twill guide on how to implement a digital first solution.
About the Author
Andy Sekel As a previously practicing psychologist, Andy Sekel, Ph.D. has deep experience in Behavioral Health and is currently serving as a Managing Partner at Marketplace Fund as well as a board member at several notable behavioral health companies, including Chairman of the Board of Twill. Prior to that, as CEO for Optum Specialty Networks, he oversaw behavioral health, and complex medical and physical health clinical services that improved the overall health and wellbeing of individuals in the employer and health plan markets.