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What Walmart's walk-in mental health clinic reveals about how to improve care

April 11, 2019

    Walmart recently opened a mental health clinic in one of their Texas stores. Patients can now walk in without an appointment and receive treatment for low-acuity needs (e.g., stress, grief). Walmart's motivation to get into the behavioral health care game likely stems from a desire to increase foot traffic in their brick and mortar stores. To do that, they’ve jumped on a key service gap: access to behavioral health services.

    How to improve behavioral health access in a time of severe provider shortage

    The fact that the lack of behavioral health access caught the attention of a disruptive innovator like Walmart is indicative of the problem. There's an overwhelming need for care and less than half of patients receive services.

    During last month's webconference, we unpacked the behavioral health access challenge and discussed strategies to scale services and bridge care gaps. Here are our three key takeaways.

    1. Despite promising signs for behavioral health reimbursement, significant barriers still restrict access to care

    Payment for behavioral health services seems to be on the rise—CMS has added new reimbursement codes to divert patients to psychiatric facilities when needed, and the Mental Health Telemedicine Expanion Act (HR 1301) was reintroduced in Congress earlier this year. If passed, HR 1301 would allow patients to receive reimbursable telehealth services from home.

    But major roadblocks remain ahead for improving access to care—and frankly, they're not new:

    • Provider shortages: Projections indicate that the discrepancy between behavioral health need and available providers is only going to worsen. For instance, the psychiatrist shortage is expected to almost triple between 2016 and 2030 (from 7,810 to 21,150).

    • Patient adherence: Patients face a variety of barriers preventing them from getting the care they need—whether it's the price tag, stigma, or not knowing how or where to access care.

    • Limited insurance coverage: The ACA requires insurers to cover inpatient behavioral health services, substance use treatment, psychotherapy, and counseling. However, coverage for the remainder of behavioral health services varies across care settings, payers and states. Further, private insurance denial rates for mental health care claims are twice that of medical claims.

    2. Start by filling gaps in today's common access points

    To improve access to behavioral health care, providers need to use their primary care offices to engage patients with upstream services. Many organizations already integrate behavioral health services into primary care to some extent. The next-order strategy is extending the reach of behavioral health professionals across your primary care network and expanding substance use disorder offerings. This means training PCPs on how to deliver medication-assisted treatment, adding staff to address patients' psychosocial needs (e.g., peer support), and using telehealth to scale physician-to-physician consults and primary care-based behavioral health visits.

    Providers must also be prepared to manage patients that present to the ED in crisis. Instead of boarding patients with psychiatric needs until an inpatient bed becomes available, providers must add capabilities to address acute behavioral health needs immediately. Many providers embed telepsychiatry into the ED. Those facing particularly high demand may even dedicate specialized psychiatric units in or nearby the ED to stabilize crises and connect patients to community resources.

    3. Offer new touchpoints for ongoing management

    Providers should leverage IT platforms and community partnerships to provide patients with access to care between in-office appointments. IT platforms, such as phone apps and interactive websites, are effective tools for engaging patients. Some focus on improving self-management through guided coping exercises and symptom trackers. Others serve as an extension of the care team by enabling patients to text peer coaches when they have low-acuity questions. These technologies enable cross-team collaboration, allow providers to engage with patients anytime, and monitor patients' responses to treatment.

    Community partners, such as EMS providers and housing agencies, can serve as stabilizing agents. These partners can divert patients to the right site of care and address underlying social needs. Lastly, local behavioral health providers can manage care for patients best-managed in the community following a warm hand-off.


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