The Daily Briefing's Aly Seidel spoke with Advisory Board expert Jasmaine McClain about why improving pediatric behavioral care is not just a moral obligation—it's a financial opportunity.
Question: At a time of when providers have to be choosier with their service offerings amid mounting financial pressures, why should they invest more time and resources in pediatric behavioral health?
Jasmaine McClain: Plenty of providers are asking themselves that question, but the benefits of investing in pediatric behavioral health are clear, both under fee-for-service and value-based models.
In the fee-for-service world, the demand is there. Twenty percent of youths 12 to 17 have some sort of mental health issue, so there is a population that needs to be served.
Under value-based care models, investments in pediatric behavioral health will result in better outcomes and increased continuity of care, and that's going to save providers money.
Consider patients with comorbid mental and physical diagnoses. If you're a 14-year-old with depression and you're also managing a diabetes diagnosis, you may not be able to manage everything you need to do for both of those conditions. You may fall down on medication adherence and keeping in touch with your doctor—and for providers, the result is that costs go up.
When health systems can meet patients' mental health needs, they also can manage their chronic conditions appropriately while keeping costs down.
Beyond the financial case, there's the moral case: Think of your own child, your own sibling, your own student. If this is a model that really can impact the quality of life for pediatric patients, especially in such a key stage of a young person's life, I think it's really important to meet that need.
Q: So from a provider's perspective, how does pediatric behavioral health care differ from behavioral care for the adult population?
McClain: Kids touch a lot of different facilities: They're going to school, they're working with their caregiver—there are so many different people involved. The result is that patients slip through the cracks often: 60 to 90 percent of pediatric patients who have behavioral health conditions don't receive any sort of treatment.
Q: How are providers meeting those challenges?
McClain: We're seeing a lot of different methods. In Colorado, Beacon Health Options created a program that serves 52 primary care practices that represent a high-need, low-access patient population. The program, Colorado Psychiatric Access & Consultation for Kids (C-PACK), connects primary care providers with behavioral health specialists.
Primary care providers are on the front line and really are looking for support, so both the behavioral health specialists and the primary care providers are really excited to have an extra hand to support the patient—without needing to undertake a really resource-intensive model of integration.
The program's most commonly used approach is telepsychiatry consults. When providers have a question about behavioral health, they can connect with a child psychiatrist, and they normally get a call back within 15 minutes. The primary care provider is still the treating physician, but the consulting psychiatrist can talk them through things like screening tools and medication management. After these consults, many primary care providers report increased comfort in addressing behavioral health issues in their practices.
It's been successful so far. As of last December, the C-PACK call center had supported almost 1,500 calls, representing about 1,350 unique patient cases. Six months into the program, providers demonstrated a 17 percent increase in their use of evidence-based screening tools for mental health conditions.
And the great thing about this model is how scalable it is. We've heard from providers, "Not only did this help me with this patient, but makes me feel empowered to help my next 10."
Q: You mentioned all the different players involved in kids' lives: schools systems, caregivers, providers. With so many parties in play, how can we ensure the patient gets the appropriate care from the right people?
McClain: The idea that you can just slam different institutions together and expect that everyone will know what to do is short-sighted. Dr. Marshall, a behavioral health specialist at St. Charles Health System, has spoken with Advisory Board at length about the softer skills necessary when implementing a behavioral health program. Marshall had worked in a school system before, so she had an insider's view of the challenges in coordinating care between a school and a medical practice.
One of her approaches was to create an ADHD packet, which outlined step-by-step the expectations of both the school and the physician, because she found that neither party really understood the other's expectations or goals. That's so important in pediatrics, because of course everyone wants to help the child, but there are complex organizations on all sides. St. Charles' approach was smart and thoughtful about the human elements.
Q: One last question: What advice would you give to a practice that's looking to integrate more behavioral health offerings into primary care?
McClain: Stigma surrounding mental health is real, among both patients and providers. At St. Charles, we've seen a total overhaul of how they treat patients with a behavioral health diagnosis. It starts with terminology: Instead of saying, "This person needs to see the psychiatrist," they began to use new language, like, "I'm going to take you over to visit with my colleague next door."
Those small changes can help manage some of the stigma surrounding mental health, and they can encourage young people to reach out when they need help, because they know their doctor is coming from a safe, nonjudgmental place.
Next steps: Learn 4 successful models that increase access to behavioral health care
Join McClain for a webconference Tuesday, November 8, where she'll review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.
Next in the Daily Briefing
Around the nation: Why public health groups are opposing this cigarette tax