How to Improve Care for Medicare Members by Integrating Behavioral Health

This is the third article in a six-part series exploring ways to improve the delivery of whole-person, value-based care to Medicare and Medicare Advantage populations. In this post, we explore strategies to more seamlessly integrate behavioral health (BH) services into care plans for Medicare members.

You can also download our white paper Effectively Managing Medicare Populations: 6 Focus Care Areas to get more information and insights.

Among Medicare beneficiaries 65 years or older, 13% reported depressive symptoms, according to data from CMS. Meanwhile, a recent analysis correlates treating symptoms of depression in Medicare patients with a 4% cost-of-care reduction, further confirming the value of treating more than just physical health.

Why Behavioral Health Is Critical to Whole-Person Care

Research confirms that behavioral health impacts overall physical health. According to the CDC, depression can increase the risk of long-lasting health conditions like diabetes, heart disease, and stroke, all of which are common among Medicare beneficiaries.

CDC also found that chronic conditions can increase the risk of mental illness, which makes addressing behavioral health alongside physical health especially important for Medicare populations.

Common Barriers to Behavioral Healthcare Services for Older Adults

Despite the integral role behavioral health plays in whole-person health, Medicare populations may not be getting the behavioral and mental health (MH) services they need. A Commonwealth study found: 26% of Medicare beneficiaries reported that they put off seeking help because of cost.

Another prominent challenge is a lack of access to transportation. A study published in the September 2020 Journal of Psychiatric Practice also identified the following barriers:

  • Attitudes and knowledge among older adults(e.g., negative mindset regarding seeking help for mental health or behavioral health challenges)
  • Provider-related factors including Medicare acceptance and a dwindling number of qualified professional
  • Cultural barriers and unique stigmas associated with older adults in minority populations

Should You Incorporate Behavioral Health for Improved Whole-Person Wellness?

The short answer is “Yes.”

Care teams play a pivotal role in bridging the gap between mental, behavioral, and physical health. Care management team members and clinicians need to proactively identify members who may have depression or other mental or behavioral health conditions.

Meanwhile, payers should look to integrate behavioral health services into the member health plans, while providers should address the whole patient and identify where a mental health and/or behavioral health professional(s) may be key to a patient’s long-term health.

Now, that being said, integrating mental and behavioral health isn’t necessarily easy. Care managers and clinical teams face barriers of their own when it comes to proactively linking Medicare members with appropriate services. Lack of visibility into events (e.g., a behavioral health episode that results in an ED visit; member nonadherence to a medication regimen or treatment plan) and insufficient knowledge about or limited availability of resources all can stand in the way.

How HELIOS Can Help with Behavioral Health

With HELIOS, care managers can more easily identify members who could benefit from behavioral health and/or mental health support. HELIOS can also help care teams across the continuum to provide educational resources and connect members to community organizations and programs.

Below are some ways in which HELIOS can help care managers, payers, and providers support behavioral health needs for whole-person member care.

Identify and help people who may be experiencing mental or behavioral health challenges. Automated tasks and configurable workflows help care managers identify people who may be experiencing mental or behavioral health challenges. The same workflows can also auto-create referrals, auto-assign care managers, auto-generate appropriate tasks and assessment recommendations, and auto-populate care plans.

Built-in industry-standard, evidence-based behavioral health screening tools and content. Properly supporting behavioral health needs requires a collaborative, interdisciplinary care team approach. HELIOS enables this with a dedicated suite of built-in behavioral health tools and resources such as age-specific patient health questionnaires (PHQ) and behavioral-focused care plans, protected diagnoses, regulatory reporting capabilities, and more.

Virtual behavioral health support. With capabilities to virtually link people to mental, behavioral, and other healthcare professionals, care managers can quickly and cost-effectively get the appropriate support that members need. HELIOSvisit is especially useful for Medicare and Medicare Advantage populations who may suffer from tech literacy but need extra face-to-face support, as well as for members lacking transportation. With HELIOSvisit, care managers can video chat, make phone calls, and instant message with members. For members who are isolated or have a limited support network, this can help provide motivational and emotional support as needed.

Time to build meaningful member relationships. HELIOS automates care management processes, insights, workflows, and reporting to give care teams time back to focus on member relationships. By building trust and forging deeper connections, clinicians and care management team members can better understand mental and behavioral health needs, improve care experiences and outcomes, and ultimately drive higher satisfaction rates that could influence things like Medicare Star Ratings.

Provide educational content to help members understand their behavioral health and mental health needs. HELIOS integrates with Healthwise, an industry leader in health education. Care managers can easily access and share evidence-based educational content to help members better understand any MH or BH diagnosis they may have. They can also share resources explaining how MH and BH treatment can improve physical health outcomes, encouraging them to embrace BH and MH care.

Surface population-level data indicating member cohorts that may face unique cultural barriers to behavioral health services. Armed with this information, care managers can tailor conversations about behavioral and mental health to increase trust and engagement among these members. Then, they can further identify gaps in knowledge and care and get members connected to valuable resources, services, and supports, which leads to better health outcomes and decreased cost of care.

H3: Learn More About How to Improve Medicare Population Health Management

Check out the other five posts in this series to see how to improve medication adherence and outcomes for members who need additional support and services.

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