by Mercy's Jordan Larimore
ST. LOUIS — It’s no secret that access to behavioral health care has been a challenge across the United States for decades. That’s true for patients as well as health care providers and organizations. A shortage of mental health specialists often means long waits for patients who need appointments, sometimes urgently.
According to Patty Morrow, vice president of behavioral health operations for Mercy, the root of the problem is simple.
“There simply are not enough providers to meet the demand, particularly in areas where health care disparities already exist,” she said. “We cannot rely on the traditional referral approach to help people gain access to mental health care. Instead, we need to deliver more innovative and responsive solutions for our patients and communities. If we tried to go out and hire 20 psychiatrists, it would take 10 years. And even in that amount of time, I’m not sure we could do it.”
In 2017, the Centers for Medicare & Medicaid Services authorized a new model to help address the problem. Rather than approach the more complex issue of developing more psychiatrists and psychologists, CMS decided to allow behavioral health care access within the primary care setting. The approach is called Collaborative Care Management (CoCM). In 2021, Mercy began working with a company called Concert Health to provide this collaborative behavioral health care to patients.
“This approach is not only innovative, but scalable,” Morrow said. “Instead of a referral out, it brings behavioral health experts into the existing relationship between the patient and their primary care provider.
Concert Health provides behavioral health managers to patients via virtual and telephone visits, while a consultative psychiatrist supports the primary care physician in the diagnosis and treatment of various mental health conditions, such as depression and anxiety. The primary care provider, who already has the established relationship with their patient, manages the treatment, but with the support of the behavioral health care team working alongside them. Typically, patients can be enrolled in the Collaborative Care program within 24-48 hours, which is so important for patients experiencing mental health distress.”
The relationship between Concert Health and Mercy was piloted in Joplin, Missouri, and has recently expanded to Arkansas and Oklahoma, with plans to be implemented in all of Mercy’s communities by the end of 2023.
The Concert program made all the difference in the world to one Mercy patient. Caden Ullum, of Springfield, was told he’d be on a waitlist potentially eight months long to get a traditional appointment with a psychiatrist — even by phone.
“And you’re almost never going to get prescriptions written after your first appointment,” he said. “So, who knows, maybe it could’ve been closer to a year before I got help. I wasn’t on the brink of anything, but I was definitely going through a really tough time.”
Ullum decided to try the Collaborative Care program through his Mercy primary care provider. His call was returned the same day, and he had an appointment within a week. Today, he says he’s happy for the first time in years.
“I literally had to stop working for a second because I realized I was crying because of how happy I was,” he said. “I felt at peace that day, and that’s something some people take for granted because they don’t realize there are people who can’t be at peace in their own minds. “It’s not normal to feel at war with yourself. The respite I got, the moment I realized I wasn’t fighting, it was amazing. Without clinical help, I could not have moved forward as fast.”
Ullum said he believes collaborative care in outpatient behavioral health can literally save lives. Someone with suicidal thoughts, for example, may feel unimportant or defeated if they’re told they can’t be seen or receive treatment for months.
“It’s something that is an epidemic of its own, the amount of people that need help,” he said. “Not just that they are going through a rough time, but that they absolutely need help immediately. They don’t need help in eight months. They need it as soon as they can possibly get it.”
Another difference between the collaborative care model and traditional behavioral health care is cost, Morrow said. In a traditional care delivery model, patients would have to make a co-payment at each visit or therapy session. With Concert, the care is billed monthly based on how many minutes of care are needed.
“Maybe the patient needs a weekly touchbase. Maybe the patient needs a few minutes every day or three days out of the week,” she said. “It allows for the flexibility to have one 60-minute appointment, five 12-minute appointments or whatever else. In other words, you can tailor the care to what the patient needs. This approach is based on evidence-based care, and most patients see a significant reduction in symptoms. It has been an incredibly valuable component to our care model and transformative for the patients we serve.”