Opinion: Everyone Deserves Access to Top-Flight Behavioral Healthcare

The Centers for Medicare and Medicaid Services recently announced that they will launch a pilot program that could help many people with mental health conditions and substance use disorders secure the coordinated care they need to overcome their health challenges.

Innovation in Behavioral Health, or IBH, will kick off this fall and run for eight years. The model will link Medicare and Medicaid beneficiaries with community-based behavioral health providers, who will work to address not just their physical and mental health but the social factors that influence it.

Ideally, the model should be expanded to those who have employer-sponsored coverage, too. Doing so would ensure that many more people can benefit from it. Such an expansion could even save taxpayers money.

The need for IBH is clear. One-fourth of Medicare enrollees experiences mental illness. Four in ten Medicaid beneficiaries grapple with mental illness or substance use disorder.

The program takes an integrative approach whose goal is to “bridge the gap between behavioral and physical health.” Beneficiaries receive health screenings, outpatient care, referrals to specialists, and ongoing monitoring.

Consider a person with hypertension and generalized anxiety disorder. Under the IBH model, that person could be placed in exercise and meditation classes and undergo regular check-ins with a primary care provider to assess their blood pressure levels. The program pairs patients with a care team that includes a peer support advocate and a case manager who can connect them with resources for food insecurity, housing instability, or unemployment.

Unfortunately, there’s a benefit cliff inherent in the IBH model that is not in patients’ — or the government’s — interests.

Imagine that enrollees in the model succeed. They secure effective treatment for a mental health challenge or opioid use disorder and are able to find work and disenroll from public coverage. What then? Under the model’s current structure, they’d lose access to the coordinated, community-based providers and counselors that have helped them gain control over their health.

They might relapse — and fall back into the grip of mental illness or addiction. They could lose their jobs — or worse.

According to the National Institute of Drug Abuse, effective care depends on consistent treatment over time and requires ongoing monitoring and reassessment. A longitudinal study from UC San Francisco and Kaiser Permanente found that individuals with substance use disorders were more than twice as likely to avoid relapsing when they had continuing care after treatment.

The government, meanwhile, may end up paying more for their care than if it had allowed them to continue with the IBH model after disenrolling from public coverage. Employers lose out on workers they’ve trained and are counting on.

Most importantly, beneficiaries lose access to care that’s made a difference in their lives.

That’s why it makes sense to expand the model to include people with employer-sponsored coverage as potential beneficiaries. Employers can pay for the cost of their employees’ care through the model. The important thing is that they retain access to it.

And there are likely a number of people with coverage through work who would benefit from gaining access to the integrated services offered by IBH. One-fifth of American adults experience mental illness, and around 15% have a substance use disorder.

Two additional tweaks could make the IBH model even more effective: adding coverage for dental and vision care.

For enrollees in the IBH program to recover successfully, their dental needs will need to be assessed and treated. Without dental care, they may struggle to integrate into the world around them and obtain and keep jobs. Studies have found that people who struggle with mental health are more likely to have poor dental hygiene. And oral health problems including periodontal disease are among the most common comorbidities of substance use disorders.

Similarly, correction of vision is key to recovery and functioning well in the world. Research has shown that substance use can lead to vision impairment.

An effort to address the health needs of people with serious mental health and substance use challenges is incomplete without delivering dental and vision care.

The Innovation in Behavioral Health model represents a profound shift in how American health officials think about mental health and substance abuse disorders. They can be manageable and treatable, with comprehensive, coordinated treatment.

Everyone deserves access to it. Medicare and Medicaid can move us toward that goal by opening the model up to those with employer-sponsored coverage.

Jessica Brooks-Woods is the CEO of the National Association of Benefits and Insurance Professionals.