May 23, 2023
Mental Health Awareness Month

Interview with Dr. Donna Baldwin, Chief Quality Officer and Head of Clinical Strategy and Sue Mihojevich, Vice President, Strategic Partnerships.

Creating a More Equitable Care Model in Women’s Health
Video Thumbnail - Mental Health Awareness
Q: Is mental health still a really important topic in America? What are you seeing?

A: Sue - Absolutely. you know, nearly 21% of the population reports being diagnosed with depression in 2021. About 55% of primary care physicians are reporting seeing a rise in patients with depression within their practice. We continue to see the need for mental health and behavioral health resources accelerate.

Q: Can you tell us what's been changing in healthcare in America?

A: Dr. Baldwin - Since the beginning of the pandemic we've seen an incredible upsurge of mental health concerns and conditions. According to stats from US News and World Report, around one in five American adults have dealt with a form of depression, with data indicating symptoms are most prevalent among young adults and women. May is also Women's Health Month, a topic that’s very near and dear to my heart, so it’s especially important we recognize the toll the pandemic and these past few years have taken on women.

As family medicine physicians, we see patients with chronic conditions. And depression and anxiety play a huge role in actually improving the wellness of certain conditions. The data certainly suggests that people with diabetes, people post MI or heart attacks, do have depression and anxiety. So what's changing is that in a primary care setting, we're having to really address these conditions up front in order to really make differences in chronic conditions. We also know that people are finding it harder and harder to find the care that they need with the shortage of primary care physicians as well as the shortage of behavioral health providers.

Q: What are you seeing from a business perspective?

A: Sue - Buyers of behavioral health services are increasingly becoming employer organizations. Having an EAP is table stakes for any employer organization, but they're recognizing unless they offer resources that are more longitudinal in nature, that they're not really providing to their employees kind of a whole package around behavioral health.

What employees are doing is examining how well what their employer does in terms of an overall culture of wellness, supports their individual behavioral health, and people are making decisions about whether or not they can or can't work within certain environments based on how closely those two values are aligned for them. 

I also see that employers are tired of paying for behavioral health resources, perhaps through their payer, through a third party, and then not seeing any kind of qualified outcomes. So they're interested as a self-funded employer - or one that's heavily invested in retention and retaining employees over the long run - in making sure that the resources that they're making available are actually creating an outcome that allows for that employee to feel healthier and happier and more productive at work.

The other thing that employers are looking towards is making sure that their solutions that they're offering to their employees aren't disparate. They're looking for an opportunity to combine resources and create meaningful referral pathways between supported benefits that they're paying for, for their employees with the idea that the synergy between those resources should create a better outcome than offering individual point solutions that the employee has to navigate on their own.

Q: How is virtual care impacting the treatment of mental healthcare issues?

A: Dr. Baldwin - So as we discussed earlier there is a severe lack of access for patients to receive mental health care and virtual care can really help innovate and solve some of these access issues. I do think there's still a stigma around behavioral health. And so a virtual care solution that really allows for whole person care really can make a difference. Patients don't have to decide if they need to see a therapist, a psychiatrist, or a primary care provider. They can actually come on [the platform] and see just a primary care provider who can assess their needs. They can also help them get to the resources that they have in their existing healthcare ecosystem. 

I do believe, as Sue mentioned, the importance of maintaining outcomes and studying outcomes. We know that more and more people are using technology to access care, and agreeing that digital health services have made mental healthcare more accessible, whether it be directly speaking with a provider or using cognitive behavioral tools or even using therapy virtually. So, using a comprehensive approach to mental health is really important, and certainly primary care is that nice entry point for patients to feel comfortable and to get the coordinated care that they need.

Q: We saw a lot of new mental healthcare providers come online during the pandemic. Are all of these models sustainable? Do we now have enough mental healthcare providers?

A: Sue - We absolutely do not have enough care providers for everybody's needs. And in fact, the delta on what we need is nearly 15,000 additional therapists in order to provide adequate services to everybody who could use them. The digital tools allow for providers to create greater access and to be able to tailor their treatment plans around the specifics of the patient. So not everybody needs to see a licensed clinical social worker or a psychologist or a psychiatrist. And so a lot of the models have introduced things like life coaches, mentors, mental health, wellness coaches, and that entire group of professionals are perfectly designed to address some of the common stressors that happen in everyday life, whether it's the birth of a new baby or you're changing jobs you have some complicated grief, maybe you've lost a parent or you're coming out of covid and still really struggling with what's happening.

That's different from somebody perhaps who has an actual diagnosis of mental health, may need a medication evaluation, should be seeing somebody in a more intensive way. So the digital tools have allowed for scale and for the scope to increase, but in terms of actual therapists that are still needed for the general population, there's gonna be a shortage for quite a while. And that access barrier, again, as Dr. Baldwin talked about, can be overcome, especially when you have a virtual primary care model that's able to drive people to the right resources and cut through some of that access and confusing web and get them hooked up with the right provider and the right service as soon as possible.

Q: Why is the role of the primary care physician so important in delivering mental healthcare?

A: Dr. Baldwin - I think there's still a lot of stigma around mental healthcare, and so it makes it more comfortable for patients to often be seen for something else. I saw a lady yesterday who was coming on [the platform] for concerns about her diabetes and she was struggling with not taking her medicines. Come to find out she was depressed. And we discovered that through asking questions, listening. And so without being able to address her depression, her diabetes was never gonna get better controlled. 

I think sometimes patients don't know that they have depression or anxiety or they're too afraid to talk about it. I also see women that think it's silly to take time out to talk about being anxious when in fact it really does impact their wellness. And so creating a, an environment that's safe that's comfortable and that's easy for them to talk about, really helps to, as a primary care physician, to really address these issues and help people to wellness.

Q: Can you talk about the benefits of identifying issues earlier?

A: Dr. Baldwin - Just like any other disease process, the earlier in the time that symptoms start showing up can make it easier to treat, but also preventing other comorbidities or issues down the line. For example a urinary tract infection that goes unnoticed or untreated can really lend itself to a kidney infection, sepsis requiring more healthcare cost as well as more potential for harm. Depression is the same way if depression goes unnoticed, untreated and unmanaged can lead to things like suicidal thoughts, poor productivity, possibly inpatient hospitalization. So the healthcare costs for mental health conditions really equal that of other diseases that we see in the medical field.

Q: What would you add onto that from the employer's perspective, in terms of treating mental health earlier and identifying issues sooner rather than later?

A: Sue - Employers are in a perfect position to make behavioral health resources more accessible. They are in an ideal position to address things like cost and assist with navigation. Aligning their culture to one of wellness allows for them to address the stigma that is still associated with reaching out for help. And I think overall, if employers and other plan sponsors can provide really well-rounded options so that there are multiple points in which somebody may be able to reach out for help through their employee assistance program, through their virtual primary care solution, through their health and wellness benefits and initiatives. That way they give people a number of different ways to think about accessing care. And they don't have to wait until somebody is diagnosed or their stressors have become a productivity, a job performance, or a really major life stressor, but keeping behavioral health in the forefront of how they talk with their employees about taking care of themselves.

Q: Why does it make such good business sense to be taking care of mental health issues?

A: Sue - Cost is a big driver. Healthcare spending overall increased more than 14% between 2016 and 2019, and 29% of that was related to mental health. Half of the millennials, 75% of the Gen Zers, indicate that they've left the job either voluntarily or not due to a mental health concern. And so employers are in a perfect position from a financial perspective to protect their interest and retain quality employees that are gonna be productive and help them meet their financial goals.

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