May 2023

Mental Health: Managing the complex needs of the dual-eligible population

by Jordan Anderson, MD and Jennie Byrne, MD, PhD

When Belong Health opened its doors in 2021, our mission was clear, urgent, and deeply felt: to reshape the future of healthcare for those most underserved by the status quo. That mission hasn’t changed. If anything, it’s only been emboldened by our early successes and by enthusiastic partnerships. 

Through each of those relationships, we’ve gained an deepening knowledge of the thorniest complications of the healthcare system — from staff burnout to scarcity of resources to a communication gulf widened by differences in geography, education, and cultural background.

Among these many challenges, the topic of mental health, one that influences and complicates every age and sector of American life, seems to bubble to the surface with stunning regularity. In keeping with our commitment to whole-person care, we believe addressing the mental health challenges of the members we serve will lead to noticeable improvements in nearly every aspect of their lives. 

 

Recognizing a Challenge

In early 2020, the onset of the COVID-19 pandemic changed the world forever. Businesses were shuttered, futures were reimagined, and millions of lives were lost. Across America, those rippling impacts are still felt today, including a 25% increase in mental illness since the pandemic’s beginning.

In the face of this new reality, our nation’s healthcare system struggles to respond. Today, in New York state alone, the average wait time for an appointment with a mental health provider remains at around six months, according to the Journal of the American Medical Association (JAMA).

This troubling gulf between mental health demand and the supply of mental health clinicians is especially costly for members of the Dual Special Needs Plan (D-SNP) population, whose rates of mental illness (64%) are significantly higher than those of Medicare beneficiaries who are not also on Medicaid (40%).  Compared to those without mental illness, members with comorbidities and mental illness carry two times the medical expenses, even as they aren’t extended two times the response in medical aid. 

Instead, such members frequently find themselves in a healthcare purgatory, adrift and without prompt follow-up after emergency room visits or inpatient hospital stays. Between 2019 and 2022, according to a study from Trilliant Health, half of patients who were treated in an emergency department for anxiety or depression did not receive care from a behavioral health provider within 60 days after that visit.

That figure rose to 83.5 percent for patients treated in an emergency room for alcohol or substance use disorders (SUD). In fact, care network gaps for mental health and SUD regularly worsen for members of Medicare and Medicaid members, as the less-favorable reimbursement rates offered by these programs motivate fewer psychotherapists, psychiatrists, and other mental health specialists to accept them.

With the expertise of our personalized care management teams, Belong Health works diligently to help fill those gaps where D-SNP patients are most in need. During health risk assessments — or during transitions of care, as beneficiaries move from an inpatient hospital stay into their post-discharge period – we provide holistic support that reliably links each patient to exactly the care they need at exactly the time they need it.

 

Minding the Gaps

By design, Belong Health is deeply invested in strengthening the human side of healthcare with data and resources its experts need most. In furthering this mission, we’re well-positioned to fill key gaps — whether in research, capacity, or technology — that otherwise overburdened regional health plans often can’t address, especially in respect to the D-SNP community.

It is all too common, following a discharge from the emergency department or an inpatient hospitalization, for a patient not to have follow-up appointments necessary for a safe transition to an outpatient setting. This is especially true for patients with mental health needs, as the prospect of scheduling timely mental health appointments can often be challenging for them.

This gap in care, generated by poorly managed mental health issues, can threaten a patient’s ability to manage their other medical needs. To prevent such an outcome, our care management team — which includes a registered nurse, a social worker, a community health worker, and a pharmacist — glides in to provide additional support. In such cases where mental health needs are identified, a mental health clinician is integrated into the team to address any patient challenge.

Together, the care management team members forge a sturdy and personalized bridge — one that gently guides the member through clinician assessments and treatment to address pertinent mental health conditions. Their expert support helps provide each member not only with full personal agency but also with a deeper understanding of their respective conditions. 

Based on the severity of the conditions presented, care management team members can also connect members with longitudinal care and other crucial systems of support, leaving no periods of potential relapse or isolation to chance. Once such treatment gaps have been covered and the member’s needs have been stabilized, their care plan is communicated to their primary care provider (PCP) — and their longitudinal care is smoothly transitioned to an appropriate longitudinal care provider. This provider can be either their PCP, whom they already know and trust, or a community mental health specialist.

Whatever the case, as Belong works in service of each beneficiary’s best possible outcomes, the all-too-pervasive notion of “siloed” and impersonal healthcare melts away — and is replaced by a commitment to best practices and to a deep understanding of that patient as an individual.

 

Differentiating Our Approach

Our unique approach to whole-person care strengthens not only each member but every regional medical system it touches. Primary care providers frequently tell us that, thanks to our support, they now feel more grounded in the knowledge and resources needed to address the mental health needs of their patients in deeply personalized ways.

This humanistic touch is especially crucial when addressing the needs and lives of dual-eligible members, for whom medical visits are a routine, yet often overwhelming, fact of life. We credit our commitment to behavioral science as a major factor in our ongoing success, and we regularly rely on it to help us fully understand — not simply treat — the life of each beneficiary. 

For example, through the lens of behavioral science, the simple question of “where do you hurt?,” is replaced with an interpersonal and more positive conversation — a dialogue about what the patient enjoys doing, their day-to-day social engagements, and whatever personal ambitions they may hold dear.

The result of these dialogues, we’ve found, consistently lowers barriers to treatment and empowers the member. It focuses on possibility rather than on solely deficiency. It emphasizes and clarifies support systems and resources while simultaneously reducing potential for negativity bias and error.

In short: it brings doctor, patient, and community closer together.

In just two years, our behavioral science-based approach — and an unwavering commitment to the cultural competency that fuels it — has earned us the trust of populations that have historically been skeptical of healthcare plans and providers.

Crucially, our healthcare experts know and love the communities they serve, because they are of those communities, themselves. Those intimate relationships — fed in part by race, ethnicity, and personal experience — simply can’t be duplicated by larger national healthcare players.

We know there are few topics more sensitive, more personal, and more complex than mental health — perhaps especially among those communities that have, for too long, been shortchanged by the healthcare landscape at large. Now, we’re ready to target those previously unmet needs with the considerable resources, empathy, and cultural specificity they deserve.

Most of all, we’re eager to build a future in which mental health needs are supported, not stigmatized. A future in which no one, of any community, feels lost in a post-visit medical purgatory ever again.