How providers and payers are collaborating to improve behavioral health care

As demand for behavioral health services continues to strain the capacity of the health care system, it’s more apparent than ever that solutions will require innovation, collaboration and trust.

We’ve been demonstrating that here in Rhode Island, where the state’s largest psychiatric hospital for children and the state’s largest and locally based insurer have been increasingly working together to expand access to care for Rhode Islanders. 

At Bradley Hospital and Blue Cross & Blue Shield Rhode Island (BCBSRI), we have been partnering on a variety of initiatives to create a community-based system of care that focuses on prevention and early intervention. With a shared vision – one that seeks to overcome industry workforce shortages and maintain affordability — we are finding solutions to help individuals and families in Rhode Island better access expert mental health care. 

At the recent Behavioral Health Tech Conference, we teamed up to share some of the lessons we’ve learned and accomplishments we’ve achieved. They include the following: 

Reducing administrative burden

 In 2018, BCBSRI launched the first in a series of market-leading steps to eliminate prior authorization requirements for mental health and substance use treatment, saving time and money for everyone. The biggest winners have been patients. 

When patients “board” in the emergency department waiting for inpatient care, it is stressful for them and their families, costly for payers, and operationally challenging for providers. Removing prior authorization has helped create a more efficient and humane system.

Embracing cost-saving innovations (and funding them sustainably)

There are exciting pockets of innovation everywhere, but funding them sustainably is difficult when they don’t fit with established approaches and billing codes. With the dramatic rise in childhood anxiety, Bradley Hospital recently developed a team-based model of care for obsessive compulsive-disorder, where trained providers can supplement clinicians by working under the supervision of licensed psychologists.

BCBSRI saw the program’s potential to greatly expand access to evidence-based care and developed reimbursement for these nonclinical providers. With that added financial support, Bradley was then able to win an $11 million grant from the national Patient-Centered Outcomes Research Institute for the expansion and evaluation of different treatment modalities.  

Thinking beyond the walls of the hospital/therapist’s office

Medical care only accounts for 10-20% of a person’s health and well-being. What would it look like if we reimbursed for youth mental health care as if social factors, such as the school environment, mattered too? Bradley and BCBSRI have started to do this.  

BCBSRI now reimburses for children to transition from intensive treatment programs at Bradley to “transition days” back at school, recognizing that school is a place where less intensive treatment can be delivered. Successfully reintegrating students into school can improve long-term outcomes and, we hope, reduce the need for future care.

Facilitating and supporting provider training

The Verrecchia Clinic, part of Bradley Hospital’s Center for Autism and Developmental Disabilities, developed an 18-month training program for community providers to modify treatments for neurodiverse children and youth. This is an important program that will help innumerable Rhode Island youth, but we know that for providers in private practice or community outpatient settings, time is money and it’s difficult to take time out of seeing patients for this type of training. 

That’s why BCBSRI is providing a $100 hourly stipend for providers to attend this training.  It’s another example of how doing the right thing — expanding access to quality care close to home — may ultimately be the efficient thing, enabling more children to receive care in less acute, community settings.   

We know there is much more work to be done, but these efforts are underscoring how providers, payors and others committed to improving behavioral healthcare, and trusting in one another, can collaborate on new and innovative approaches to expand access to care and better support the mental health needs of Rhode Islanders.