Three Focus Areas for Improving Behavioral Health

January 25, 2024 · Andy Reynolds

Behavioral health—which we define as the promotion of psychological wellbeing, including the treatment of mental health and substance use disorders—is a 2024 priority for NCQA.

We’re focusing on three related challenges:

• Access.
• Quality.
• Costs.

Here’s an update on what our research team has found.

Access

Demand for mental health and substance use care is rising.

• 17% of youth have had a major depressive episode.
• 11% of adults and 3% of youth have alcohol use disorder.
• 7% of adults and 5% of youth have an illicit-drug-use disorder.
• 21% of adults have a mental health condition such as depression, anxiety or schizophrenia.
• Nearly 6% of young people experience a serious mental illness such as schizophrenia, bipolar disorder or post-traumatic stress disorder.

While demand was already high for behavioral health care before the pandemic, COVID drove demand higher. Many of these trends persist or have worsened since then:

• Suicides reached an all-time high in 2022 (nearly 50,000), a 3% increase over 2021.
• Rates of anxiety and depression increased 25% during the pandemic—and remain higher than they were in 2020.
• Opioid-involved overdose deaths rose by 24% from 2021 to 2022 (and by 110% from 2017 to 2022). These rates continue to rise.

What’s more, nearly half the population lives in areas experiencing a mental health care workforce shortage.

In addition to workforce issues, NCQA is also addressing network adequacy and timeliness of care access.

Quality

More kinds of providers are delivering more kinds of care—a situation that invites uneven or uncertain quality.

Behavioral health is a complex system of services that go beyond providing psychotherapy in an office setting, and include:

• Skills development.
• Medication management.
• Inpatient or residential treatment.
• Outreach and engagement services.
• Peer support and other social supports.
• Case management and care coordination services.
• Mobile crisis teams and other crisis response services.
• Education, engagement and other services for families.
• Screening, Brief Intervention and Referral to Treatment (SBIRT) for substance use disorders.

Practitioners who deliver behavioral health services include:

• Social workers.
• Case managers.
• Recovery coaches.
• Peer support specialists.
• Occupational therapists.
• Community health workers.
• Psychiatric nurse practitioners.
• Marriage and family therapists.

Due to rising demand and workforce shortages, new types of service delivery and providers are emerging. For example, primary care providers are playing a larger role in mental health care.

We’re also seeing “workforce extenders” provide behavioral health care. This includes care by unlicensed providers. In some cases, prescribing privileges have been extended for specialty treatment of opioid use disorder.

Technology is also being used to expand behavioral health care capacity through virtual care.

The expansion of services and provider types in behavioral health creates a need for quality standards and quality improvement.

Cost

The cost of behavioral health care continue to rise.

Historically, behavioral health has been structured and funded separately from other health services. Newer regulations put access to mental health and substance use-related services on a par with medical and surgical services.

A number of payment models now support integrated care:

• CMS funding of collaborative care models.
• Payers funding integrated healthcare models.
• Interprofessional and consultation codes in pay-for-performance models.
• Increasing recognition of behavioral health as an essential part of physical and population health.

At the same time, the cost of care has risen. For example, spending on mental health services among Americans with employer-sponsored insurance increased by more than 50% from March 2020 to August 2022.

No matter how you measure it, mental health or substance use disorder treatments are important drivers of total health care costs.

We see new payment models, like Certified Community Behavioral Health Clinics and some value-based purchasing payment strategies, as opportunities for NCQA involvement.

Quality measures can help assess how effectively these models are working, and we see a place for NCQA there as well.

Now What?

1. Putting research into action. In our next blog post about behavioral health, we’ll outline what we want to learn and do in each focus area (access, quality and costs).
2. If you’d like to join us, tell us. We’re always looking for allies and partners in improving behavioral health. Let us know if you’d like to work together.