Geisinger has increased his behavioral telemedicine services in the past year, reducing the number of backward patients from 18,000 to 3,000.
The integrated health system based in Danville, Pennsylvania has expanded its employee recruitment efforts and hired an external telepsychiatry service to increase its behavioral health capacity and reach, said Dawn Zieger, associate vice president of psychiatry and behavioral health. While psychiatrists, psychologists and social workers can now treat behavioral health patients in other states, demand still outstrips supply, particularly in specialties such as pediatric behavioral health, she said.
“We have had more requests than ever for behavioral health services,” Zieger said. “We think we will have to continue working on our augmentation strategy as people cope with the trauma of COVID and the erosion of social structures.”
Health systems across the country are grappling with an increase in behavioral health cases and a lack of providers.
Half of the counties in the United States do not have a psychiatrist or addiction medicine specialist, according to new data from George Washington University. The shortages have disproportionately affected low-income consumers, as nearly 1 in 4 behavioral health care providers saw no Medicaid beneficiaries in 2020, according to an analysis of workforce data from health analysis firm IQVIA, of the Centers. for Medicare and Medicaid services and state licensing committees.
The lack of behavioral health workers has created welfare deserts across the country, forcing many patients into understaffed and often ill-equipped hospital admissions. Patients typically stay in hospital settings longer as outpatient settings also struggle to find workers. Health systems have rushed to fill the short- and long-term staff shortage exacerbated by the COVID-19 pandemic.
Systems like Geisinger and Sanford Health seek to treat more patients as they broaden their pipeline of behavioral health workers by partnering with medical schools and reimbursing tuition for those who enter the field.
Geisinger, for example, pays students’ tuition if they specialize in family medicine, internal medicine, paediatrics, or psychiatry and remain with the health system for a specified period of time. She also has a two-year social work fellowship program that helps participants obtain their clinical license, as well as a psychology internship that offers training in adult clinical and health psychology, pediatric integrated primary care, and clinical neuropsychology.
Sanford Health, a health system based in Sioux Falls, South Dakota, has a behavioral health internship program and a master’s degree in social workers, said Dr. Jeremy Cauwels, Sanford primary.
“Ninety-one percent of North Dakota counties are designated areas of mental health deficiency,” he said. “Our hope is that our supply will continue to grow and improve so that we can continue to reach the people who need us.”
Virtual behavioral health care and broader recruiting efforts have helped fill some of the access gaps. However, the United States would need more than 7,700 additional behavioral health workers to meet current demand, according to estimates by the Health Resources and Services Administration. There is a projected shortage of 14,000 psychologists by 2030, according to the agency.
The imbalance between supply and demand has created a significant burden on primary care providers. In Texas, for example, 70 percent of its counties would have no one providing behavioral health care if it weren’t for primary care providers, according to data from George Washington University. Even with primary care providers, 23% of Texas counties have no providers for severe mental illness.
“We will not create a new army of suppliers,” said Dr. Harry Greenspun, chief medical officer at the Guidehouse consulting firm. “The problem of capacity will not be solved with people, it will be solved with different modalities of care”.
Project Extension for Community Health Outcomes, which uses video conferencing to train, advise and support primary care providers, can strengthen the current workforce, said Ryan McBain, a policy researcher at RAND Corp. University of New York researchers Mexico launched the ECHO project in 2003 to educate suppliers to seek to expand access, reduce referrals and increase profits.
“Unlike normal telemedicine models, which allow providers to reach people in different areas, but do not broaden the reach of behavioral health personnel, models like Project ECHO have a multiplier effect because they allow new people to provide services,” he said he said.
Reimbursement for telemedicine services and the relatively low salaries of mental health professionals are still barriers, health care executives said.
“We’ve begun to see that some payers don’t pay the same rate, or don’t pay at all, for telemedicine of office visits,” said Geisinger’s Zieger. “Even if there is legislation on equality, the reality is that the payment does not cover the cost of the services.”
Federal and state policy makers should enforce mental health equality laws, which require insurance coverage for mental health conditions to be no more restrictive than coverage for other medical conditions, experts said.
States have only recently started paying peer support specialists and community health workers. Meanwhile, psychiatry, pediatrics, and primary care rank among the lowest specialties in terms of annual compensation, according to Medscape’s 2022 Medical Compensation Report.
“We need more funds to attract the workforce to this field,” Zieger said.