Access woes complicate heightened focus on behavioral health
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Sen. Majority Leader Harriette Chandler (D-Worcester).
A lack of access to providers can pose barriers for people needing behavioral health care, according to industry officials who on Thursday suggested expanding access to telemedicine services.
At a roundtable discussion hosted by a group of senators studying health care costs, Karin Jeffers, who chairs the Association for Behavioral Health's board of directors, said the outpatient behavioral health system in Massachusetts is "in an absolute crisis." Ninety-six percent of the association's members that operate outpatient mental health clinics reported an average loss of $447,000 a year, she said.
Thursday's discussion, focused on behavioral health, was the first of a series the working group plans this month as it works to develop a health care cost containment bill. The panel's efforts began late last year with a trip to Minnesota, and took on new context after lawmakers last month rejected a series of MassHealth eligibility reforms proposed by Gov. Charlie Baker, pledging to continue debate on health care and come up with an alternative plan.
"It's a big bill that we're writing, and it's an important bill," Senate Majority Leader Harriette Chandler said. She said Massachusetts is trying to learn from innovative cost control initiatives in other states but wants be a national leader.
"We need to be first again," the Worcester Democrat said. "We need to cut these costs. The costs will kill us, ultimately."
Also Thursday, the Baker administration announced a major expansion in its restructuring of the MassHealth program towards an accountable care organization model, with 17 health care organizations agreeing to participate. The accountable care organizations will receive more than $100 million in new funds this year to work toward a variety of goals, including reducing avoidable emergency department use and enhancing coordination with behavioral care providers.
The Senate invited representatives from community health centers, hospitals, health plans and other areas of the industry to share their thoughts on the state of behavioral health delivery in Massachusetts. Several described challenges patients can face in accessing care, including a supply of providers and treatment beds that does not meet the demand for services.
They said when patients lack access to behavioral health services, they can end up in the emergency room for treatment or their conditions can become more severe, both of which make care more costly.
"There are questions as to whether or not there are enough beds in the western part of the state, where perhaps there are about 200 or so," said Dr. Mark Keroack of Baystate Health. "Worcester County has built a tremendous number of beds in the last year, I think nearly 200 additional beds, but I don't think it's staffed them to the point where they can begin to accommodate patients, so there's a shortage not only of staffed beds but also of mental health workers, psychiatrists, et cetera."
Ken Duckworth, the medical director for behavioral health at Blue Cross Blue Shield of Massachusetts, suggested promoting telehealth services could be one way to make "more efficient use of the current number of providers."
Telehealth or telemedicine involves using telecommunications technology for health services, allowing care to be delivered over a distance -- for example, through a video conference between a patient and a doctor.
Several bills pending before the Legislature aim to increase access to telemedicine, including one filed by Chandler (S 501) that would require health insurers to cover telemedicine services "to the same extent as if they were provided" in person.
"I've been trying to get a telemedicine bill through this legislature for 10 years, and we've been rather slow in doing it," Chandler said. "I watch every other state getting involved. It makes a difference."
Jeffers, of the Association for Behavioral Health Care board, heads the Western Massachusetts behavioral health agency Clinical & Support Options, and said telehealth presents a "significant opportunity" for rural areas, where the workforce may be smaller and recruiting can be difficult.
"If anybody has tried lately to hire a psychiatrist to go to Athol, I'd like to know how successful you were. It's not an easy opportunity," she said.
Jeffers said each of her agency's six clinics is outfitted for telepsychiatry services, but less than half of their payers will pay for such services. "On the one hand, we have the technology, but we don't have the payment and regulatory support to do that," she said.
Steve Walsh, the president and CEO of the Massachusetts Council of Community Hospitals and a former state representative, identified telehealth as among the "low-hanging fruit" lawmakers can pursue, and Sen. John Keenan of Quincy said lawmakers "have the ability to look at" the role telehealth can play in expanding access to treatment.
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