What’s ahead for behavioral health? Diving into challenges and opportunities

By Philip Kaufman, Chief Operations Officer, UnitedHealthcare Employer & Individual.

The COVID-19 pandemic began as a public health emergency focused on the physical impact of the disease and how to keep people separated — and safe. Those physical considerations remain critically important today. The mental health impact from the pandemic, though, has taken center stage. 

The last 15 months have taken a heavy toll on many people’s financial security and emotional well-being:

• A stunning 40% of U.S. adults have struggled with mental health challenges related to the pandemic.¹
• 36% reported symptoms of anxiety or depression, and that number jumps to 74% for people ages 18–24.²
• For youth ages 12–17, ER visits due to mental health issues rose 24% between April and October 2020, compared to the same period in 2019.³
• Other groups whose mental health was disproportionately impacted? Hispanic and Black Americans, essential workers and unpaid adult caregivers.⁴

These numbers demonstrate the behavioral health challenges we all face. We empathize with those affected and don’t pretend to have all the answers.

I would like to share how we are responding on behalf of those we serve, as well as how I see the mental health landscape evolving over time. I’d love comments from you about your experiences; this is nobody’s challenge to solve alone — it’s a collective effort among insurers, employers and providers.

An integrated approach to helping those in need
The pandemic has illuminated why and how behavioral health is such a critical component of a whole-person health care strategy. The wisdom of folding behavioral health into an integrated approach to whole-person care — including medical, pharmacy and specialty benefits — has only become more apparent since COVID-19. Often, a member’s first point of contact for care is with a PCP. Interactions with a PCP are an invaluable opportunity for screening, early intervention and ongoing support for navigating care. This is especially true within our adolescent population.

With integration, there’s a broader understanding of how behavioral health intersects with medical needs and an individual’s ability to lead a meaningful, productive life. Seamless connectivity between PCPs and behavioral health clinicians — about prescriptions, for example — is crucial. We’ve embraced this whole-person approach for years, and it’s designed to deliver value to both employers and employees in the form of quality care and reduced costs.

Reducing stigma and expanding behavioral health resources
It’s hard to find silver linings in this pandemic. But I’d like to recognize three related to behavioral health: 

1. Behavioral health challenges have been further destigmatized. We have all experienced the pandemic together. This fact has made problems like anxiety, depression and substance abuse more visible. There’s a broader acceptance of behavioral health as a need within employee populations, making it a key element of employer benefits strategies. 
2. The pandemic has accelerated patients’ access to and comfort with virtual care. In January and February 2021, a significant percentage of UnitedHealthcare members’ behavioral health visits occurred remotely rather than face-to-face — a sea change from early 2020. Providers have shifted rapidly to deliver behavioral health care effectively in virtual settings and patients feel connected to clinicians. The convenience factor lowers barrier to entry, and we’ve seen some alleviation of provider shortages in more rural areas.
3. Resources have expanded for behavioral support. When it comes to mental health, asking for help is such a critical first step. That step may start with a family member, friend or someone in the community. From there, resources such as employee assistance programs (EAP), care advocates and online tools like Sanvello are available to support on a broad spectrum of mental health needs — from proactive support and education to a fully integrated experience dedicated to whole-person health.

Despite progress, challenges remain
Even as we witness these advancements, it’s worth noting a few primary challenges I see on the horizon:

• The first is what I call the last-mile challenge. This is about helping people understand the type of behavioral support they need and then connecting them to specific providers. Working with a therapist is similar to building any relationship — it’s important to find the right fit, to have a connection between patient and provider. Even after selecting and seeing a therapist, though, tapping into “care extenders” via digital tools and personal relationships helps surround an individual with support options.
• Number of behavioral health providers. Stigmas are receding, and more people are ready to seek help — but many don’t know who to call. We’ve expanded our behavioral health network by 37% in the last three years⁵  and there are specific areas we continue to focus upon. Recruiting additional specialty providers in the areas of medication-assisted treatment (MAT) and adolescent mental health are two examples. We’re also elevating the overall expertise of our provider network by working with organizations that serve communities such as LGBTQ+, making cultural competency training available to better serve this population, among others.
• The data challenge. We still have much to learn about the precise value of behavioral care for both employees and employers. Many of the benefits accrue in very different ways from traditional medical care (such as improved relationships with family, friends and co-workers), making behavioral care’s impact fundamentally harder to measure. We are maturing behavioral health toward value-based care incentives that would quantify and reward better outcomes. We’re also launching measurement-based care pilots with outpatient provider groups to continue building a data set that will inform and evolve our behavioral strategy over time.

There’s work yet to be done. And as we keep gathering and analyzing data, I’m confident additional solutions will come into view. The health of employees and their families depends on it.

Putting members in the driver’s seat
A winning benefits strategy is built on personalization. Members aren’t passive in their everyday consumption habits digitally or in person — access to goods and services at the fingertips is the expectation — and it’s no different for their health care. They want to feel in control of their benefits experience, and they seek plan options dialed in to their needs. What matters most is going beyond one-size-fits-all offerings to help meet members where they are with tailored services, wellness experiences and plans.

For example, we’re evolving the digital experience to allow for customized member-portal dashboards and seamless access across devices and platforms. It’s about helping people get the type and level of information they need so they can better understand and use their benefits — whether they use them frequently or only a couple times a year. We also are working with employers to allow them the ability to offer more plan options at time of enrollment.

We are relentless in our efforts around this and I know that it will be a journey. I am a Bruce Springsteen fan and like this quote from him on delivering on behalf of the “audience” — for us, that’s our employer clients and their employees and their families: “Getting an audience is hard. Sustaining an audience is hard. It demands a consistency of thought, of purpose, and of action over a long period of time.”

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