Expanding behavioral health network strategies to provide greater access to care

While the demand has accelerated for mental health and substance use support due to the pandemic, a recent report found behavioral health services have struggled to meet the need.1 This isn’t surprising given that the U.S. is only fulfilling 27% of its total need for mental health professionals.2 And diversity in networks is lacking, as about 8 in 10 psychologists are white.3

To help address these challenges, UnitedHealthcare’s efforts focus on more than growing the network of providers. It also includes reducing barriers to accessing care and increasing engagement across a comprehensive continuum of care starting with self-help apps to inpatient treatment. This model is designed to address different levels of behavioral health conditions more effectively by helping to guide members to the level of care they may need and adjusting the level of care as needed.

“When we think about network, it’s also about building strategies to improve quality, provide greater value and drive affordability,” says Stacie Grassmuck, Director of Behavioral Health Product and Innovation at UnitedHealthcare Employer & Individual.

With over 269,000 providers and 73,000 state-licensed virtual care providers,4 strategies to help expand networks and provide greater access include:


Increasing the virtual care network


Offering more specialty professionals in areas such as substance use and eating disorders


Offering preventive mental health solutions to avoid crises 


Efforts to increase network diversity for minorities, children and teens

Increasing the virtual care network

The pandemic created momentum around virtual care, including virtual therapy that is not slowing down. About 68% of employers plan to increase their emphasis on mental health offerings over the next two years, especially in virtual care and digital tools.5 More than half of U.S. adults are likely to use virtual tools for behavioral health needs.6

At UnitedHealthcare, more than half of behavioral health visits in 2020 were virtual for employees with UnitedHealthcare coverage.7 Providers are seeing 50—175 times more patients virtually than they have before.8

3 key takeaways on behavioral health care

  1. The U.S. is only fulfilling 27% of its total need for mental health professionals.
  2. About 68% of employers plan to increase their emphasis on mental health offerings over the next two years, especially in virtual care and digital tools.
  3. A continuum of care that offers behavioral health support starting with self-help apps to inpatient treatment is designed to address different levels of severity more effectively by guiding members to the level of care they may need.

“Most of my patients prefer virtual. It’s eliminated commuting and wait times in the office. At first, I had reservations about switching to virtual care, especially with new patients, but it hasn’t made a difference working with them,” says Dr. Martin H. Rosenzweig, Chief Medical Officer of Optum Behavioral Health, which supports UnitedHealthcare’s behavioral health benefits.

These new virtual offerings are designed to help meet the needs of individuals and improve access to care.9 Offering virtual care options may also reduce the stigma surrounding seeking mental health support. Stigma tends to prevent older adults from seeking care versus younger adults who are more accepting of mental health care.10

Offering specialty professionals for specific behavioral health conditions

Incorporating virtual care and providing specialty services may help manage specific behavioral health conditions more effectively.

“Our core offering has grown to meet the changing needs of employees and their families,” says Stephen Lewis, Vice President of Strategic Initiatives at UnitedHealthcare Employer & Individual. “This has included offering Applied Behavioral Analysis or ABA therapy for children with autism, and digital and virtual care tools.”

Other specialized solutions include support for those with eating disorders, substance use disorders, pharmacy and medication management services for employees with behavioral health conditions, and medication-assisted treatment with group counseling for opioid addiction.

“Behavioral health was a priority for many of our clients this past year. Employees were under  tremendous stress and they wanted to find ways we could support them,” Lewis says. “There were concerns with depression and anxiety for adolescents and teens, and increased opioid abuse.”

To address this need, UnitedHealthcare has over 42,000 substance use disorder providers11 and nearly 8,900 medication-assisted treatment locations with 95% of members living within 20 miles of a provider.12 Genoa Healthcare, one of the largest providers of pharmacy, outpatient telepsychiatry and medication management services, has a network that includes 6,400 prescribers, including 3,500 telepsychiatrists across nearly all 50 states.13

Preventive mental health care to help avoid crises

Offering a continuum of care helps employees take proactive measures to help maintain their mental health and overall well-being similar to physical health. This approach may help prevent a mental health condition from progressing in severity.  

 

One of UnitedHealthcare’s efforts to help reduce barriers to entry, engagement, and medical and behavioral coordination is the development and launch of virtual behavioral therapy and coaching, which proactively outreaches and connects members to a licensed behavioral specialist to help address their condition.

“Historically, a member’s first step into behavioral health has been a therapist or psychiatrist. What we found is that not all members need that level of care,” Grassmuck says. “We’ve brought forth more options like a self-help app that can help get at contributing factors of depression and stress, and behavioral health coaching that can help mitigate triggers.”

Increasing network diversity for minorities, children and teens

During the pandemic, mental health conditions have impacted many populations, but have been the most profound among women, teens and racial minority groups.14 Employers can help address this with targeted campaigns to highlight available resources and services such as virtual care that may help reduce stigma.

“We’ve found mental health disparities in these population groups have worsened during the course of the pandemic,” says Dr. Rhonda Randall, Executive Vice President and Chief Medical Officer for UnitedHealthcare Employer & Individual.

Stigma may also be more prevalent in some minority groups and evidence shows they do not seek mental health support as often as their white counterparts. Among adults with any mental illness, 48% of whites received mental health services compared to 31% of Blacks and Hispanics, and 22% of Asians.15

To support network diversification by raising cultural competency and promoting network diversity, UnitedHealthcare’s plan has included:

  • Strategic recruitment of specialty providers such as medication-assisted treatment providers
  • Cultural competency training
  • Adding provider ethnicity, gender and language as provider search criteria
  • Scholarships for child psychiatrists and providers from diverse backgrounds

“Data shows more licensed professionals in all 50 states, but some areas of the country lack certain types of providers,” Randall says. “We’re always looking for ways to expand and diversify our network while supporting providers who are feeling the strain of increased demand.”

These efforts along with increasing the virtual care network, specialty care in areas such as substance use and encouraging preventive mental health care to avoid crises play a role in creating greater behavioral health access for employees and their families.

Integrating medical and behavioral benefits help employers deliver a better health plan experience

This strategy is designed to help employees manage co-occurring medical and behavioral conditions more effectively.

Digital tools increase access to behavioral health at a time of growing need

Virtual care and self-help apps help fill gaps in the care continuum.

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Footnotes

  1. Behavioral Health: Patient Access, Provider Claims Payment, and the Effect of the COVID-19 Pandemic. U.S. Government Accountability Office. Mar 21, 2021.
  2. U.S. Census Bureau, Household Pulse Survey, 2020
  3. Psychology’s workforce is becoming more diverse: News on psychologists’ education and employment from APA's center for workforce studies. American Psychological Association, Nov. 1, 2020.
  4. Behavioral Health Source of Truth, SURE Network Summary Dashboard, Q3 2021; Karimzadeh, Sept. 28, 2021.
  5. Behavioral Health Top Insights, UnitedHealth Group, 2021.
  6. Optum Consumer Insights Telehealth Consumer Research, Nov 2020.
  7. UnitedHealthcare Employer & Individual claims, 2020.
  8. Ibid.
  9. Behavioral Health Top Insights, UnitedHealth Group, 2021.
  10. Behavioral Health Top Insights, UnitedHealth Group, 2021
  11. Behavioral Health Solutions Provider Network Summary Dashboard, updated May 24, 2021.
  12. Behavioral Health Source of Truth; SURE Network Summary Dashboard, Q3 2021; Karimzadeh, September 28, 2021.
  13. Genoa Telepsychiatry internal data, June 2021.
  14. Behavioral Health Top Insights, UnitedHealth Group, 2021.
  15. Mental Health Disparities: Diverse Populations. American Psychiatric Association. 2017.