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How COVID-19 Accelerated Changes in Mental Health Care

A Conversation With Behavioral Health CMO Dr. Frank Webster

Many people will seek professional help for a mental health need at some point, and experts say addressing these needs plays an important part in our physical health and overall well-being. The COVID-19 crisis created challenges for delivering care while also causing widespread loss, isolation and economic disruption, adding more stress and anxiety to people’s lives.

Dr. Frank Webster, a psychiatrist and chief medical officer of behavioral health for Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, recently discussed helping members get services during the pandemic, as well as the latest developments in improving access to care and support in the future.

What is your role as chief medical officer of behavioral health for an insurer?

Dr. Frank Webster

My goal is to make things work better and make sure people get needed services. There are more than 400 employees and an operational budget of probably $55 million. If we were a carve-out, we would be about the third- or fourth-largest behavioral health operation in the country. We are actively engaged with so many areas of the company, including analytics, service delivery and government programs.

What did COVID-19 reveal about our members’ needs for behavioral health services?

Visits for all 2020 outpatient visits, — which include those for mood disorders, anxiety and substance use — trend upward from about 266,000 in January to more than 314,000 in October.

In less than eight weeks in the spring, we went from about 300 to 114,000 virtual visits per month. Throughout the rest of the year, office visits and virtual visits were about 50-50.

The provider community made an almost miraculous change from a way it had provided care. It was out of necessity for people needing services, and providers needing to keep seeing people safely. Providers who had never done a virtual visit in their careers figured out a way to do it.

How did we help providers pivot to virtual visits?

We supported and educated our members and providers. We made sure any kind of behind-the-scenes work we did rolled as seamlessly as possible. We made people aware they had access to virtual visits, whether through MDLive or their normal providers. We made sure people knew how to bill a virtual visit and copays and cost shares were waived through the end of 2020.

Does this shift appear likely to outlast the pandemic?

I do roughly 30 minutes of clinic a week, and none of my patients want to come back in the office. Telehealth is a huge convenience for people, safety issues aside. Roughly half the visits are face-to-face now, half the visits are virtual. More people are keeping their virtual appointments than those scheduling face-to-face visits. If you increase appointment efficiency, you improve capacity. Virtual visits have allowed more people to be seen, or helped people be seen more frequently.

Are digital self-help tools useful in providing behavioral health services?

We have a digital self-service tool we’re planning to implement in January. It offers initial assessments, with standardized screenings for depression and anxiety and some additional questions. Depending on results, the platform may recommend online learnings, computer-based therapy or virtual coaching. The platform could fill a huge gap for untreated people by helping them calibrate what they can do without formal behavioral health treatment.

For those receiving treatment, the platform offers tools providers typically recommend patients use between office visits. It offers an array of tools and will recommend those with high assessment scores seek professional care. If we can nudge people to this platform, it may be less threatening for them than making an appointment. Access means giving people easily accessible channels. We don’t want stigma to prevent people from getting important services.

Is behavioral health part of how we think about holistic health?

Absolutely. For instance, we know mood affects the immune system. People with chronic stress have higher risk of heart attack and stroke. I am very happy to see the move to integrate medical and behavioral health information.

When I’m seeing patients, one of the things I ask them about is medications. A lot of chronically mentally ill people have diabetes. If you don’t take an interest in medications and physical health, you’re missing a huge part of what needs to happen for people. I’m a big believer that mental and physical health are connected and should be connected, especially in understanding that sometimes medications impact how people are feeling or thinking.

Your team is working internally and with others to improve behavioral outcomes using measurement-based care. How does it work?

There are five pillars in trying to improve behavioral health outcomes, including improving access to care, measurement-based care and collaborative care. We know using measurement-based care and collaborative care produce better outcomes in the treatment of depression and anxiety.

We have done some initial analysis of providers who are doing measurement-based care and collaborative care. We are looking for opportunities to work with accountable care organizations and large groups to expand the use of these models.

For depression and anxiety, most care is provided by primary care. We need to make sure our primary care folks and behavioral health practitioners are following sound principles of measurement and evidence-based care.

It’s not complex. Using data we collect, we have the potential to do outcomes-based assessments and treatments for conditions such as depression. Having that data could allow us to see what’s happening with our members and providers. We’re pushing to make services better and make sure we have the tools to do that.

Note: This interview has been edited and condensed.



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