Catching Up: Healthcare IT and the Behavioral Health Industry

Catching Up: Healthcare IT and the Behavioral Health Industry

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The need for Integration

Behavioral health issues have become increasingly prevalent among the American population. According to the Association of Mental Health’s 2012 National Survey on Drug Use and Health, an estimated 43.7 million (18% of) adults aged 18 or older in the United States had some sort of mental illness in the previous year. People with behavioral health issues also tend have other chronic conditions, such as cardiovascular or pulmonary diseases, and may have an increased prevalence of risk factors such as smoking, obesity and substance abuse.*

Currently, primary and behavioral care facilities operate in silos, with no information-sharing and coordination between providers and systems. While the primary care market has begun to widely participate in healthcare information exchanges (HIEs), federal privacy laws and lack of incentives have slowed down progress in the behavioral care setting. As a result, patients with behavioral health issues may be receiving disjointed, redundant or inappropriate care, leading to an increased risk of complications and increased healthcare costs in general. Since behavioral health is an essential part of overall health, providers, federal agencies and other stakeholders must work to improve integration of behavioral and primary health systems in order to reduce costs and improve population health.

In this article, we’ll explore current challenges that exist with regard to behavioral health information exchange, what’s needed to move forward with integration and implementation of behavioral health information sharing, and highlight a few initiatives which are currently leading the way in these efforts.

The challenge of privacy

Federal and state regulations set in place to protect patient privacy have hindered efforts to create an information exchange between primary and behavioral care practices. Federal confidentiality regulations drafted in the 1970s require that patients must provide written authorization for their physician to view personal records related to substance abuse history or treatment. Some states have even more strict guidelines. The HIPAA Security Rule sets national standards for the security and protection of electronic health information, giving patients certain rights for their data’s safeguarding and use, including information in their personal health record. With many of these regulations in place, mental health practitioners are often unable to record or share patient data electronically, for fear of repercussions. Without the proper connection between the primary and behavioral health partner, patients cannot get the level of care that they need and deserve.

The challenge of funding

The Health Information Technology for Economic Clinical Health (HITECH) Act helped coordinate the nationwide use of electronic health records (EHRs) for centralized access to patient information. These systems would enable health care professionals and hospitals to access centralized patient information in order to better coordinate care. As hospitals and other healthcare practices began to adopt EHRs, the Centers for Medicare & Medicaid Services (CMS) started offering reimbursements and financial incentives for providers who met meaningful use criteria. However, these incentives exclude participation from mental and behavioral health organizations, thus eliminating the funding needed for implementation projects. According to Behavioral Healthcare magazine, as of April 2015, more than $20.5 billion in incentives were given to other healthcare providers as incentive payments for the Medicare/Medicaid EHR program. In order for the behavioral health industry to stay on a level playing field with the rest of the healthcare industry, eligibility needs to be extended to behavioral health as well. Currently, advocates such as the Behavioral Health IT Coalition are working to advance legislation such as the H.R. 2646 bill (the Helping Families in Mental Health Crisis Act of 2015), which will help increase coordination between the federal government mental health agencies, encourage integration between primary and behavioral care, and provide needed funding to drive innovation and use of electronic medical records.

Leading the way in Behavioral Health IT

Stakeholders throughout the country have begun experimenting with strategic initiatives to integrate primary and behavioral health to achieve cost savings and improved care. For instance, Maine’s HIE, HealthInfoNet, aims to help behavioral health providers adopt EHR systems and connect with the exchange. Maine will be using part of the $33 million in funding they received from a $250 million federal innovation grant, made possible by the federal Affordable Care Act, designed to foster state-wide innovation in health care programs.

Another initiative includes coactionHealth, a partnership between Verizon, Centerstone Institute and MIT-startup Ginger.io designed to use mobile technologies to help patients with complex behavioral disorders. The program uses mobile surveys, wellness coaches, health data tracking apps and connectivity tools to provide a support system and connectivity tool for patients. While these tools are not currently integrating with health IT systems, they are resulting in improved clinical outcomes, while giving providers greater access to health trends for better decision-making.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has established a series of strategic initiatives aimed at health care systems integration between behavioral and primary health care. Among their objectives are to:

  • Analyze current integration efforts throughout the country
  • Remove financial barriers and help develop new provisions for EHR implementation
  • Increase behavioral health providers’ access to and participation in the health care delivery system and health information technology
  • Provide training and technical assistance to support IT adoption among the behavioral health community
  • • Develop compliance standards to enable secure collection and distribution of electronic health information while maintaining patient privacy

Looking ahead: The future of behavioral health

With improved healthcare policy development as it relates to the electronic delivery of behavioral health data, and organizational advocates leading the way with funding and advancement efforts, patients will begin to see more of an integration of primary and behavioral health. With increased effort from these and other parties, we will begin to see more integrated care, improved data exchange, as well as enhanced population health.

*Source: National Association of State Mental Health Program report, 2006