Behavioral health information technology (HIT) adoption efforts have struggled and are still plagued by a number of challenges. Since 2011, the federal government has incentivized the industry to the tune of $37 billion. However, according to US Senator Sheldon Whitehouse (D-RI) “psychologists, community mental health centers, psychiatric hospitals, and others that specialize in treating addiction and mental health conditions do not qualify for this funding.” This has been a significant cause of poor electronic medical record (EMR) adoption in the behavioral health sector1.
In fact, the EMR adoption rate for behavioral health providers is believed to be less than 30%2, only about a third of the rate among physical health office providers (87%)3. Why are EMR’s important? They are fundamental to HIT efforts and, in many cases, the driving force behind many major HIT investments in technology infrastructure, data/analytics and transparency. In addition to issues with EMR adoption, behavioral health providers also experience a myriad of challenges which have stonewalled efforts to advance HIT, including:
While many providers in the physical health world are compensated with rates which take into account operational overhead (including HIT investments with infrastructure, training, software, data/analytics etc.), behavioral health providers, largely, are not given the same treatment. Payment rates and models with behavioral health providers are shortchanged in many cases by not adjusting for the true overhead costs necessary for HIT investments.
Training and Education
Many providers who invest in HIT experience hurdles when it comes to long term sustainability of technology. As systems are initially put in place and staff are trained, outside consultants are bound to disengage and leave providers to the task of maintenance and operations. In many cases HIT investments can end up becoming shelf ware or the investment is avoided from the get-go.
Physical HIT-driven integrative care efforts not as inclusive
While there are solid efforts across the US to include behavioral health in physical health IT investments, more must be done to ensure behavioral HIT is an essential part of physical HIT. For example, a Health Affairs publication in 2016 found that Medicare ACO’s, which are intended to provide more whole person care, have seen limited success. And an earlier Health Affairs 2014 publication (referenced in the 2016 study) noted “few ACOs pursue innovative models that integrate care for mental illness and substance abuse with primary care.” 4,5 ACO’s and other whole person-centric initiatives which predominantly rely upon physical HIT systems must be more inclusive of behavioral health. They need to collaborate with behavioral HIT stakeholders to drive more interoperability and data/analytic standards which could extend beyond physical and behavioral health to consider other data sources such as social services and determinants.
While adoption rates are not as high as they should be, the good news is, a variety of efforts are taking shape and helping to accelerate the behavioral HIT agenda, let’s explore a few.
Centers for Medicare and Medicaid Services (CMS)
CMS is doing their part to support integrative care initiatives through Waivers (1115/1332 etc.), MMIS enhancements, innovation center (CMMI), transforming clinical practice initiative (TCPI), All Payer Claims Database & Health Information Exchange funding, and much more. Many of these focus on more whole person-centric solutions which look to collect data from physical/behavioral/social service delivery points and provide meaningful insight back to policy & program administrators, improving clinical decision making, cost of care, quality and access. States like California are taking advantage of these opportunities with whole person care initiatives, I encourage you to learn more about the CA Whole Person Care pilot here.
On March 31, 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental Health Act. Part of this legislative act called for the creation of a new Medicaid provider type called a Certified Community Behavioral Health Clinic (CCBHC). These new entities operate in eight states and are meant to “provide a comprehensive range of addiction and mental health services to vulnerable individuals while meeting additional requirements related to staffing, governance, data and quality reporting and more." A survey by the National Council for Behavioral Health suggests the initiative has also led to significant adoption of new technology.
Many states are taking it upon themselves to improve their behavioral health system. California, for example, passed legislation in 2004 which imposes a 1% tax on seven figure incomes with the goal of improving the behavioral health system across CA counties.6 The San Bernardino County Department of Behavioral Health is one such county who has improved their HIT infrastructure with more robust data and analytics and realized amazing benefits. Check out San Bernardino’s success story and a related video.
While challenges exist, examples such as these remind us that success is within reach and HIT investments offer powerful value to behavioral health, and the entire healthcare system. As a final note, please be on the lookout in the coming months for our new white paper from SAS and the National Council for Behavioral Health which will explore the topic of behavioral HIT in greater depth.
4 Lewis V.A., Colla C.H., Tierney K., Van Citters A.D., Fisher E.S., and Meara E., Few ACOs Pursue Innovative Models that Integrate Care for Mental Illness and Substance Abuse with Primary Care, Health Affairs, October 2014, pp. 1808-16.