Issues with Medicaid Psychiatry
Psychiatric issues often fall upon the most vulnerable populations and can lead to later onset treatment leading to poor outcomes. Medicaid is the payor of last resort, but it only kicks in after a situation has hit rock bottom. Even the best attempts to provide mental health care treatment through Medicaid (named differently depending on state) will run into the same problems:
- A lack of available providers: while the pool of mental health providers has expanded recently to include nurse practitioners, psychologists with prescribing privileges in some states, physician’s assistants, and the reimbursement of therapists hasn’t kept up with the needs of mental health treatment, especially as awareness of mental health issues has increased.
- Dual diagnosis issues: recent advancements in treatment of mental health issues have found that more issues are best addressed with both standard medical treatment and mental health treatments. This dual diagnosis, with physical and mental health, has added to the pool of diseases that mental health professionals are expected to treat.
- Inability to provide early intervention: all research has shown that early intervention is key to mental health treatment. Many mental health issues spiral to become worse over time, so an early intervention can prevent deterioration of quality of life and actions taken because of mental health issues. Often this can help move those with mental health issues out of high-risk categories and lead to better outcomes.
- Lack of emergency intervention availability: due to the lack of providers and the inability to provide immediate outpatient intervention, emergency departments have become the first line of support for mental health. Since emergency departments become overwhelmed, the rate of boarding or inability to provide treatment, especially for dual diagnosis issues, has significantly decreased. While everyone wants to provide high quality treatment, the time and resources aren’t there.
- Long waiting times for outpatient care: due to the lack of mental health providers, a referral to an outpatient provider who accepts Medicaid can be useless if the wait time is measured in months instead of weeks or days. The high demand for mental health care professionals often leads to providers not accepting payment rates and either working with only private insurance or in some cases not accepting insurance at all and simply charging their own direct rates. These costs are often out of the reach of the patients who need them the most, leading to a lack of ongoing care as referrals become useless for treating issues that can be addressed on an outpatient basis but still need fast referral to treatment times.
Issues with FQHC and CMHC Treatment Locations
Federally Qualified Health Care Centers, often a Medicaid provider for rural areas, and Community Mental Health Centers, often a Medicaid provider within cities, work to provide the best care available. Case workers integrate with mental health providers to provide high-quality care with mental health professionals in an attempt to lift up patients from mental health illnesses and poor situations. The attempts to unify treatments and planning for clients create a unified approach to improving situations of individuals requiring mental health treatment on Medicaid.
Unfortunately, these treatments and coordination face the limitations of few available mental health professionals, a lack of health professionals willing to accept Medicaid rates, and a significant missed appointment rate. Mental health resources that can be provided can’t provide care if clients can’t access the providers on their terms, and providers are similarly frustrated when they can’t meet the patients at their terms. This takes the care out of mental health care.
Collaborative Care Model – What is It
A recent move backed by research and clinical outcomes is the use of the collaborative care model. In this model traditional healthcare providers team up with mental health providers to create a unified treatment plan and team for the clients of various health facilities. By working together they can treat any dual diagnosis, provide immediate feedback and patient notes between each other, and work to ensure the patient sees every type of medical provider needed without long referral times.
On the mental health side, these often come with higher appointment frequency for mental health with shorter individual appointments. A typical appointment schedule can be weekly appointments including initial appointments that only lazst 30 minutes each.
How Telepsychiatry Staff Outsourcing Can Help
The move to a collaborative care model can seem daunting, especially with the resources needed to find qualified professionals to take on the role of frequent provider. One move to counter lack of availability is the use of telepsychiatry, or the use of two-way video conferencing between a patient and an off-site provider. Not all telepsychiatry providers are familiar with this implementation, and it’s important to find those that have done this environment before. While this can be done in house within an agency, the fact that this is a new treatment modality means that better results can be achieved when it is outsourced, but finding the right partner can be difficult. Among outsource telepsychiatry groups, FasPsych is a leading provider of the comprehensive care model for behavioral health, and finding experienced staff is key to making this the future of Medicaid psychiatry provided in various environments.
Next Steps
If your Medicaid facility is interested in implementing the collaborative care model, a decision must be made as to whether it’s something that you have the staff to do it and a guideline on how it will be implemented. If the staff is unfamiliar or you don’t have the staff to complete this, additional steps need to be taken, including bringing in any needed resources, and deciding whether this will be done with in-house or outsource resources. If outsource resources need to be used, research needs to be done into partnership with an experienced third-party vendor. Once the correct vendor is found, the availability of their staff and ability to implement this needs to be verified to create a plan to implement this.
Collaborative care model treatment has shown a lot of promise both in treatment and also removing the barriers in access to care but having it in place isn’t easy. It’s a boon for Medicaid psychiatry, but not always as easy as it seems. Don’t let the daunting startup effort stop your facility from moving forward; use it as an impetus to change how you work with clients and create the best possible outcomes.
