The Path Forward is a multi-stakeholder, national-local push to promote the evidence-based, data-driven practices and policies with the best chances of increasing equitable access to quality mental health care and accelerating integration of mental health and addiction care into the broader health system. We achieve our results through radical collaboration across the entire health ecosystem.
The Path Forward achieves equitable access by educating employers, states, local governments, unions, and other health purchasers to help them demand more from their health plans and third-party administrators. We provide education through our partner National Alliance’s Regional Multi-Stakeholder Coalitions and technical assistance through our detailed Quantitative Data Templates.
How Can Purchasers and Insurers Achieve Equitable Access?
- Cataloguing state and federal standards and encouraging a national benchmark
- Advocating for simplified credentialing and reduced administrative burden
- Embracing technology to eliminate antiquated paperwork requirements
- Assuring adequate reimbursement for all manner of in-network behavioral health care (psychiatrists, for instance, lag 25 to 50% behind other medical specialties)
- Helping insurers to recruit clinicians into their networks
- Maintaining COVID policy gains to enable within and cross-state practice
- Promoting the efficacy and safety of telemedicine while also improving its quality
- Reimbursing audio-only comparably to in-person and video
- Promoting and enabling accountability on parity compliance by insurers
- Supporting state regulators with rigorous, fair, and enforceable parity guidelines across states
- Robust DOL parity compliance guidance for employers to follow as required by the Consolidated Appropriations Act of 2021
- Generating quantitative data to identify current deficiencies and support measurement of change over time
Collaborative Care : The Gold Standard for Integration
Collaborative Care is the gold standard for behavioral health integration in primary care and the most evidence-based model that exists. Adding a behavioral health care manager and psychiatric consultant to a primary care clinician’s team, it brings the mental health screening and referral process directly to the person in need during a primary care visit.
We are engaging philanthropists, health systems, and health payers to fund the needed training, IT support, and technical assistance to accelerate adoption of Collaborative Care. Our partners at the American Psychiatric Association train primary care doctors, psychiatrists, and support staff in the model, and our partners at the Meadows Institute provide technical implementation assistance to large health systems (18 major systems in Texas alone).
Why Should Health Systems and Primary Care Groups Accelerate Adoption of Collaborative Care?
- Fewer transportation barriers, less time out-of-work
- Less stigma associated with visiting primary care doctors cross-culturally
- Equitable across age, race, and ethnicity, including Black and Hispanic communities
- Allows pediatricians to detect and treat behavioral health needs with critical supports from mental health specialists in real time
- Half of all mental illnesses begin by the age of 14; three-quarters by the time the brain stops developing at age 25
- Early detection reverses the 8-to-10-year lag time between onset and diagnosis that’s now standard
- Earlier intervention improves outcomes and saves lives
- Leverages psychiatrist time three to four times over
- This allows our highly constrained behavioral specialty workforces to focus on more complex conditions by moving mild to moderate conditions into primary care and pediatrics
- Improves remission rates in depression six to eight-fold
- Over 90 randomized trials proved efficacy in diverse populations, diagnoses, and settings
- Already supported with dedicated billing codes
- Health systems can fully cover their costs
- Health payers can realize gains by reduced emergency room use short term and reduced costs longer term associated with diabetes, heart disease and other conditions that fare better when depression and anxiety are treated
- Employers could see cost savings of $1815 per employee/year
- Universal adoption could cut healthcare spending by 5-10% saving $26-$28 billion/per year
High Quality Care
Better quality mental health care begins with the same approaches that have reduced mortality and morbidity rates for heart disease and cancer every year for the last few decades: employing person-centered, precision measurement tools to detect needs early—optimally before the person or their family even knows there is a problem—and tracking the outcomes of care systematically to inform treatment choices and drive person-centered results. We call this Precision Medicine, and it is grounded in an array of Measurement-based Care (MBC) tools. Path Forward is promoting Precision Medicine and MBC with purchasers, payers, and health systems. We also seek action from the major accreditation agencies on national standards that allow for accountability.
Why is Precision Medicine with MBC the Essential Step to Higher Quality Treatment?
- Person-centered, validated screenings beginning in childhood detect mental health conditions
- Use of validated measures (for example, PHQ-9, GAD-7, and the Brief Phobia Scale) helps identify behavioral conditions and systematically measure response/non-response to care
- Improves outcomes by 20 to 60%
- Can increase remission rates by up to 75% compared to usual care
- Improves quality of mental health care in Primary Care, OB-Gynecology, Pediatrics
- Standard with Collaborative Care
- Transforms specialty mental health
- Rapidly improving technology enables tracking, sharing, and alerts through electronic health records across increasingly vertically integrated health care delivery systems
- Working with the National Committee for Quality Assurance (NCQA) on strategies to upgrade accreditation programs and HEDIS measures to incorporate MBC as well as network adequacy and Collaborative Care
- Working with URAC to update standards for MBC-based precision medicine.
- Working with the Centers for Medicare and Medicaid Services (CMS) on approaches to improve standards and accelerate adoption of outpatient measures for Collaborative Care and Measurement-Based Care more broadly in primary care
- Working with the Joint Commission to develop standards around general medical hospitals (non-psychiatric) for Collaborative Care, MBC, and suicide screening more broadly.
- Helping providers implement the US Preventative Task Force’s (USPTF) for Anxiety and Depression screening; working to screen for suicide too and for depression earlier
- Major health systems can reward doctors for person-centered and effective care using MBC
- Universal electronic health record technology can accelerate system-wide adoption
- Payers should expect precision medicine empowered by MBC as part of their core contract requirements with providers to ensure accountability for results
At a national level, we are deeply engaged in ongoing conversations with trade groups, accreditors, every major insurer, and government officials driving national policy. But America’s healthcare system was never designed as one system. It is a tapestry of institutions and funding sources across 50 states and even more jurisdictions, with significant federal overlays, multi-state insurance companies, and multi-state medical institutions. National change is at its core an aggregate of numerous ripples of local reform, across states and localities.
See below for the progress we have achieved and the local transformations we already have underway.
Regional multistakeholder coalition partners are educating employers and insurers about Path Forward reforms
State regulators who have adopted our Quantitative Date Templates to regulate insurance plans statewide
Health System/Medical Group
Health system/practice implementation pilot site for Collaborative Care or Measurement-Based Care
Health System/Medical Group
Texas-wide health system scaling initiative for Collaborative care AND Measurement-Based Care