Achieving the goals of the Triple Aim requires care that is not only efficient, effective, and patient-centered, but also equitable. Yet a lag in adoption of innovative, evidence-based care models only exacerbates well-documented health disparities, especially for individuals with mental and behavioral health needs.
Health inequities contribute significantly to the cost of care in the United States. While racial and ethnic inequities are the most common, individuals with severe mental illness (SMI) also experience significant health disparities, as well as inequities that contribute to them. SMI populations bear significantly greater burden of illness than their peers without mental health diagnoses, with life span disparities of as much as 10 years or more.
One contributor to inequity in populations with behavioral health conditions is limited resources for addressing them. Where resources are available, they are not well coordinated with physical health care. People with behavioral health needs often experience gaps in basic wellness and primary care services, and the stigma frequently associated with behavioral health conditions can lead to avoidance of treatment and feelings of isolation and loneliness.
Nonprofit, community-based, provider-aligned health plans are uniquely positioned to address the barriers to care and management of both mental and physical health conditions that negatively impact outcomes, quality of life and productivity, and costs. They are natural incubators for new models of care, in collaboration with their provider networks. Like all health plans, they play an important role in achieving the Triple Aim by ensuring access to care through adequate provider networks, and benefit and payment structures that balance access to quality care with sustainability of resources available to care for all enrolled members.
ACHP will leverage the unique role its members play in managing diverse populations and maintaining high-quality provider networks to disseminate a study from PCORI’s mental/behavioral health portfolio that uses peer-led strategies for improving access and quality of care. Additionally, it will enhance understanding of the specific questions health plans must answer to implement and sustain proven innovations by incorporating them into their benefit and payment structures. These questions can then be used in the design and dissemination of future research.
Evidence-based, peer-led strategies provide a potential solution for the challenges plans face in ensuring access to care and improving patient-reported metrics linked to new payment models—but only if they are financially sustainable.
A secondary goal of this dissemination effort will be to learn the most effective ways to disseminate research to a health plan audience. Health plan executives evaluate new benefits and care models based on their impact on the population for which they are responsible. Unlike clinicians, who make care decisions based on a specific individual’s needs, health plans must consider individual members’ needs, overall population health, and health plan financial sustainability. These equally important considerations involve very different decision-making processes. This project will illuminate the types of information and evidence required to make evidence-based care models feasible and sustainable.