12 Dec Reviewing the Top Behavioral Health Trends in 2022

The behavioral healthcare system continues to transform rapidly. Industry disruption has been unrelenting and threatens traditional ways of doing business. As 2022 comes to a close, it’s the perfect time to review what’s changed in behavioral health this year and see what’s on the horizon for 2023.

Medicaid

Medicaid is a collaboration between the federal government (SAMSHA) and states. It is the single largest payer of mental health and substance use services in the country, and accounts for almost half of all Medicaid spending.  This year, the focal point has been on funding and access to programs and services to address the mental health crises in the United States. Medicaid funding is set to expand certified community behavioral health clinics (CCBHCs), reauthorize the Pediatric Mental Health Care Access and Community Mental Health Block grants, and support the implementation of the 988 Suicide and Crisis Lifeline.

Enrollment in Medicaid has increased by about 26% since the pandemic. Over 90 million people are enrolled in Medicaid; 46.5% are children. Behavioral health benefits are continuing to expand. There are a number of states with new mental health benefits or enhancements to current ones. And thankfully, there are no states that have plans to restrict mental health and substance use treatment benefits during the 2023 fiscal year. These initiatives target maintaining access to telehealth, improving access to services, promoting health equity, and addressing workforce reimbursement, training, and shortages.

Social Determinants of Health

There are several trends that should be monitored for their impact on behavioral health, with social determinants of health (SDOH) leading the list. Addressing social determinants of health for things like housing, food and nutrition, transportation, social and economic mobility, and social service connections is one area that has an outsized impact on the behavioral health industry. Studies show that these health inequities increase the risk of poorer health outcomes and negatively affect one’s mental health and well-being by as much as 50%. Because Medicaid beneficiaries are often impacted by SDOH, it’s imperative that government agencies address these health equity disparities and make a concerted effort to reach this most vulnerable population.

Organizations are forming partnerships to address the intersection of the SDOH and behavioral health, and others are joining federal and state programs to increase behavioral health’s integration into the healthcare ecosystem. By combining resources and capabilities, partnerships have closed gaps and increased resilience to disruption and staffing demands. They’ve explored ways to apply resources and innovations. In this way, collaboration is essential for advancing progress.

Technology’s Impact on Mental Health

Technology has certainly impacted healthcare access and patient engagement for Medicaid beneficiaries, with telehealth playing a major role. Access and the use of telehealth technology increased significantly during the pandemic. In 2020, telehealth facilitated nearly half of all behavioral health visits. 

Early in 2022, the 988 crisis line and mobile response services expanded, making care more proactive. 

The industry is still learning how to capture, integrate, analyze and share this insight and information. Analytics will continue to evolve to include more data from new sources, incorporate social determinants, and anticipate prior and underlying conditions. Progress will be measured by improved outcomes, lower costs, and expanded access to care.

Payment Structures

Recent reporting from the Health Care Payment Learning & Action Network shows almost 41% of U.S. healthcare payments came through value-based arrangements. Slightly over 39% were strictly fee-for-service and 19.8% were straddling both payment structures. The Centers for Medicare and Medicaid Services (CMS) finalized new rules aimed at expanding access to behavioral health. The rules allow for greater flexibility in billing and supervising certain types of providers, permanently covering some telehealth services, as well as the Hospital Outpatient Prospective Payment System. 

Pending Legislation

There are a number of bills still pending in Congress that seek to reform behavioral health reimbursement. The top regulatory issues for the behavioral health industry include compliance reporting for mental health parity, the future of telehealth, eliminating the X waiver which requires special training and restricts panel size for Medically Assisted Treatment (MAT), and expansion of reimbursement for more licensed mental practitioners to address workforce shortages. 

Leaders must be able to ask questions and evoke answers from the entire healthcare ecosystem that can help them address core issues around spending, contract performance, patient outcomes, and provider satisfaction. This level of insight can help them take action, manage more risk, and identify growth opportunities. The industry is becoming more complex. More new and diverse offerings are entering the market every day, and regulatory and compliance demands continue to escalate. 

Business as normal is not sustainable. Understanding trends and impact will lead to greater innovation in every aspect of behavioral health.