Addressing the Rise in Behavioral Health Needs from the COVID-19 Pandemic

Unaddressed behavioral health needs impact a health system’s financial, clinical, and equity strategies. According to Milliman, treating patients with behavioral health diagnoses costs about $875 per member per month more than patients without such diagnoses. In 2017, deaths of despair (i.e. those related to suicide, alcohol, and drugs) reached the highest rate since the CDC began collecting this data in 1999.

The lasting pandemic has only exacerbated this trend, with nearly 50% of U.S. adults currently exhibiting some signs of depression. The greatest burden of symptoms occurs among populations with compounding stressors (e.g., job loss and limited childcare) and the least access to financial and social resources.

With the increase in telehealth utilization across health systems, more patients have access to behavioral health consults through virtual channels. However, current approaches to addressing behavioral health needs are often inadequate and fragmented. Despite the relatively high prevalence of affected patients, significant barriers still restrict access to treatment.

Providers must create a proactive strategy to identify, assess, and manage patients’ behavioral health needs—particularly for at-risk populations and caregivers. A comprehensive behavioral health strategy includes at least three tactics:

  • Integrate behavioral health services into all medical and physical health services. Initial targets often include primary care for ongoing management and the ED for crisis stabilization.
  • Leverage technology (e.g., apps and online communities) to scale in-between visit care. Beyond tele-visits, IT tools can enable ongoing symptom management at scale.
  • Activate community-based partners (e.g., social service organizations) in regional hotspots. Partners can help mitigate symptom escalation among hard-to-reach groups.

Redesigning Chronic Disease Management

Chronic diseases are defined as conditions lasting one year or longer, require ongoing medical attention, and/or limit daily activities. Today, chronic diseases affect millions of Americans and drive over $1 trillion dollars of annual healthcare costs. Beyond direct healthcare expenditures, research indicates the indirect costs of the chronic disease burden from lost economic productivity exceed $3.7 trillion – almost 20% of the US GDP.

While historically challenging, chronic disease management has become even more difficult amid the coronavirus pandemic. Patients are limiting their interactions with the healthcare system and care has shifted to virtual platforms. Providers must implement strategies to proactively engage patients with chronic diseases to manage ongoing care and prevent exacerbation and avoidable cost in the future.

The lasting pandemic creates an opportunity for the development of new care models and innovative solutions that address longstanding challenges that are particularly acute among chronic disease patients, such as medication adherence, care coordination, and inequitable access. Such strategies will set the foundation for long-term transformation that will ultimately drive improved patient outcomes and population health.

Renee DeSilva: Member Lessons on Equity & Inclusion

A few months ago, I shared my personal reflections on race and health. I was encouraged by the warm response and since then, the national conversation on diversity, equity, and inclusion has accelerated. The Academy has strived to create opportunities for our members to share success stories, pitfalls, and common challenges. Most recently, I had the chance to engage with CEOs, key physician leaders, and D&I experts across healthcare.

Here are a few of my takeaways:

The CEO owns the Equity Agenda: Executive teams, and especially CEOs, must be bold and willing to lead from the front. Unsurprisingly, organizations further along the D&I journey are led by an unambiguously committed CEO. Common among these leaders is a ‘bias to action,’ which often starts with self-reflection and education on what it means to be actively anti-racist. Carl Armato, President and CEO of Novant Health modeled this when he took 20 senior white male leaders off-line to attend the White Men’s Caucus (check out White Men as Full Diversity Partners before you react to the name). Carl understands that all senior leaders need to be Chief Equity Officers.

Inclusion matters: Executive engagement and strategy alone won’t drive performance. Darin Latimore, M.D., Deputy Dean & Chief Diversity Officer at the Yale School of Medicine said it best, “If your culture is not inclusive, it will eat the best D&I strategy for lunch.” Successful organizations start by investing in and measuring inclusivity and belonging. They work hard to create space where diverse voices can be heard and they acknowledge that D&I is not just a ‘thing’, but rather a way to do all things.

One size does not fit all: Driving strategy and execution depends on the context of your organization, and sometimes, it may feel like the work conflicts with operational priorities. Lisa Gutierrez, Chief Diversity & Inclusion Officer, IU Health, recalled her work in manufacturing that championed Six Sigma methodology, which has a focus on reducing variation. Diversity and inclusion, on the other hand, is designed to draw out the differences that elevate our impact. Lisa tweaked the strategy to align with Six Sigma’s other themes of effectiveness and efficiency. DE&I efforts require leaders to adapt their roll-out to reflect the nuances of their own organization.

In closing, consider this challenge issued last week by Dana Beckton, Chief Diversity & Inclusion Officer, Sentara Healthcare to our Physician Leadership Program cohort: Before the end of the year, identify one structural process or policy that works against an inclusive culture. Lean in, build some muscle, and commit to changing that practice.

Preparing for a Future of Remote Work

While a multitude of forces such as changing workforce demographics, technology adoption, globalization, and automation have increased the prevalence of remote work in recent years, COVID-19 has catalyzed a large-scale shift to a fully remote environment for many organizations. Despite the early experimentation, the US workforce is largely interested in maintaining their newfound flexibility. A majority (72%) of US office workers report wanting to work remotely at least two days a week post-COVID, and almost one-third (32%) would prefer to stay fully remote.

This rapid shift to remote work for office workers globally required organizations to quickly adjust and create new expectations, norms, and processes to maintain operations. Challenges with maintaining culture in a remote or hybrid environment, assessing productivity, recruitment and onboarding, and people development will all be critical for organizations to address in a widely remote future. As remote work becomes the norm, organizations will need to rethink their approach to the workforce and redefine the competencies necessary for success.

Renee DeSilva: Personal Reflections on Race & Health

On a cold night in January 1997, my phone rang in the middle of the night. On the other end of the line I heard my mother’s voice, distraught and hysterical, as she tried to tell me my 34-year old brother had died at the hands of police. I was a senior in college, 300 miles away from home, and desperately trying to wrap my head around the news. I was heartbroken. 

Across the next few months, I was thrust into a role that my 20 year-old self was not ready for. I led conversations with the police, talked to witnesses on the scene, and represented my family with the media. I will never forget the heartache. As I witness the recent examples that demonstrate a lack of value placed on black and brown lives, my heart continues to break.

I am a black daughter, wife, sister, aunt, and mother. I have never had the luxury of being unaware of what it means to be black or brown in America. I’ve written letters to the police department on behalf of my nephew after frequent racial profiling and taunting. My biggest fear is that my children will not be safe. At 25, 14, and 11 and despite our affluent neighborhood, I know that they are not immune. They can tell you they’ve heard versions of this talk many times.

I also have the privilege of serving as CEO of The Academy, where I reflect on these issues in multiple ways. From the standpoint of an executive, I am often the only person of color and woman in the room. It can feel lonely and isolating at times—I am aware of the subtle and overt ways that this is plays out in corporate America.

As a healthcare leader, I think about the mountain of research across the industry highlighting the inequities in US health care system. The disproportionate impact of COVID-19 exemplifies this, with “African-American deaths being nearly two times greater than would be expected based on their share of the population.”

Where do we go from here? At The Academy, we typically avoid religion or politics. But in this case, these are human issues. As the leader of an organization with a platform of thousands of health system and industry leaders, we must explore ways to create a safe space for dialogue on challenging topics. Moreover, we need to drive the national conversation on equity and inclusion. I am pushing myself to get out of my own comfort zone and lead from the front.