2 Mistakes Payers Can Avoid in Mental, Behavioral Health Screenings

Payers have been tapping self-service screenings to address behavioral and mental healthcare, but that process has been anything but perfect.

This is evidenced by the fact that the mental and behavioral healthcare crisis has not abated: a Blue Cross Blue Shield Association (BCBSA) report recently found that a third of Millennials have a behavioral health condition. Depression among Millennials rose by 43 percent from 2014 to 2018.

Poor mental and behavioral health screenings are not causing the increase in disease burden, but it could be why so much mental illness goes untreated.

According to Salvatore Cieri, clinical coordinator of behavioral health services for BlueCross BlueShield of Western New York (BlueCross BlueShield), there are two pitfalls that payers\u2019 screenings may exhibit.

First, payers might not appropriately adapt the language for users without a clinical background, letting health literacy considerations fall by the wayside.

\u201cThe biggest concern really is that these screenings were developed to be given by clinicians or by doctors,\u201d Cieri explained to HealthPayerIntelligence.

\u201cWe want to remove any barriers that they might have to getting a screening. The more people who can get a screening, the better. Putting it into this format is going to ensure that the most people possible can take the step of screening and realize maybe they have a need to pursue some type of mental healthcare.\u201d

Like most payers, BlueCross BlueShield already had screenings for behavioral health conditions which the company used to help identify patients in need of support.

Before joining BlueCross BlueShield, Cieri delivered such screenings as a licensed clinical social worker, providing care in behavioral and mental healthcare settings as well as in hospital psychiatric units.

He and his team knew that these screenings were designed to be delivered during a care visit. The user was a provider who would guide a patient through the questionnaire to make a determination on her mental or behavioral health. The screening concluded with a scoring sheet that presented the results in clinical terms.

In a self-service screening, the user is the member or patient. Without a provider leading them through the questions, members may not be able to fully comprehend their diagnosis. This would make the screening of little benefit to the member.

Second, payer self-service screenings may leave users with the diagnosis and fail to provide strong next steps in pursuing the appropriate level of care. At best, this can be challenging for patients, who often struggle with care navigation. At worst, it can be discouraging for patients who may feel hopeless in their illness.

With these two considerations in mind, the BlueCross BlueShield team released two new screenings to help members\u2014as well as the general public\u2014assess their own mental health condition, particularly when access to providers might be limited.

These tools help users identify their potential conditions as well as the severity.

\u201cWe're really proud to have recently launched these screenings,\u201d Cieri said.

The screenings, which are available to the public online, present users with multiple questions to assess whether the individual is showing signs of a mental or behavioral healthcare condition.

There are two screenings, one examining individuals for anxiety and one for depression. The screenings are based on PHQ 9 and GAD 7, two strongly validated formats for these behavioral healthcare conditions.

The screening guides users through the questions one at a time and offers them a score at the end with some educational material on what the score indicates.

The results page of the screenings includes a summary of their answers for each question along with their score and recommendations for care based on the severity of their condition. The results page is designed so that users can screenshot or print out the page to share with a provider.

\u201cThe unique part of our screening which goes beyond what the screening has been on the website in the past\u2014for us and other payers\u2014is that actionable step,\u201d Cieri shared.

\u201cYou\u2019ve taken the screening, you now know if how you're feeling might be related to an underlying mental health condition, and now here's what you can do about it. You can make it actionable, you can do something about it and start feeling better.\u201d

The screening is designed for public use and is not behind a member login wall, so that anyone could access it.

Still, Cieri said that some of the action steps are created specifically for BlueCross BlueShield members.

\u201cClearly, it's made with our members in mind when we developed the screening,\u201d Cieri confirmed.

\u201cSome of the resources that are present on the customized results page are specific to our members, maybe most notably our behavioral health care managers. We have case and disease managers for behavioral healthcare. And one of the recommendations on certain severity levels of the screening is to get in touch with those care managers either right through our website enrollment\u2014which is very easy\u2014or by calling the phone number.\u201d

The screenings are another tool in BlueCross BlueShield\u2019s arsenal of strategies around behavioral and mental healthcare. Other solutions that the payer has implemented include instituting the region\u2019s first value-based contract with a behavioral healthcare provider group as well as telehealth options.

Cieri acknowledged the greater role telehealth has been playing in these types of care and the possibilities that those digital tools present.

\u201cIt's impossible to know what's going to happen course in the future, but I think a lot of the push towards telehealth is going to persist beyond just these few months here,\u201d Cieri said.

\u201cIt's accessible, it's private and again for a lot of behavioral health concerns that are so verbal in nature of their diagnosis and treatment, it's very effective and just as valid a form of treatment as in-person office care for many conditions.\u201d

As payers strategize around addressing the growing demand for mental and behavioral healthcare, keeping solutions comprehensible and actionable for patients will be key.