Addressing Mental Health Care Delivery in the Era of the COVID-19 Pandemic: Understanding Alternative Payment Models for Helping Patients With Complex Medical Needs.

The COVID-19 pandemic brings a jarring emphasis to improve the mental health care access and coordinaiton in the United States (US). Across the globe, anxiety and fear spurred by feelings of isolation, unemployment, and loss of close friends and relatives, have contributed to mounting pressures on the mental health of patients affected by the pandemic. Older adults with mental health disorders who already face complex medical needs oftentimes deal with co-occurring physical ailments, which pose costly and unique challenges.

Approximately 62 million people were enrolled in the Medicare program in 2020. Types of Medicare coverage play an influential role on the overall patient experience, care coordination, and population health. For example, the payment structure of traditional fee-for-service (FFS) plans has been regarded as incentivizing health care providers to focus on the quantity of health services, rather than the quality and overall well-being of the patient. In contrast, Medicare Advantage (MA) plans have increasingly been recognized for its potential at providing more integrated care compared to traditional FFS plans because of how MA plans can incentivize quality of services. MA plans were designed to provide patients with more insurance options where beneficiaries can select plans that they deem best meet their specific health care needs. Further, policy changes have encouraged MA programs to use patient-centered care models draw more value out of the overall delivery of health services to reduce cost while still promoting quality outcomes. Inevitably, total enrollment in MA increased from 6.9 million in 1999 to 24.1 million in 2020.

The study by Lianlian Lei et al. explored how MA plans and FFS Medicare differed in their roles at promoting value-based care coordination around prescription management. Specifically, the study explored whether patients in MA plans were less likely to be prescribed high-risk prescriptions for opioids and central nervous system depressants than patients in traditional FFS health plans. This study aims to understand whether high-risk prescribing practices might be better managed with MA, a health plan that might be more suited for care co-ordination. Results of the study suggested the positive role of MA in terms of improving patient safety among the aging population. Evidence on MA's long-term impact on quality is still needed.

Meanwhile, Lei's study called for more future research to better understand through which mechanisms, such as the reimbursement strategies, health care delivery system can be designed to promote integrated mental health care and achieve the Triple Aim for improving the quality of care, improving the population health, and reducing the cost. Alternative payment models that incentivize care coordination has emerged. For example, evidence has suggested that the accountable care organization model can promote integrated care because of its shared medical and financial responsibility among providers to ensure timely and appropriate health care to patients. Comprehensive Primary Care Plus model adopts advanced primary care medical home model and encourages public-private partnership to improve health care access, continuity of care, patient and caregiver enragement, and care coordination.

To shift the mental health care system toward a better integrated system, research on evidence-based practices, mental health disparities, payment models, and care coordination is needed. Well-integrated care coordination programs can support elderly patients and their caregivers to navigate disease management plans and coordinate care among multidisciplinary teams. Successful integrated care can ideally prevent avoidable hospitalizations or readmissions, reduce duplication of medical services, as well as decrease waste of resources and risk of medical errors.

In a period of increased demands for mental health services across a fragmented US health care system, the need to improve the integrate mental health care is ever more urgent. Understanding how to incentivize different stakeholders—including patients, caregivers, health care providers, the community workforce, and payers such as Medicare—to work together and sustain the investment and activities promoting cost-effective practices is critical. Such innovative strategies should also reflect the cultural competency to provide high-quality care for the diverse aging adults with serious mental illness and coexisting health conditions, who constantly face substantial social stigma and barriers to mental health care.

DATA STATEMENT

The data have not been previously presented orally or by poster at scientific meetings

AUTHORS CONTRIBUTIONS

Both Merianne Rose T. Spencer and Jie Chen conceived, wrote, drafted, finalized and approved this perspective paper, and thus were responsible for its entire development.

DISCLOSURE

The authors report no conflicts with any product mentioned or concept discussed in this article.