Healthcare leaders met at the 2024 Northern California State of Reform Health Policy Conference to discuss barriers to accessing the state’s behavioral healthcare delivery system, and recommended improvements.
Moisés Barón, former president and CEO at the San Diego Center for Children and former president of the California Alliance for Child & Family Services, said families across the state need a robust continuum of care that goes beyond inpatient and outpatient treatment for behavioral health concerns. Barón said mental health services need to be intertwined with primary care and school-based care. He said youth in Medi-Cal managed care plans have issues accessing those services.
“The rate of penetration is about four percent, so if you think about it, 25 percent of kids need help, only four percent are being seen, and only three percent are being provided ongoing care. We have a serious problem,” Barón said.
Barón said the rates of youth participating in county-based behavioral health programs are higher than those participating in Medi-Cal’s. He highlighted Medi-Cal’s enhanced care management (ECM) initiatives, which connect patients with a care manager that provides comprehensive care management and coordinates their health-related care and services, while connecting them to the quality care they need. He said ECM can identify youth with mild-to-moderate mental health challenges who may need assistance for severe mental health challenges.
“ECM can be a way to help transition from one system to another,” Barón said.
When speaking with providers and clinicians, Barón found that 50 percent of their time, on average, is spent filling out paperwork due to state requirements.
“If we are able to do documentation reform, we might be able to increase productivity by 20 percent, easy. We don’t need to spend this much time on paperwork,” Barón said.
Reforming the state’s documentation system would create an immediate increase in the numbers of hours of care medical staff can provide, Barón said.
“This is an important issue with retention. A lot of our providers are telling us, ‘I didn’t get into the field to write, I got into the field to help people,’” Barón said.
Ryan Quist, director of behavioral health services at Sacramento County, said healthcare systems have to continue to evolve with the needs of communities.
“It seems really obvious, but at the same time, to a large extent, a lot of our systems are not evolving. We still have our universities, colleges, and institutions training individuals to deliver services in a way that’s office-based and probably not very relevant to many of our populations today. Not just the mental health population, but also those that are being served by private insurance or managed-care plans,” Quist said.
While private insurance and managed-care plans have different preferences on how services are received, policy needs to be in place to help push reforms that emphasize a proactive and early intervention response, Quist said.
“There really is a financial incentive for our private insurance and managed-care plans to do proactive and early intervention,” Quist said. “We know that if you intervene early, you’re going to have better outcomes. You can actually change the course of potentially life-changing, long-term chronic behavioral health disorders by early intervention.”
Quist said individuals living with behavioral health challenges can have increased costs related to their physical health.
Sacramento County has a Mental Health Board and a Behavioral Health Youth Advisory Board, which provide consistent and direct stakeholder feedback. Based on the last five years of feedback garnered from members of the community, Sacramento County completely redesigned the outpatient healthcare system for youth, adults, and people living with substance use disorders, Quist said.
“In listening to our community stakeholders, they told us they want to see some changes. And as a result, some of the biggest structural changes that were made were that the community members said, ‘You’re not in the right places; you need to be more geographically spread out,’” Quist said.