Washington’s behavioral health system faces many challenges—including workforce, access, and equity issues—as officials work to reform it. Experts discussed those challenges and possible solutions at the 2024 Washington State of Reform Health Policy Conference last month.
Jane Beyer, senior health policy advisor at the Washington State Office of the Insurance Commissioner (OIC), discussed findings from KFF’s 2023 Employer Health Benefits survey. It found that only 60 percent of large employers say there’s a sufficient number of behavioral health providers in the plan’s network to provide timely access to services.
“And for substance use disorder services, only 59 percent felt there was a sufficient number of providers,” Beyer said. “And these are in their own networks they’re trying to build for their employees. We hear a steady drumbeat from consumers with concerns about the fact that they’re not able to access behavioral healthcare from network providers. They call and they call, and the providers are not accepting new patients.”
Anna Nepomuceno, director of public policy at the National Alliance on Mental Illness (NAMI) Washington, said gaps in care are very prominent in Spanish communities, communities of color, and communities that rely heavily on Medicaid.
“We have a system here where the healthcare workers in a community aren’t getting compensated enough,” Nepomuceno said. “So what you have is a high turnover rate (and) a high burnout rate. That consistent turnover makes things really difficult for anybody on Medicaid.”
Communities of color also face challenges in offering diversity in their healthcare workforces, Nepomuceno said.
“Most of the workforce is white (and) affluent. With NAMI, we talk with people all over the state, and what I hear consistently from Latino communities, people of color, and minority communities is they want a provider that looks like them; someone from their own community so they can understand their struggles. And there’s a real lack of diversity in that workforce. So a lot of those communities don’t look for mental healthcare.”
— Nepomuceno
Access to care is also a problem in rural communities, Nepomuceno said.
“The constant feedback I hear from them is that they have nothing,” she said. “They travel two hours to get to the nearest psychiatrist. They have no behavioral health providers in their communities. If they do, it’s a long wait or they’re only asking for out-of-pocket pay. There’s a high suicide rate among the agricultural community, and there’s no help for them.”
Behavioral health service providers also face numerous challenges related to credentialing, prior authorization, and post-payment audits, Beyer said.
“What we have is a situation where we have too few providers,” Beyer said. “When you compound (this) with the concerns of those providers, related to contracting with any health plan—whether it’s Medicare Advantage, fully insured, (or) self funded—the fact is that they have the option to go out and hang up their shingle and have a cash-only practice. And we see that more and more.”
Rami Rafeh, vice president of provider strategy at Premera Blue Cross, said the health plan’s Matchmaker Behavioral Health program could help improve access to care. The program connects patients to care providers based on their health plan, needs, and preferences. The program initially attempted to match patients with up to four in-network providers accepting new patients.
“It took us a long time initially. Systematically, we got better and better at it, and now we provide at least two [matches] that are accepting new patients, and we offer that match to our patients.”
— Rafeh
Nepomuceno said the development of Washington’s crisis/988 suicide prevention system has paved the way for improved access to crisis services. She serves on the Crisis Response Improvement Strategy (CRIS) Committee.
“We discuss where the gaps are in the crisis system (and) what needs to be addressed,” Nepomuceno said. “CRIS just released its recommendations to the governor, and a lot of those recommendations were (about) lived experience, and it is definitely a need.”
OIC is working on several measures to improve access to behavioral health services as well. It updated its website last fall to include a page that instructs consumers and behavioral health providers on how to appeal insurance denials for care.
“Hopefully folks are using that,” Beyer said. “And later this month, we’re going to release an analysis on (the) use of and payment for behavioral health services in health insurance plans that we regulate. We’re going to be publishing a massive data dashboard on our website, and it’s going to provide information on the use of mental health services by diagnosis, by urban and rural region, and between adults and kids.”
The challenges highlighted in the Washington State of Reform Health Policy Conference regarding the state’s behavioral health system are indeed pressing, particularly in terms of workforce sustainability, equitable access, and service availability. The insights from Jane Beyer and Anna Nepomuceno shed light on critical areas needing immediate attention, such as the insufficiency of in-network behavioral health providers and the specific struggles faced by communities of color and those in rural areas. It’s encouraging to hear about initiatives like Premera Blue Cross’s Matchmaker Behavioral Health program and the development of Washington’s crisis/988 suicide prevention system, which aim to improve access to necessary care. The efforts by the OIC to provide resources for appealing insurance denials and the forthcoming data dashboard are also promising steps towards transparency and better service provision. Thank you for bringing these important discussions to the forefront.