In this episode of Quality Matters, we dive into the complexities of behavioral health care with Julie Seibert, Assistant Vice President of Behavioral Health at NCQA, and Tom Tsang, founding CEO and Chief Strategy Officer at Valera Health. Together, they explore the interconnected challenges of access, quality and payment in behavioral health, emphasizing the need to treat the whole person by addressing both mental and physical health. Julie highlights NCQA’s three-part framework for behavioral health—access, quality, and payment—emphasizing that linking these elements is critical in improving care.

Tom shares how conversations around mental health have changed since the pandemic, making the connection between behavioral health and physical health more clear. He discusses the ripple effects of mental health conditions on chronic disease management and diverse societal problems, such as rising rates of adolescent substance abuse and suicide. Both Julie and Tom reflect on the potential of innovations like measurement-based care, telehealth and value-based payment models to expand access and improve outcomes. They also discuss ongoing systemic barriers, including a shortage of providers who accept insurance.

Julie and Tom shine a light on emerging solutions, from CMS payment reforms to NCQA’s development of quality measures tailored for behavioral health. This discussion offers invaluable insights into addressing the urgent need for accessible, high-quality behavioral health care that meets the needs of an increasingly diverse America.

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Key Quote: 

“Access, quality and payment are tied together. If payment models are not sufficient to cover costs of care, you have fewer practitioners that provide services. And if there are fewer practitioners, it's difficult to have access. If there are not enough people to permit sufficient access, that lowers quality. They're all inextricably combined.”

-Julie Seibert

“People recognize that it does impact our physical health and that we have to take into account physical and mental health as a whole. People with chronic medical conditions, 30 to 40 percent of their total cost of care could be impacted by their mental health conditions. 

A lot of people have changes in morbidity and mortality because of loneliness. Depression can impact someone's intake of food consumption, impacting fasting glucose and adherence to medical management of their chronic illnesses. We've also seen the impact on the child and adolescent population in terms of learning disabilities, teenage suicides, drug use, alcohol consumption. 

We've seen all of that happen over the last five years.”

-Tom Tsang

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Time Stamps:

(00:30) The Complexity of Behavioral Health

(03:18) A 3-Pronged Model for Behavioral Health

(06:23) Quality Dimensions in Behavioral Health

(08:42) Bringing Value-Based Care to Behavioral Health

(11:57) Payment Models and Challenges in Behavioral Health

(15:25) Telehealth in Behavioral Health: Opportunities and Challenges

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Links:
NCQA White Paper: Developing a Behavioral Health Quality Framework

Connect with Julie Seibert

Connect with Tom Tsang