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Behavioral health providers face staffing and reimbursement challenges as demand grows for services

Demand for behavioral health services has increased greatly, not necessarily because people need more services, but because some of the stigma around mental health care has lessened in recent years. Unfortunately, staffing is not keeping up with demand. Some providers have closed programs, even though the demand for those services is increasing because they can't staff the need. When behavioral health providers can even find the right staff, they have to pay much more than they did previously to compete with what people could make at a Walmart or McDonald's. 

Parity in reimbursement is also an issue with behavioral health providers. They do not benefit as much as other healthcare provider types from Medicare and Medicaid reimbursement, and revenue limitations make it harder for these providers to both compete for talent and to invest in technology that could create efficiency and better healthcare outcomes. 

Reimbursement parity 

There are new programs that partially address the parity issue. One is the federal Certified Community Behavioral Health Clinic (CCBHC) program. CCBHCs are required to serve anyone who requests care for mental health or substance use, regardless of their ability to pay, place of residence or age. Several states are creating similar programs, focusing on crisis intervention combined with care coordination. So, if a patient comes to a behavioral health provider, the provider is compensated properly to help the patient get any necessary primary care, in addition to the behavioral healthcare they receive.  

Better healthcare integration 

Integration between primary care providers and behavioral health providers will continue to be important. Challenges to successful integration include the cultural differences between behavioral and non-behavioral clinicians, the barriers to the flow of information between provider types and billing challenges related to private insurers and government programs like Medicare and Medicaid.  

The most common way for primary and behavioral providers to interact is where the primary care provider screens a patient for their healthcare needs and then makes a referral to behavioral health colleagues. A slightly better model is when behavioral care managers are embedded with the primary care practice at the same facility. The ideal arrangement is when both types of providers work at the same facility and they coordinate under one management structure. 

The behavioral health sector has also been transitioning from a cost reimbursement model to a managed care model, and using telehealth more, which affects operations. How do providers select and implement the right technology? How do they determine costs? Are they monitoring the right metrics?  

Fragmented health sector 

Because behavioral health remains one of the more fragmented provider sub-sectors, with many small providers, the sector will continue to be attractive to private equity investors looking to consolidate providers in each area as well as introduce efficiencies. While 2021 was a record year for M&A activity in the behavioral health space, deals were down about 20% in 2022. Deals related to providers of autism services, however, were up 15% year-over-year. 

Housing will also become a more significant part of behavioral health services. If someone is in crisis, it becomes more difficult for them to heal if they don't have stable housing. The Department of Housing and Urban Development (HUD) is looking to expand its Sec. 811 program, a rental assistance demonstration program, and providers are anxiously waiting for HUD to release millions of dollars in Sec. 811 funding. 

New funding released in the second half of 2022 was aimed at mental health services for youth. This funding will provide for more mental health providers in schools. 

The challenge for behavioral health providers in 2023 is meeting everyone’s needs as providers deal with increased demand and limited staffing. Providers should try to avoid being a one-stop-shop for all behavioral health needs and focus on core competencies, and then look for affiliations with another provider or thinking outside of the box to meet patient needs. 

For more information on this topic or to learn how Baker Tilly’s healthcare specialists can help, contact our team

Krista K. Pankop
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