The American Medical Association (AMA) released a report defining opportunities to incorporate technology to advance behavioral health integration (BHI) and outlining a framework to measure BHI models. This report, which was informed by a diverse working group, proposes a set of practical solutions that stakeholders—including physician practices and health systems, health plans and coverage programs, federal and state policymakers, employers, and behavioral health companies—can pursue to accelerate the widespread adoption of sustainable BHI.
Behavioral health conditions among Americans have worsened over the last several decades, a challenge that has only been made worse by the COVID-19 pandemic. The long-standing shortage of behavioral health providers has limited timely access to treatment. BHI is essential to solving the nation’s growing behavioral health crisis. The current evolution towards digitally-enabled care models presents an opportunity to enhance the effectiveness of BHI through digital tools for screening and intake, clinical decision support, and telehealth care delivery.
In the report, the AMA stated three goals to advance BHI through digital tools: defining opportunities and limitations with digital BHI, solutions to address gaps hindering widespread adoption of BHI, and representing the value of AMA’s Return on Health framework.
I. Use of Technology to Support BHI: Defining Opportunities and Limitations
The COVID-19 pandemic augmented the adoption of digital health tools, especially those related to telehealth. There are several opportunities within a patient’s experience with BHI where technology can be used to generate value for both patients and providers. These include digital intake and screening tools, machine learning algorithm-enhanced clinical decision support, and digital medication management tools.
On the other hand, there are limitations to the use of technology within BHI. For instance, the use of technology will not work for everyone—both patients and providers have preferences related to the use of technology, and some may lack digital literacy or broadband access, among other factors, to effectively utilize them.
II. Solutions to Address Gaps Hindering Widespread Adoption of BHI
The report includes practical solutions that various stakeholders can use to address specific gaps currently hindering the widespread adoption of BHI. Solutions include providers incorporating digital health solutions into standard workflows to increase behavioral health diagnoses and using measurement-based standardized instruments (e.g. Patient Health Questionnaire-9 [PHQ-9], PROMIS tools) to measure, assess and track symptoms and outcomes and tailor treatment. Additionally, Health plans could expand coverage and provide support to primary care practices to integrate behavioral healthcare.
III. Applying the AMA’s Return on Health Framework to Digitally-Enabled BHI
AMA’s Return on Health framework is a policy that aims to advance BHI adoption and defines the goal of generating value through virtual care. The framework includes six value streams that can be standardized and used to assess the value of digitally-enabled BHI models:
- Clinical Outcomes, Quality and Safety
- Access to Care
- Patient, Family and Caregiver Experience
- Clinician Experience
- Financial and Operational Impact
- Health Equity
For example, diagnostic screening and assessment tools, such as PHQ-2/PHQ-9 and Alcohol Use Disorders Identification Test-Concise I. Executive Summary 7 (AUDIT-C), can be used to measure clinical outcomes, quality of care, and safety.
Incorporating technology into BHI models is a critical tool in addressing the behavioral health crisis facing our country. Importantly, a broad range of healthcare stakeholders can leverage and support that technology to make treatment that addresses peoples’ behavioral and physical health needs accessible and a more standard practice within primary care.