Behavioral healthcare for Geisinger Health Plan members
Approximately 1 in 5 adults and 1 in 6 children/adolescents have mental health concerns within a given year. Since the onset of the COVID pandemic — and since then — the need for mental health services continues to grow in the United States, especially among children and adolescents.
Access to mental healthcare and engagement in treatment are longstanding concerns in the U.S. Multifactorial barriers to access include specialty-specific or geographic limitations in availability of mental health providers, stigma, social determinants of health, inflexible models of care, a paucity of treatment algorithms, limited integration of physical and mental healthcare, and the absence of patient-centric measurement-based care focused on not only symptom improvement but functional and quality of life impacts.
Access to behavioral healthcare (BH) matters. Geisinger Health Plan is committed to improving availability, ease of use and timeliness of access for our members in need of BH across the continuum of services. The medical literature tells us that post-BH hospitalization is a high-risk period for patients, and access to after-care appointments with a BH provider within 7 days is critical. In addition, patients with mental health diagnoses often have medical comorbidities that affect their mental health and in turn are affected by their mental health.
In comparing health plan members with behavioral health diagnoses to members without a behavioral health diagnosis, the total cost of care is 2x to 3x higher for those with a diagnosis. This difference is largely driven by non-behavioral health, non-pharmaceutical medical/surgical costs, pointing to the potential holistic impact of access to non-urgent, longitudinal behavioral healthcare and better integrated care.
Geisinger Health Plan in part assesses access to behavioral healthcare using results of our annual member experience survey and guidance timelines established by the National Committee for Quality Assurance (NCQA):
- Care for a non-life-threatening emergency: Within 6 hours
- Access to urgent care: Within 48 hours
- Initial visit for routine care: Within 10 days
- Follow-up visit for routine care: No set NCQA timeline — Geisinger Health Plan strives for within 10 days of the member’s desired appointment
Beyond continuing to expand our network to meet provider gaps and supporting innovations such as virtual visits and the adjunctive use of digital therapeutics such as Teladoc’s MyStrength platform, feel free to share with us other suggestions for ways the health plan can facilitate access for your practices and patients.
On behalf of the health plan, we thank our behavioral health providers for their commitment and dedication to providing timely access and quality care to our members.