Opioid Treatment: Building Psychiatric Capacity to Deliver Appropriate Opioid Treatment That
Aligns with Plan Policy
by Micah Hoffman, MD, DABPN, FAPA
AllMed Behavioral Health Medical Director
The pandemic has exacerbated existing barriers to mental and behavioral health care even as its stresses have spurred greater need. At the core of the issue is a severe shortage of psychiatrists and other mental health providers.
“Patients typically have to wait weeks or even months to see a psychiatrist even if they have access to one.”1 – Ryan Kimmel, Psychiatry Chief of Service for University of Washington Medical Center
The shortfall is particularly acute in rural areas, less advantaged urban neighborhoods, and community mental health centers that often treat the most severe mental illness—and it’s escalating. By 2025, demand for psychiatrists is forecast to outstrip supply by 6,090 to 15,600.2 As a result, many health plans, which rely on the expertise of qualified psychiatrists to help them manage complex claims relating to opioid use, find themselves in a bind. They are looking for solutions to close the gap, so that they can ensure that members receive care that is appropriate to their circumstances and aligns with plan policy.
A Challenge Decades in the Making
The roots of the current crisis run deep. Factors fueling the shortage include greater awareness of mental health problems, which has inspired people to seek treatment; the aging of the baby boomers, many of whom now need mental and behavioral health care; and a retirement drain in the field. In 2015, more than 60 percent of practicing psychiatrists were over the age of 55—one of the highest proportions among all specialties.3
Uneven distribution of resources complicates the situation further. At last count, there were about 30,451 psychiatrists in active practice in the United States, yet 60 percent of U.S. counties have no psychiatrists at all. 4 While there are 612 psychiatrists per 100,000 people in parts of New York State (a 1-to-163 ratio), there are fewer than one per 100,000 in Idaho.5
Building Capacity While Extending Existing Resources
Medical schools and teaching hospitals are taking a variety of measures to address the issue by increasing the number of future psychiatrists in the pipeline. Since 2000, medical schools have increased the number of spots available in psychiatry departments by 30 percent.6 Hampering progress is the fact that the federal government, which funds medical residency programs, put a cap on them in 1997 with the Balanced Budget Act. The cap, not meant to be permanent, has become a bottleneck. Recognizing the dire need, in some cases hospitals have taken on the added training costs themselves. This effort appears to be bearing fruit: according to American Association of Medical Colleges (AAMC) data, from 2010 to 2015, the number of new psychiatry residents grew 5.3 percent.7 From the standpoint of health plans in need of help now, this expansion offers hope but no immediate solution.
Another timelier approach to solving the problem connects psychiatrists with primary care providers (PCPs) and physician extenders, who are often on the front lines of treatment. Telepsychiatry frequently enables these partnerships, in which licensed psychiatrists advise PCPs seeking guidance on behavioral health treatment. A version of this strategy can be key to effective management of complex mental and behavioral health reviews as well.
Partnering for Optimal Care Supported by Legally Defensible Determinations
At AllMed, our board-certified practicing psychiatrists collaborate with your team, providing the on-demand expertise needed to ensure that members receive appropriate treatment for their opioid use disorder within the language of the plan. Through our reviewers’ extensive clinical experience and rigorous process, we help you allocate resources and dollars optimally, ensuring that the documentation you receive supports the determination.
Cases of court-ordered treatment offer a good example of how such a collaboration could be beneficial. Sometimes, the lack of specialized training or familiarity with local resources can make it difficult for members of the court to identify the level of care and treatment plan that will best fit an individual member’s circumstances.
We help you successfully navigate at the intersection of the law and medicine to address these complexities and determine medical necessity, when necessary. Our experts draw on their experience, applying the most relevant clinical evidence and standards of care to each case they review. Leveraging their knowledge enables you to address your members’ needs at the right level of care, with the most clinically appropriate treatment, controlling costs while improving the quality of care.