TCIV Spotlight: Providers Rising to the Challenge During Pandemic

The COVID-19 pandemic has driven up the need for the services provided by behavioral health and addiction treatment centers and simultaneously put a crunch on their finances. As providers look to help those in need of their services, the hurdle of breaking down barriers to care—a challenge even in non-pandemic times—persists, as does the need to secure funding and obtain protective equipment for staff members.

At the upcoming Treatment Center Investment & Valuation Retreat, Shawn Coughlin, president and CEO of the National Association for Behavioral Healthcare, will discuss advocating for treatment centers during the ongoing crisis. In the meantime, he spoke with Behavioral Healthcare Executive about some of the challenges that executives in the field are facing and the tools they’re using to overcome them.

Editor’s note: This interview has been edited for length and clarity.

Even in non-pandemic times, the idea of breaking down barriers to care has long been a challenge for mental health and addiction treatment providers. How does that become an even more difficult task in light of COVID-19?

I know everything is focused on COVID-19, and you’re correct in that we’ve had problems in accessing care. ... We know there are tens of millions of individuals who have reported having a serious mental illness, but only about 1 in 3 receive treatment. We have more than 20 million with substance use disorders, and we’re only seeing about 11% with access there. ... Obviously, when COVID started this year, that got worse immediately. As hospitals started cancelling elective procedures, there was a ripple effect throughout the system, and we started seeing individuals who, quite frankly, didn’t want to go to a hospital or to any kind of healthcare provider under any scenario. We saw a dramatic cutback in census across our membership. We know that lasted for a few months, but since then, there has been a huge rebound. There have been a whole host of flexibilities and guidances that the federal government put out, some blanket waivers.

The key case study I talk about in my presentation is the dramatic expansion of telehealth. Most of our members engaged in that across the board. As a result, we saw a rapid return of patients recognizing that we’re seeing telehealth providing an access point that a lot of individuals liked and continue to enjoy. We saw a dramatic reduction in no-shows for appointments. And then in the addiction treatment community, we saw examples of patients being able to take home a month’s worth of medication. They didn’t have to go to a facility every morning to get their medication. That’s another example where we saw a dramatic switch. Patients had access to a month’s worth of medication and were showing up reliably and reporting that they liked those services. We’re also seeing an increase in demand beyond what we would consider a normal baseline. That’s a direct result of COVID in that we’re seeing a whole host of adverse impacts. Obviously, job loss and job insecurity, the loss of loved ones and not being able to be with them during treatment of their illness. We’re seeing spikes in loneliness, anxiety, depression. That’s impacting a broader portion of society than those traditionally engaged in behavioral health issues. We’re seeing an increase in demand at this point, and because of the flexibility that the federal government has provided and the leadership they’ve shown on expanding eligible covered services under Medicare, expanding the types of providers eligible to bill for telehealth, and the other flexibilities they’ve created, in an unusual way, we’re starting to see an emphasis on the need for behavioral services and we’re seeing a much greater outreach for those services. We had the ongoing opioid epidemic. We had the ongoing suicide epidemic. And then we layered COVID on top of it, and as a result, it has brought a focus on behavioral healthcare much more to the forefront.

The pandemic has, of course, created conditions that have increased the need for mental health and addiction treatment services, but at the same, we know some of the other health impacts COVID is causing. Does there become almost a competition for funding between various specialties within healthcare?

I’ll use access to personal protective equipment as an example. When this first hit, the focus was on ICUs and med/surgical hospitals. All PPE was being sucked out of the system and into the surgical side of the equation. That applies across the supply chain—disinfectants, cleaning supplies—but it also highlights the fact that behavioral is part of the healthcare system, and our members had to engage in the same kinds of things. They had to purchase PPE and look into new infection control mechanisms, things that haven’t been as heavily emphasized in the behavioral space as they have on the surgical side of the equation. Behavioral has always been considered kind of the redheaded stepchild, we got out in front of that to beat the drum loudly to say we’re facing the same costs and problems, and we need the same access. I think that was recognized in the CARES Act. Many of our providers were recognized as eligible for some provider relief fund dollars. We continue to push for additional clarification. We saw that addiction treatment services were identified as an essential health benefit early on, so that was very helpful. We’ve seen as we’ve gone on through the process and funds have been released that they are reaching further and further into the behavioral health space and addiction treatment to identify providers to shore that up. Initially there was that competition, but I think we’ve seen some pretty good success in achieving some balance and ensuring we’re receiving resources. Now, hold your breath, knock on wood, whatever the terminology is, as we’re seeing the surge again and hospital capacity being exceeded, it’s something we’re keeping an eye on. Are we seeing some of those supply chain chokeholds again? We haven’t yet; our members have access to PPE. But it’s something we’re worried about as we see in the Midwest particularly this spread of COVID.

In light of that, what’s the message from treatment centers looking to secure funding now? As we see those concerns rise again as we hit this next wave, what’s the message?

Our message has been pretty consistent from the beginning: We need dedicated resources set aside to address the behavioral healthcare industry’s needs—building out new space, remodeling, investing in telehealth capabilities, infection controls, PPE, all of that stuff we’ve been making the argument for dedicated dollars. The funds that were initially available in the Provider Relief Fund are still being paid out. … As we look to the next phase, Congress is stymied unfortunately on the COVID 4.0 package, but we continue to make that same message that notwithstanding the fact that we don’t have ICUs, our patients still need access to our facilities and we still need to address the same things—testing supplies, protocols for infection, PPE, cleaning supplies and the like. We continue to beat that very same drum.