An Equity Plan for Healthcare Professionals Who Take the Time to Talk

Institutions are being challenged today to correct longstanding inequities. The behavioral health field knows inequity, stuck as it is with chronic underfunding and the resulting deficits in compensation for clinicians and staff. While primary care is better funded, primary care physicians (PCPs) lag their peers in compensation. These professions are alike in an important way. They rely more on personal communication than technology.

Compensation is tied to many factors, and a significant one for our field is stigma. Yet the parallels between primary and behavioral care reveal broader issues. The US healthcare system thrives on technological advancement, and this drives financing on several levels. As one expert has argued:

Our healthcare system rewards those providers that invest in technology and transactional specialty services, at the expense of those who choose to invest in primary care, geriatrics, addiction services, and behavioral healthcare. … While technological advances remain a critical component of delivering effective healthcare, a 21st century health system should presume that collaboration and time are at least as important as technology.

This expert was CEO of Harvard Pilgrim Health Plan for 10 years, and in January he ended 8 years as governor of Massachusetts. Charlie Baker is neither a healthcare professional nor a radical reformer. He is a fiscally conservative, Republican politician who understands the value of therapeutic conversations.

His comments above are from testimony supporting a 2022 state bill to create a Primary Care and Behavioral Health Equity Trust Fund. The bill’s ideas are transformative yet practical. Governor Baker understands that much of healthcare requires “time and connection.” Putting aside politics, the bill merits discussion as a blueprint for advocacy. Our field’s future may depend on such thinking.

Closing the Gap with 30% Growth for 3 Years

Governor Baker’s bill set an increased spending target—30% higher for 3 years—for primary care and behavioral health “to reorient the way insurers and healthcare providers invest.” These services are “underfunded by today’s payment models.” The math is simple. A payer previously spending $100 million on these services, for example, must fund a total of $130 million by the implementation date.

The governor knows if we do not “reorient” or re-baseline our spending on these services, words of appreciation for this work are hollow. If we do not “reward providers and provider organizations that invest in a comprehensive set of physical and behavioral health services,” we cannot expect them to be readily available. The governor explicitly wanted to help both patients and clinicians with this bill.

This plan is not an across-the-board funding increase for healthcare. It requires that “overall healthcare spending remain within the confines” of established benchmarks. Payers are given flexibility on how to meet goals, but all funding cannot rise in this plan—just our traditionally underfunded areas. It is expected that behavioral systems will use these new funds to expand networks and boost clinician pay.

The other key financial mechanism in this bill is the Health Equity Trust Fund established to fund provider systems caring for Medicaid members. This addresses another form of inequity, namely, disparities based on social, economic, and cultural factors. Primary and behavioral care may be underfunded in general, but large disparities in funding and health outcomes exist by social group.

When Institutional Change Needs a Financial Stimulus

A wide range of lessons can be taken from this legislation, including:

1. Given the historical marginalization of our field, we will have more clout to effect change by collaborating with our primary care colleagues.
2. Clinicians will never gain pay equity without a major adjustment to funding levels, and so a mechanism like the one in this bill must be found to re-baseline behavioral healthcare.
3. Because pay equity is self-serving and leaders need objective reasons for change, achieving a balance between communication-based care and technology-based care is compelling.
4. Limited, gradual change often leads to inconsequential results, and so our field needs a bold plan embedded in a solid financial model to drive meaningful change.

The Massachusetts bill recognizes that our field needs a revenue boost to fairly compensate clinicians. Low pay is a core weakness in our field. We are entering an era of consolidation with large healthcare enterprises, and rectifying pay inequities may be feasible for a brief time. As our field fits into a financially strong healthcare industry, we should consider new services and new financial agreements.

This equity plan is silent on how primary and behavioral care should collaborate. While the plan points to such linkage, the nature and implications of this connection are left for another initiative. Behavioral care may indeed be primary care, but both aspects of communication-based healthcare urgently need a financial stimulus today. It is time for executive action, not theoretical debate.

Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.

Reference

Baker C. Why we need to reorient our health care system. Commonwealth Magazine. Published online April 11, 2022. Accessed May 19, 2023.