Thinking Differently About Health Disparities, the Pandemic and Behavioral Health

Melissa Fox, MHA, FACMPE,  FACHE

There have been thousands of articles written about the effect of the pandemic on existing health disparities and the worsening of certain conditions as a result of the year-long quarantine and public health crisis. It’s no secret that COVID-19 exposed the historical gaps in the healthcare system which have always made it difficult for those who are already suffering the most to efficiently and consistently access the care they need. Though these issues weren’t created during the pandemic, they were absolutely exacerbated. Just as importantly, the pandemic elevated the conversations about the Social Determinants of Health and the critical role these factors play in achieving optimal care outcomes – especially as it relates to behavioral health concerns. 

Disruption Factors Driving Change

With all of this information – much of it common knowledge – how do we now challenge ourselves to think differently and courageously as providers to shift the care delivery system?  Some components are obviously outside of our control (think reimbursement and regulations), but many things are not.  The time has now come to begin thinking and planning differently as it relates to the care we provide, because by not doing so we miss an opportunity to create a much better system than the one we woke up to in early March 2020. 

In January 2021, Deloitte published an article which outlined 6 factors they believed would disrupt the global delivery of behavioral health post-Covid and would help drive meaningful change in the sector. Though many of the factors weren’t surprising since they are similar to the needs of the system pre-pandemic, the expectations related to data, consumer empowerment and care access have obviously significantly changed in the aftermath of a global public health crisis.  

Cultural and Behavioral Change has different implications as it relates to physical vs. behavioral health, and thus requires a different type of response from providers.  For instance, discussions related to healthcare have historically focused on primary care or acute physical care settings like hospital systems. Those levels of care typically address health concerns after they have already occurred, and they aren’t regularly inclusive of preventive measures which can include the social determinants.  Though well-being is understood to be inclusive of mental healthcare, those components have been on the periphery of the care continuum until fairly recently. The pandemic has further prioritized topics which have typically been relegated to secondary status. So, the question now becomes, how does our sector assume a leadership role in shifting the care paradigm – especially now that it has become clearer than ever that community-based social and human services providers are critical to overall health outcomes? 

Even after considering items like the 6 factors referenced by Deloitte, behavioral health providers still have to reckon with existing barriers to care such as: 

  1. Provider shortages 
  2. Limited funding and reimbursement 
  3. Stigma and lack of overall trust in the health system 
Considering all of the issues outside of our control, there are several aspects of care that are within our control, and they offer the opportunities we need to think differently about the way our sector provides care in our new reality: 
  1. Partnerships and collaborations – Addressing the health disparities which exist in our communities, especially post-pandemic, will require alignment of key stakeholders on a level many providers haven’t historically embraced. This goes beyond simple referral arrangements, and instead challenges us to create community-based care systems within which people can receive support. 
  2. Developing “institutional courage” as it relates to changing longstanding norms – One of the biggest enemies of progress is complacency disguised as status quo. Community-based providers take great pride in being mission focused and different from other types of care providers.  The time has come to cultivate cultures of innovation within our ranks and leadership in order to best position our agencies and our communities for success. 
  3. Speaking a language other than our own – If we are going to be part of an effective and larger healthcare continuum, it’s important to align with the quality standards and outcomes of physical health providers.  This helps to strengthen care transitions and allows us to work more collaboratively with payers as well.  It also helps to reduce stigma related to mental health and SUD treatment by normalizing the care we provide. 
  4. Identifying and confronting the bias within our ranks – It goes without saying that many disparities which exist in healthcare are due to implicit and/or explicit bias within providers.  Behavioral health providers are no exception, and the increased level of need in some of our most vulnerable communities post-pandemic requires us to be as informed and empathetic as possible in our care delivery. 
  5. Embracing data as an asset and a vehicle – Too often, data collection can be seen as a necessary evil and only a task to be completed in support of billing or care management.  But data, when managed proactively, can be so much more than that. It can provide community-level trends which affect care innovations, locations and even care partnerships. If the pandemic has revealed nothing else, it has revealed that providers should have a population health lens through which they are viewing their data at all times. 

All in all, we’ve all talked at length about the pandemic and its effects on health disparities, social determinants, and access to behavioral health care. The conversation must now shift to thinking differently about care and courageously implementing changes to address the new care landscape. The pandemic may be lessening in strength, but the disparities will likely linger. What will be our response as a sector? 

View more Population Health articles on the AIHI Blog.