Thankfully, Americans are much more aware of the need to maintain their mental health than they were even a few years ago. But millions of people still struggle to find mental health providers, and even if they find a provider, it may be difficult to find ones that meet their needs.

On this episode of HealthChangers, host Ashley Bach speaks with Dr. Mike Franz, executive medical director for behavioral health for Regence. Besides overseeing our behavioral health programs across our four states, Dr. Franz is also a practicing psychiatrist. We discuss the current state of mental health in the U.S. and what Regence is doing to expand access to mental health care – for our members and across the states we serve.

Listen to the full podcast episode on the player above. Below are some highlights, which have been edited for length and clarity. 

AB: Dr. Franz, we've been so fortunate to have you on the podcast at least once a year to talk about mental health, and it’s an important enough topic that we could probably cover it on every episode. How would you describe the current state of mental health in the U.S.?

MF: I would say that we've been talking about the mental health crisis as we've come out of the pandemic, and unfortunately, we're still in a mental health crisis. We're seeing very high prevalence of behavioral health conditions throughout the population. I know in the past, you and I have talked about the high prevalence of hopelessness and persistent sadness among our adolescents, and that continues. I will say the numbers have improved just so slightly, so perhaps it's a trend in a better direction, but it's still there.

Likewise, with our adults, we continue to see high prevalence, especially with substance use disorders. But again, I would say there's been some improvement, especially with deaths related to overdoses in the substance use space. So, a few emerging spots of hope, but by and large, the trend continues that our population is struggling and suffering.

The demand for behavioral health continues to be at a very high level while the supply lags; we still need to produce more mental health professionals in order to meet that need. We are not going to change this overnight, but we have been working very hard to address it and be strategic and creative and innovative in our efforts to make sure that we can meet the need at least of Regence members.

AB: Here at Regence, we are committed to increasing access to mental health care. How would you describe Regence’s overall commitment?

MF: At Regence, we believe mental health is health. It's integrated into everything we do, from internal operations – I work shoulder to shoulder with my other executive medical director colleagues. I consult to them. They consult to me. We kind of mirror in our internal operations the interdependence and the integration of behavioral health and physical health, so that our members have a seamless experience of being able to get their medical and behavioral health needs met, oftentimes in a single setting, maybe a single visit. For example, in primary care integrated settings, where they might be able to see a behavioral health clinician in the same visit that they're seeing their primary care provider or get some psychiatric consultation in that clinic.

We are very committed to quality behavioral health. We are increasingly looking to incentivize providers to perform what's called “measurement-based care,” where they actually measure their clinical outcomes, so that we can pay them for quality results, rather than just volume or number of services or duration of service. And we really seek to further develop the [behavioral health] workforce as well. We, to a certain extent, rely on our foundation for that – the Cambia Health Foundation – to work as a partner, to fuel some of the resources needed to develop a workforce that is in great demand and short supply.

AB: There are a couple different areas we're really tackling the issue. We're working to address those immediate access needs, but also those systemic challenges facing mental health care in the states that we serve. There's also a regulatory component that we'll touch on later in this conversation. But first I wanted to start with those immediate access needs. What is Regence doing to address those?

MF: Since 2021, we have nearly doubled our behavioral health provider network. We have added more than 26,000 net new providers across our four states. It's truly remarkable. We have also done this through the development of new strategic partnerships with select behavioral health partners. And these are generally virtual-forward national organizations that offer very rapid access to care. I'm talking that 95 percent of our members can get into these behavioral health strategic partners within one week, within seven days of their request, and many of them within 24 to 48 hours.

We also have had significant success in increasing utilization of behavioral health services. This might sound paradoxical that a health insurance company would want to increase utilization, but we know that when we have members that need behavioral health services, that if they don't receive it, and if it's not effective, not only do they suffer and their clinical conditions don't get better, but total cost of care increase substantially. Somewhere on the order of two to six times, depending on the behavioral health condition, into comorbid chronic medical conditions that drive the bulk of those costs.

We have a strong desire to look at metrics to see if we're actually increasing utilization among our behavioral health providers, because we know the prevalence is there, and we look to closing that gap between the prevalence of behavioral health conditions among our member population and those that are actually receiving care. And we've seen a 31 percent reduction in Regence members with behavioral health conditions who have no evidence of having received care, and that is because we measure it, and we are specifically implementing strategies to improve that.

Finally, I'd say that, money matters, reimbursement matters. Historically, there's been some disparity between reimbursement for behavioral health providers and other medical providers. We have significantly increased reimbursement rates for behavioral health providers across our regions and across a variety of services in an effort to attract and retain high quality clinicians.

AB: How much have we seen utilization of behavioral health services go up among our members?

MF: Specific to virtual care, we’ve seen a 28 percent increase in virtual behavioral health utilization across our four states just in the past year. For our professional behavioral services – think of it as the psychotherapy services, the classic one hour of therapy – utilization has increased 48 percent since 2022.

AB: You talked about strategic partnerships, many of them with virtual-forward providers. These seem so critical as we work to ensure our members have access to the mental health care that they need. What else can you say about these partnerships?

MF: I mentioned they do measurement-based care. I mentioned that they have really terrific and previously unheard of times to access care of being under a week, in 95 percent of the situations. There are many times we can get someone connected, not just to a therapist but a psychiatrist, and in under 48 hours.

This is unique to our behavioral strategic partners. This does not happen in the community. This does not happen in the brick and mortar world. Those waits continue to be – depending on the service – weeks or months. In fact, a great example, we just recently executed a contract with an organization called Bend Health, and they're able to offer pediatric neuropsychiatric comprehensive evaluation and testing within two to three weeks. I mean, this is, transformative. This takes six months, sometimes a year, to get that in the community, generally. So this is an example of how innovation can improve timely access while maintaining good quality. Again, because they're doing measurement-based treatment.

We've brought on behavioral strategic partners that are both generalists, and then we have specialists. So, some like Headway, Talkspace, Rula, I would call generalists in that they treat a variety of conditions: depression, anxiety, some bipolar disorder, pediatric conditions, adult conditions, and do a very good job of it, providing both therapy and psychiatric medication management. And then we have some specialty behavioral strategic partners like Eleanor Health, that focuses on more severe substance use disorder; Boulder Care, that does excellent medication assisted treatment, along with peer recovery support; nOCD, which is just an outstanding best practice, exposure response, prevention, treatment for mild to severe OCD.

And we recently brought on another strategic partner called Meru Health that uses a very innovative interface, where therapy is available virtually, but it also uses chat texting functions so that there can be continuous interactions between the therapeutic team and the member throughout the week, using smartphone applications that really keeps the member engaged in treatment, building skills even between more traditional treatment appointments.

AB: Part of the issue with mental health access is also systemic, like reducing the mental health stigma and addressing the shortage of behavioral health workers. What is Regence doing in this area?

MF: We partner closely with our foundation, Cambia Health Foundation, which really works to improve the community and our states as a whole. The Cambia Health Foundation has done amazing work the past five years or so, as long as I've been here, in that they have prioritized behavioral health in their own strategic plan, to the extent that they've given more than $5.5 million to our communities to strengthen the behavioral health workforce, and a lot of this is geared towards provider training. They've helped train 1,700 providers in integrated care, specifically, including the collaborative care model, by training providers to be able to deliver behavioral health in integrated settings such as primary care. They're really increasing the capacity for the system to meet the high demand that's out there.

Another example is with our customer service department, which is really the front door for our members. This is who they reach when they call that 1-800 number on the back of the insurance card. Every single one of them are trained in behavioral health so that they can help navigate our members to appropriate services and treatment.

And we've also led comprehensive initiatives to educate members, providers and employers, to raise awareness of behavioral health services and their value. We've convened employers to share ideas and best practices in supporting employee mental health.

AB: State regulators are a key partner in ensuring that health insurance companies are serving their members and providing the benefits they need. What is Regence doing on the regulatory front to ensure mental health access?

MF: We take our regulatory requirements seriously and remain committed to compliance, transparency and continuous improvement so that our members receive the behavioral health support that they need. We implement state and federal requirements in good faith, and we continually refine our processes as rules evolve and expectations become more clearly defined. We value ongoing collaboration with regulators and welcome opportunities to help shape future rulemaking that provides clarity, consistency and the best outcomes for members.

We take the parity rules in legislation very seriously. I'm involved in these processes professionally in my role here, and I am quite proud of how dedicated we are to ensuring that our members that have a behavioral health condition don't have any more onerous utilization management process compared to members receiving medical services, and that there's equal access to behavioral health as there is to medical.

I think it goes back to how we really prioritize integrating behavioral health into medical treatment, in that we just don't see health care happening without a whole-person, whole-health approach that really looks at one's behavioral health as part and parcel of how our members are doing in regards to their total health picture, and that really requires that we approach everything we do with parity in mind.