“This is a time of unprecedented need and opportunity for behavioral health care,” said Bradley Karlin, PHD, ABPP, MBA.
As executive medical director of Behavioral Health for Highmark Health since 2021, he is leading Highmark’s efforts to transform behavioral health (BH) care.
In a recent interview with Provider News, Dr. Karlin discussed the current challenges in BH care; the unique opportunities and benefits presented by virtual health care and other innovations; and Highmark Health’s enterprise behavioral health strategy.
Dr. Karlin has dedicated his career to transforming behavioral health care in large public and private systems. Prior to joining Highmark Health, he served as vice president and chief of Mental Health and Aging at EDC, a global consulting firm. He is currently an adjunct professor in the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, Maryland.
At the Department of Veteran Affairs (VA) in Washington, D.C., he served as the national mental health director for Psychotherapy and Psychogeriatrics. During his 7-plus-year tenure in this role, he led the nation’s largest implementation of evidence-based psychological treatments and the transformation of geriatric mental health services.
These efforts were part of a broader process to transform the VA mental health care system to an evidence-based and recovery-oriented system of care. As a result, this work led to robust improvements in patient outcomes and a fundamental change in the treatment culture and model.
“Mental health problems are at an all-time high. There was a behavioral health care crisis prior to COVID-19, but the pandemic added fuel to an existing fire,” Dr. Karlin said. “Now we have a behavioral health crisis that is even greater than what existed a couple of years ago.”
“We know that only 40% of individuals who have a behavioral health problem receive any type of treatment,” he said. “But even more sobering, is that only 15% receive what's considered minimally acceptable treatment according to clinical practice guidelines.”
While Dr. Karlin is clear-eyed about the current challenges, he’s optimistic about the opportunities for transforming behavioral health care, especially the use of technology and innovation to expand access and quality.
“In 2020, we saw within Highmark close to a 7,000% increase in virtual behavioral health care,” he said. “Two years later, we're still seeing a very high degree of telebehavioral1 health care delivery, outpacing every other specialty area.”
Dr. Karlin praised primary care physicians (PCPs) for the critical role they play in the delivery of BH care: “Primary care providers are pivotal to both the detection and treatment of behavioral health issues.”
“In addition to being the front line for behavioral health issues,” he continued, “PCPs provide the majority of behavioral health care in the nation, not to mention the fact that upwards of 70% of cases seen in primary care have a psychological or behavioral component.”
“What's often challenging for primary care providers,” he said, “is having a mechanism to address some behavioral health issues once identified, particularly in the current environment of need and especially for those who require more specialized focus or referral to specialty care.”
Highmark Health is working to transform the clinical and business model of behavioral health care and enable behavioral health to be an equal pillar to physical health. This involves making BH care more proactive, more personalized, and more quality and value-focused. One key initiative designed to increase both access and quality is the development of a high-performance behavioral health network, with an expected initial launch in 2023.
The network—in conjunction with a partner organization—will significantly increase access to care by expanding the existing network, particularly for specialized needs and populations. In addition, this network will allow providers to more fully realize the “quality promise of behavioral health care,” emphasized Dr. Karlin, by advancing the delivery of Grade-A-recommended, evidence-based treatments, which are currently provided to a small minority of patients across systems. The high-performance network will also feature enhanced navigation and coordination, as well as a closed-loop physician referral program.
“Within this referral program, referring PCPs will receive communication regarding the disposition of the BH case following the referral, a piece often missing from the current process,” said Dr. Karlin.
Dr. Karlin emphasizes that the increased focus on and priority of behavioral health care—combined with recent technological and clinical innovations—present a considerable and unprecedented opportunity to fundamentally transform the field of BH care.
To achieve this transformation and effectively solve current needs, he urged, “We must not only expand access, but also ensure that the most effective treatments and technology solutions that science has to offer are the treatments those in need receive. We must also be proactive in engaging individuals in personalized care and support much sooner than the average 8–10 years it takes for those who seek care after symptoms present.”
Dr. Karlin sees the field of BH care at a defining moment.
“This is a moment we are not likely to see again in this generation. How we approach this unprecedented time of need and opportunity will shape the future of the field and our ability to change the clinical trajectories of many.”
He noted that health economists estimate that with the advancement of digital and virtual behavioral health care, the field has innovated over the past two years the equivalent of 20–30 years prior to the pandemic.
“We need to transform,” he continued, “what has been a somewhat sleepy industry for decades and build on this innovation and momentum to change how behavioral health care is delivered and financed in the years to come.”