Healthcare systems vying for talent in fast-growing behavioral health services are struggling to compete against telehealth providers while working through inconsistent reimbursement policies.
As a result, the systems are getting creative, developing pathways to train and graduate psychiatrists and using different types of mental health specialists as they advocate for expanded payment models.
By 2024, the country is projected to have a shortage of between 14,000 to 31,000 psychiatrists, largely as a result of many psychiatrists nearing retirement age, a 2022 Association of American Medical Colleges report found. Meanwhile, the demand for mental health services is surging.
Here are four strategies being deployed by employers.
Create a pipeline
Health systems are increasingly offering development and training programs for behavioral health specialists and advertising the career path at high schools and colleges.
At New York City Health + Hospitals, individuals who have dealt with their own mental health or substance use issues can train to become peer specialists to support people going through similar experiences. The peer specialists are then considered for full-time jobs.
The system also partners with New York University on an educational program to help psychiatrists become leaders in their field.
“We have many residency programs across the system and what we're starting to do is reach out one-on-one to each of the graduating residents and have calls with them about opportunities,” said Dr. Omar Fattal, psychiatrist and assistant chief of behavioral health at NYC Health + Hospitals.
In addition, New York City Health + Hospitals has tackled the subject of student debt. As part of a program that started in 2022, employees who agree to work there for at least three years are eligible to receive up to $50,000 to help repay their student loans. The system has distributed $1 million to 36 employees.
At Hackensack Meridian Health, based in Edison, New Jersey, leaders have developed a mental health administration curriculum in partnership with a local junior college. Hackensack Meridian also created a training and certification process for mental health technicians.
“Mental health technicians usually aren't specially trained—they're trained by the organization that hires them,” said Don Parker, president of behavioral healthcare transformation services at the health system. “We're going to set it up so that we can train people in partnership with a junior college and [they can] get credit for that training.”
All Hackensack Meridian Health hospitals provide tuition assistance benefits and encourage behavioral health staff to continue their education and pursue bachelor's degrees in peer counseling or social work so they can get into care management at the system, Parker said.
Increase pay and WFH jobs
Behavioral health professionals are often paid less than other clinician types for the same services, meaning for-profit systems that can afford higher salaries and more flexible schedules typically have an easier time recruiting and retaining mental health workers.
The other big competitor for hiring managers: telehealth companies like BetterHelp and Talkspace, which provide online counseling and therapy.
“We know for a fact that we've lost people to those kinds of platforms and services,” Fattal said. “There is a convenience to it that is very hard to compete with.”
To make roles more attractive, nonprofit systems are offering more work-from-home opportunities and realigning the salaries of psychiatrists, social workers, psychologists and behavioral health associates.
NYC Health + Hospitals recently launched a 24/7 virtual urgent care behavioral health service to attract more staff and assist with the lack of mental health providers in certain areas, Fattal said.
Using temporary funds from the American Rescue Plan Act of 2021, some states increased the reimbursement rates for certain behavioral health providers and gave health systems funds to hire clinicians.
Expand the credentialed workforce
Some employers are tapping other areas of the behavioral health workforce, using unlicensed, non-clinical mental health professionals to augment the work of providers.
More facilities are beginning to employ community health workers, behavioral health technicians, peer specialists, unlicensed substance use counselors and other employees to provide additional support for patients, said Michele Gilbert, senior policy analyst for the health program at the Bipartisan Policy Center.
However, these staff members often cannot bill on their own or be directly reimbursed by certain payers for their services.
At the state and federal level, different regulations govern the credentialing and certification necessary for behavioral health practitioners to be reimbursed. Education and training requirements can also be inconsistent.
In 2022, Congress passed the Mental Health Access Improvement Act, which allows the services of marriage and family therapists and licensed mental health counselors to be covered by Medicare. A few states have extended direct reimbursement privileges, including New Jersey, which has designated licensed clinical social workers as a type of provider that can bill independently.
There is also a push for more states to allow reimbursement for license-eligible behavioral health workers practicing under the supervision of a licensed provider.
Fight for higher reimbursement
Twenty eight states implemented higher fee-for-service rates for Medicaid behavioral health professionals in fiscal year 2022 or plan to do so in 2023, according to a 2022 KFF survey of state Medicaid officials.
Historically, behavioral health has been inadequately reimbursed by government and commercial payers using a fee-for-service model due to the time-consuming nature of mental health care, said Caitlin Gillooley, director of quality and behavioral health policy at the American Hospital Association. That has led to some advocating for increased payment amounts or different coverage models altogether.
Making reimbursement even more difficult to achieve are the numerous staffing and administrative requirements organizations must meet to receive Medicare and Medicaid coverage for behavioral health services, she said. For example, staff at inpatient psychiatric facilities must have certain levels of expertise to carry out various tasks. There are different skills required of clinicians holding group therapy sessions for substance use disorder versus pediatric behavioral health.
