Ethan Benoff, JD Anticipated May 2024, Law and Public Policy Scholar
Mental health has long been a topic that is under-examined, underfunded, and underrepresented throughout the field of medicine. The statistics are startling. It is estimated that one in five (52.9 million) Americans will suffer with some form of mental illness during their adult-life; however, only 23.9% of them will be able to access beneficial mental health assistance that leads to improved patient outcomes. In Philadelphia alone, 46% of adults reported “experiencing poor mental health” at least twelve times over the course of a year. Similarly, Pennsylvania reported 2,014 suicides throughout the state in 2021.
Given the pressing need for more effective and accessible mental health treatments, the University of Pennsylvania launched an innovative mental health program called Penn Integrated Care (PIC) in January of 2018. PIC is based upon a relatively new treatment model for mental illness, referred to as the Collaborative Care Model (CoCM).
CoCM provides a patient’s primary care physician (PCP) with the primary responsibility for patient diagnosis, prescription decision-making, and emergency responses for mental health crises. However, as the term “collaborative care” implies, the PCP does not provide mental health treatment to a patient unaided. Instead, as illustrated below, the PCP is supported by a team of mental health specialists, including a behavioral health care manager (BHCM) and a psychiatric consultant, to best serve patient needs.
PIC changed the standard model of CoCM by adding “mental health intake coordinators” from Penn’s Resource Center to the care-team, as can be seen in the image below. The Resource Center is described as an operation which “assesses patients by phone referring them to appropriate level of care using decision-support software, and facilitating engagement in community based specialty care.”
Employing CoCM and their already established connection with Penn Medicine, Penn’s Department of Psychiatry and Primary Care Service Line created PIC to better serve those individuals throughout Eastern Pennsylvania suffering from a mental illness. In the first year of the program, eight PCP offices agreed to participate, allowing 6,124 patients to be treated under the PIC model. Results from this first year showed that out of those patients willing to undergo their full treatment plan, 33% with depression and almost 40% with anxiety reported symptom remission, which is comparable to rates in a “traditional” outpatient treatment approach. What improves from a PIC model as opposed to a standard model is access. With a standard model, an estimated 35% of patients in the U.S. do not have access to these types of services; this, however, is not a concern with the PIC model, as treatment is never outsourced to a secondary treatment facility. Penn Medicine reports that the eight original PCP offices continue to work successfully under the PIC model, three additional PCP offices were added in 2019, and an additional five or six are expected to join the program by the beginning of 2023.
On September 7, 2022, PIC exhibited its commitment to expanding access to mental health care across the greater Philadelphia area by announcing a partnership with Independence Blue Cross beginning January 1, 2023. The driving force behind this partnership was Independence Blue Cross’s decision to sell a “minority equity stake in its subsidiary” Tandigm Health to Penn Medicine and place 275 of Penn’s doctors within the Tandigm Health System.
Tandigm currently serves all five of Philadelphia’s regional counties (Bucks, Chester, Delaware, Montgomery, and Philadelphia), with more than 400 PCPs available for patient care. As such, Penn Medicine anticipates that this purchase agreement will expand PIC access to patients who would have not otherwise been able to receive treatment under a collaborative model.
Another factor behind Penn Medicine’s decision to partner with Tandigm is Tandigm’s commitment to value-based care. The majority of health providers within the U.S. currently rely on a system referred to as fee-for-service. Under this approach, providers are reimbursed by a patient’s insurance for simply providing treatment, regardless of patient outcome. This system produces an environment where providers are inclined to treat the max number of patients in the shortest amount of time while using the most expensive treatments, all for greater reimbursement rates.
Alternatively, value-based care, the approach used by Tandigm Health, ties provider reimbursement rates directly to patient outcomes and the “quality” of care the patient receives. Just as PIC is focused on producing positive patient results and helping to resolve serious mental illness for those typically unable to access care, value-based care aims to accomplish similar goals. In fact, Tandigm reported that by using a value-based approach to mental healthcare, they reduced the number of unnecessary hospital admissions “by the thousands,” and lowered the “need for care in skilled nursing facilities” by 30%.
In addition to the benefits PIC offers on an individual patient level, the program has also shown value to the greater Pennsylvania healthcare network. An economic study of PIC estimated that for every $1 spent, there is a “$6 savings in overall medical costs.” The ability for PIC to lessen the economic burden of PA’s healthcare systems is essential, as 765,600 adults enrolled in PA Medicaid expansion just in June of 2019 alone. The $5 saved through PIC can instead be used to treat patients throughout the Commonwealth dealing with a variety of medical complications, not just mental illness.
Likewise, PIC’s commitment to the CoCM should allow for greater access to mental healthcare for the large number of Pennsylvania’s citizenry who live in rural areas. According to a study conducted by the American Journal of Preventative Medicine, 65% of “non-metropolitan counties have reported not having a single psychiatrist, while 47% of the same counties do not have a psychologist.” With 22% of Pennsylvania’s population living in counties defined as a Health Professional Shortage Area (HPSA) or Medically Underserved Area (MUA), PIC’s ability to serve mental health needs in a PCP office rather than relying on outpatient services provides the state with a promising pathway for the expansion of rural care.
Penn’s commitment to expanding the PIC program and the launch of the Tandigm partnership that is expected to commence by the new year create an incredibly promising time for the future of mental healthcare in Pennsylvania. With 1,814,000 adults throughout the state experiencing a mental health condition, PIC’s ability to scale, both in terms of capacity to treat and expansion of geographic coverage, will help push Pennsylvania to the forefront of mental health treatment.
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