Physical Healthcare & Behavioral Healthcare – Two Worlds Colliding

Change continues to be about the only thing you can count on in the world of healthcare professional liability insurance. But there’s one constant about change: it actually has the power to create some opportunities just as it takes others away. The dynamic I wrote about it “Community Health Centers and the Growing Need for FTCA Wrap Coverage” remains true. These days, we see this happening as the worlds of physical and behavioral healthcare become increasingly integrated.

Two primary goals of the Affordable Care Act (ACA) were purported to be an increase in the quality and a decrease in the cost of healthcare in the U.S.  Incentives built into the law to increase coordination of care was a big part of how these goals were meant to be achieved.  Because physical health and behavioral health are so interrelated, this coordination of care increasingly encompasses behavioral health services.

In her 2014 Social Work Today article, “The Affordable Care Act and Social Services: The Technological and Business Impact,” Lindsey Getz stated that, “Going forward, it’s believed that there will be a greater connection between the medical field and the social services sector as the ACA promotes a model of community-based care.  While the current healthcare model tends to separate physical health from mental and behavioral health, this new model aims to bring them all together.”

Ms. Getz got it right. In the 18 months since she published the article, we’ve seen the exact dynamic she described: an increased integration between physical healthcare and behavioral healthcare services.

For example, it’s happening in community health centers around the country.  Historically, these facilities have been focused primarily on the provision of physical healthcare services.  Since the passage of the ACA, this has been steadily changing.  According to the U.S. Department of Health and Human Services (HRSA), there are now about 4,000 mental/behavioral health providers working in community health centers.  What’s more:

• Nearly 70 percent of HRSA-supported health centers provide mental health counseling and treatment.
• Almost 40 percent provide substance abuse counseling and treatment.
• Close to 20 percent offer 24-hour crisis intervention services.
• The number of patients receiving behavioral health services at health centers increased by more than 21 percent since 2010 – the largest increase among all reported services in that time period.

We also see increasing integration between physical healthcare and behavioral healthcare services at behavioral health organizations around the country.  Much of this is being driven by the Primary and Behavioral Health Care Integration (PBHCI) Program, which was developed and implemented by the Substance Abuse and Mental Health Services Administration (SAMHSA).  According to SAMHSA, the PBHCI Program was designed “with the goal of improving the physical health status of people with mental illnesses and addictions.”  According to the SAMHSA website, the results of the PBHCI Program have been:

• Improved access to primary care services.
• Improved prevention, early identification and intervention to reduce the incidence of serious physical illnesses, including chronic disease.
• Increased availability of integrated, holistic care for physical and behavioral disorders.
• Improved overall health status of behavioral health clients.

As more physical healthcare services are provided by behavioral health organizations, a clear opportunity emerges for retail agents with expertise in the placement of medical professional liability policies.  After all, retail agents who place the professional liability for behavioral health organizations are not likely to be well-versed in medical malpractice.  This is important because, in general, the carriers that have traditionally written professional liability for behavioral health organizations have not shown much of an interest in covering these new medical malpractice exposures.  In fact, the behavioral health organization needing medical malpractice coverage has often been forced to get it placed on a stand-alone basis.

To be sure, there are some retail agencies with a strong focus on the behavioral health space that seem to have a good handle on their clients’ growing medical malpractice exposures.  Still, overall it seems to be a great time for healthcare-focused retail agents to explore opportunities in the behavioral health space.

Ethos Insights

• Physical healthcare and behavioral healthcare services in the U.S. are being increasingly integrated.
• Behavioral health organizations with increasing medical malpractice exposures could benefit from the assistance of retail agents with expertise in the placement of medical malpractice policies.
• As a healthcare specialist, Ethos can assist with the placement of professional liability policies for both physical health and behavioral health organizations.