by Robby Franceschini

January 24, 2019 — The Triple Aim has defined the shape of health policy reform since the Institute for Healthcare Improvement first developed the model in 2007. Its enduring impact plainly came through in Deputy Finance Director Vivek Viswanathan’s testimony during a California Senate budget hearing on January 17.  Viswanathan began with an outline of Governor Newsom’s health care budget priorities saying, “The administration has three broad goals when it comes to health care, it’s improving access, reducing cost, and improving quality. And what we’re proposing through all of our programs is finding a way for all of these goals to fit together.”

In listening to Viswanathan’s full testimony, it became clear that mental health, and specifically access to mental health, is of particular concern to the administration. Telehealth can help bridge California’s mental health access gap due to the state’s provider shortage.

Newsom’s mental health priorities target all age groups up to 65

The Governor’s proposed budget includes over $200 million new General Fund spending, in addition to funds allocated by propositions, on mental health programs. Populations of concern include children and young adults; university students; the Medi-Cal population; and the homeless. Proposed investments in mental health include:

• $25 million for early psychosis research and treatment for young people
• $60 million to provide early developmental screenings for children;
• $45 million for Adverse Childhood Experiences (ACEs) screenings for children and adults up to 65 years old in Medi-Cal;
• $50 million for mental health workforce programs;
• $100 million for supportive housing services for homeless with mental illness through Whole Person Care Pilots;
• $70 million estimated increase in county SMI health program funding based on IHSS funding realignment; and
• $5.3 million for UC Counseling and Psychological Services to improve student mental health services.

School-based mental health may be an additional legislative priority

During the discussion period, incoming chair of the Senate Health Committee and Fiscal and Budget Committee member Dr. Richard Pan indicated that securing increased federal funding for school-based mental health services may be an additional priority for the legislature this year.

“How could we leverage our Medi-Cal program to draw down federal money to help support expansion of mental health in our education system?” Pan noted in during the discussion. “We are 41st per pupil for spending on school health and mental health. We are one of the lowest in terms of LEA money that we draw down… That is federal money we are leaving on the table.”

Telehealth can assist in realizing investments in mental health access

California’s current mental health provider shortage has been well documented. A 2018 recent UCSF Health Care Workforce Center study estimates that the state will reach a severe shortage of psychiatrists by 2018, primarily due to the aging of the mental health workforce. While the Governor’s proposed budget would allocate additional funds to workforce trainings programs, issues such as implementation time lag, physician burnout, and low Medi-Cal reimbursement rates may dampen any effects of the workforce training programs. In the face of this workforce challenge, achieving the Triple Aim and expanding access to mental health services may require using novel ways to reach individuals and connect them to care.

Specifically, telehealth can increase access to mental health. Studies of live video and telephone-based psychotherapy, game-based psychological interventions, and social media show that telehealth improves clinical outcomes while reducing costs. Many emerging solutions combine several forms of telehealth offerings into the same product, allowing consumers to meet remotely with their providers over an app and access resources such as CBT-based interventions and mental health logs in between visits. Even more, digitizing screenings, including those for ACES and early development, may hold promise. Advocacy groups, such as Mental Health America, have created tools for diagnosing mental health conditions and companies have begun exploring the use of AI in diagnosis and treatment. School nurse-initiated telehealth has also been identified as a method to increase access to services, including mental health.

Although the Governor’s proposed budget is only the first step in the budget making process, it nonetheless signals that access to mental health is a priority on the political agenda this session. BluePath Health will continue to monitor these legislative developments in California.