Medicaid Mental Health Providers See Spike In Demand
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The rising number of coronavirus cases reported across Oregon each day is saddling hospitals with unparalleled levels of demand for patient care, bed space and medical supplies.
But the COVID-19 pandemic also has set off a scramble among providers of mental health services. Demand for counseling and similar services is on the rise, say front-line workers at behavioral health clinics and nonprofits that connect vulnerable Oregonians with health care resources.
“We are seeing increased needs for support around anxiety, depression and isolation associated with the uncertainty of the illness,” said Dr. Jeffrey Eisen, chief medical officer at Cascadia Behavioral Healthcare, a provider that serves many Medicaid members in Portland. “People may need support above and beyond what they get from their usual providers.”
Experts say the coronavirus pandemic has exacerbated patient needs and increased the difficulty for providers trying to reach the state’s Medicaid population, which includes roughly 1 million lower-income Oregonians receiving health care benefits through the Oregon Health Plan. Hard figures showing an increase in demand for mental health care among Medicaid recipients, in particular, are scant. The pandemic is still too new. But Eisen and other health officials say they’re facing challenges meeting the rising need while trying to drastically alter the way they provide care. Most counselors and psychiatrists no longer meet face-to-face with patients, deferring to social distancing guidelines. Organizations from preventative health nonprofits to peer recovery groups and community centers have been forced to close their doors temporarily.
“It has been variable. We’ve had some days where there’s been an immense amount of support needed, and others a little less so,” Eisen said. “It’s a bit early to tell what the increase might be, but we know there is an increase, and we’re prepared for it.”
The Oregon Health Authority has sent out information to enrollees in the Oregon Health Plan, the state’s Medicaid program, that their plans cover COVID-19 testing. The two-page notice also advises members to refill prescriptions two weeks early, and to ask their providers about scheduling appointments using telehealth services.
For those patients, responsibility for providing mental health services falls to the 15 coordinated care organizations spread across the state, tasked with organizing health care providers in local communities to provide a full range of care to patients.
The COVID-19 pandemic has accelerated a shift toward telehealth services that was already underway, several of those care organizations told The Lund Report.
Portland-based CareOregon, which manages health plan services for the state’s largest care organization as part of Health Share of Oregon, as well as two smaller organizations in southern Oregon and on the north coast have shifted most of its provider services to telephone or online contact with patients.
We have received COVID response plans from most providers, and they are mostly aligned in moving as much as possible to telehealth,” Health Share’s spokesperson Yoni Kahn-Jochnowitz told The Lund Report.
But the organization is also grappling with how to administer services like drug and alcohol treatment, residential treatment and respite facilities where staff and client interaction is harder to avoid.
“For services that must be delivered in person, (they are) offering protections such (personal protective equipment), social distancing, and centralizing to one location,” Kahn-Jochnowitz said.
Springfield-based PacificSource administers four coordinated care organizations, covering Lane, Marion and Polk counties, central Oregon and the Columbia Gorge region. Providers in its network are implementing telehealth where possible, and managing who can do their work from home.
But some services have been reduced, and basic supplies to handle the shift toward remote work aren’t always available, PacificSource spokesman Lee Dawson told The Lund Report.
“We continue to hear from many providers that need support in accessing basic equipment to support telehealth functions, but laptops are in incredibly short supply,” Dawson said. “We are working in collaboration with our provider partners to provide outreach to members and help them navigate this system, which changes every day.”
Shifting to telehealth is a bigger challenge for coordinated care organizations in rural parts of the state. Grants Pass-based AllCare Health has closed its regional offices to the public during the pandemic and is communicating service changes to members by partnering with community organizations and local television stations, spokesman Josh Balloch told The Lund Report.
“We’ve really embraced telemedicine, and that is the place where we’re really trying to get more people comfortable,” Balloch said. “We’ve got great community partners, and we’re becoming experts in that.”
The organization is trying to overcome challenges like a shortage of medical equipment for providers. But vital for the organization, Balloch said, is maintaining a continuum of mental health services at a time when depression, mental illness and substance abuse concerns are on the rise.
“We know that as this crisis in the foreseeable future will get harder, we need to have the capacity to help people struggling with depression and anxiety, and also for the population we’re taking care of to make sure they’re getting the prescriptions and services they need and make sure we keep that person out of the hospital,” Balloch said. “We all know there’s a lot more coming, and we are doing our absolute best to prepare in advance for that.”
For front-line organizations like Cascadia Behavioral Health, preparing for increased caseloads has required large-scale operational shifts. Cascadia launched an incident command center in early March to better coordinate its nearly 1,000 employees to handle patient needs. Case workers have been proactively reaching out to patients identified as having high-risk mental health needs, instead of waiting to hear from them.
“This is literally an around-the-clock, seven-days-a-week effort for us, doing everything we can to support our clients, colleagues and the community,” Eisen said.
The same is true at Central City Concern, the nonprofit provider of health, housing and employment services to Portland metro area residents dealing with homelessness, addiction and poverty.
Central City Concern President and CEO Rachel Solotaroff has seen a perfect storm of social and economic factors creating some of the toughest conditions she has ever seen for vulnerable members of the population who need its services. Food banks and pantries across the metro area that typically operated for four hours at a time are running out of food in 30 minutes, as layoffs and demand for food aid swell.
Many of the clients Central City Concern interacts with are feeling an added sense of alienation through the crisis, Solotaroff said. Besides mental health services, the nonprofit operates as an affordable housing developer, renovating old buildings to use as supportive housing for vulnerable residents trying to gain employment and greater stability. These residents benefit from social interaction with other tenants, as well as case workers and building managers, many of whom were previously homeless themselves.
“The heart of our work is building and connecting communities, and now we’re advising people to do just the opposite,” Solotaroff said. “Stay at home, stay in your room, don’t congregate in community rooms. Even in congregated settings, we’re spreading everyone out. It can be harmful to their recovery and cause a greater sense of alienation.”
Some, but not all, of the organization’s case workers continue to interact face-to-face with patients, Solotaroff said. But workers are also concerned about their own health, and Solotaroff worries that a prolonged pandemic could impact their ability to provide help, if employees at Central City Concern and other health care organizations become sick.
Maintaining contact with clients is crucial to the organization’s mission of helping vulnerable Portland-area residents reach self-sustainability. Her staff is ramping up telehealth services – another challenge for a population that often lacks reliable internet. But the ripple effects from the pandemic’s massive economic fallout is already threatening patients’ physical health as well as mental health, Solotaroff said.
“I’m worried about people’s ability to stay nourished. I think it just feeds an increased level of agitation and human suffering on the street,” she said. “You can see there is sometimes a toxic delirium on top of it, it might be substance abuse or organic mental illness. But the levels of agitation people are experiencing, sometimes they’re people where we know this isn’t their baseline. But also for people we don’t know, showing up at our door decompensated mentally. I’ve never seen anything like that before, or the level of urgency.”
You can reach Elon Glucklich at [email protected].