Co-morbidity between mental and medical conditions is the rule rather than the exception:

  • 68 percent of Americans with mental health disorders also have co-morbid cancer, heart disease, diabetes and asthma (Robert Wood Johnson Foundation, "Mental Disorders and Medical Comorbidity")
  • People with schizophrenia and bipolar disorder are up to three times more likely to have three or more chronic medical/surgical conditions compared to Americans without these mental disorders.

This patient population possesses an exceedingly poor overall health status:

  • Patients/consumers served in state mental health systems die 25 years sooner than other Americans (Centers for Disease Control and Prevention (CDC), Preventing Chronic Disease Vol. 7, No. 6 )
  • 33% of the 9 million dually eligible Medicaid/Medicare beneficiaries have a primary diagnosis of severe mental illness.

This patient population adds significant cost to the health care system:

  • Nearly 3 times more cost per capita to Medicaid for treatment of patient with co-occurring hypertension, diabetes and mental illness and drug/alcohol (vs. patient with no mental illness and drug/alcohol).

The benefits of EHR outweigh the cost:

  • According to a 2011 Health Affairs study, the average cost of EHR implementation is approximately $46,000 per physician with annual expenses just over $17,000 per physician. 

Why We Need EHRs

Cost Estimates for Health Information Technology Adoption for Mental Health and Substance Use Treatment Providers

Primary care health systems and providers have long benefited from the implementation of Electronic Health Records (EHR) systems. These digital records contain comprehensive and real-time information about a patient and can be shared across different authorized health care settings.

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provided funding for primary health care providers to adopt EHR technology – unfortunately, most behavioral health providers were not eligible to participate in this program. Due to this exclusion from available funding, behavioral health providers to this day still substantially lag behind primary care providers in adoption rates of EHR systems.

Consistent with Bipartisan Policy Center recommendations, the BHIT Coalition strongly supports full funding for the Section 6001 CMMI Behavioral Health IT Demonstration in the SUPPORT Act (P.L. 115-271). Digital information flow between primary and behavioral health care would establish integrated treatment and an increased quality of care for patients.

The BHIT coalition believes in improved integrated care for individuals seeking mental health and addiction treatment – this improvement starts with federal funding for behavioral health providers to establish a foundation of modern documentation and exchange of patient records through EHRs.

Recent Recommendations on the Inclusion of Incentives for Behavioral Health Providers to Obtain EHRs

Costs for providers to purchase, deploy and maintain a behavioral health EHR can vary based on a number of factors. The provided estimates are based on general assumptions about the costs for each agency – including the purchase, installation, deployment, and operating costs for a cloud-based, full-featured EHR.

  • ​The Medicaid and CHIP Payment Access Commission (MACPAC) released their June 2021 Report to Congress on Medicaid and CHIP.
    • Within the section titled “Integrating Clinical Care through Greater Use of Electronic Health Records for Behavioral Health” in chapter 4, they discuss the challenges associated with low behavioral health provider EHR adoption rates. On page 160, they recommend:
    • “Testing different approaches to making behavioral health EHR incentive payments. The Commission is interested in learning more about the role that the Centers for Medicare and Medicaid Innovation (CMMI) could play in strengthening clinical integration of behavioral health services. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment and Communities Act (SUPPORT Act, P.L. 115-271) authorized CMMI to test EHR incentive payments for behavioral health providers that contract with state Medicaid plans under Section 1115A of the Act. However, as of May 2021, CMMI has yet to implement such a demonstration.”

  • ​The United States of Care released their recommendations for the Center for Medicare and Medicaid Innovation models in April 2021.
    • Within the section titled “Putting Mental Health Care on Equal Footing with Physical Care”, the third bullet on page 4 addresses BHIT Incentives
    • “Data integration and sharing, when done well, can highlight successful interventions and care modalities, illuminate long-term patient outcomes, and improve the quality of care. CMMI should test a model in which financial incentives are offered to mental health and substance misuse providers to more widely utilize electronic health records in order to facilitate information exchange between providers and across payers.”

  • The Bipartisan Policy Center released their report and recommendations on Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration in March 2021.
    • Within the section titled “Optimize Health Information Technology for Behavioral Healthcare” on page 80, the BPC specifically recommends Enabling greater integration by increasing the utilization of EHRs among behavioral health providers.
    • “Provide targeted funding to support health information technology adoption and utilization by behavioral health clinicians. The exclusion of behavioral health providers from HITECH has led many to settle into a workflow absent of technology, with insufficient funding and little incentive to change. Based on the rapid adoption of EHRs initiated by HITECH, targeted funding for behavioral health providers could increase EHR utilization and expand the integrated care workforce. In 2018, Congress authorized CMMI to offer incentives to behavioral health providers for health IT use under Sec. 6001 of the SUPPORT Act.  The bipartisan CARA 2.0 Act further authorized additional funding for Section 6001. Nevertheless, CMMI has not yet developed a pilot to implement the provision. According to a Health Affairs research article, the average cost of EHR implementation is approximately $46,000 per primary care physician, and ongoing annual expenses are just over $17,000. The cost of this investment can overwhelm behavioral health practices, which tend to have comparatively fewer providers and a lower volume of patients. Moreover, the Behavioral Health IT Coalition estimates the cost of enterprise-level EHR adoption by community mental health centers, CCBHCs, inpatient psychiatric hospitals, and residential substance use disorder treatment facilities to be nearly $2 billion over five years.  A CMMI demonstration targeting grants to the providers most able to integrate care would require a smaller federal investment. For example, the coalition estimates the cost of basic EHR adoption by all psychologists and clinical social workers to be $827 million over 10 years. Congress should direct CMMI to create a targeted funding structure to assist behavioral health providers with startup costs, maintenance, and training for health IT in behavioral health settings. Demonstration participants should be required to integrate behavioral health and primary care services and meet ONC certification and interoperability standards, including the universal Fast Healthcare Interoperability Resource API standards that enable data-sharing between all platforms. Grants should also support the use of lower cost, cloud-based EHRs and direct API sharing tools."

Netsmart, a member of the BHIT Coalition, provided these cost estimate scenarios