This episode was actually published in June 2022, but this is STILL a huge issue, so we thought we would take another listen …

How can pediatric primary care effectively integrate mental health services amid insurance barriers and coding complexities?

In this episode, we tackle the significant obstacles impacting the compensation and delivery of mental health services for children. By examining Medicaid, CHIP and commercial insurance coverage for mental health, we highlight challenges that hinder pediatricians and affect their young patients and families. The conversation sheds light on potential solutions, such as integrated behavioral health and group therapy, which may offer new avenues for improving care and financial viability. Through shared experiences from industry experts, we explore potential strategies to both navigate and potentially reform the delivery of pediatric mental health services.

Considering the significant implications this has on future generations, what steps must we take now to ensure a sustainable and effective approach that genuinely meets the needs of children and their families?

[00:05- 19:41] Financial and Operational Burdens

Household income criteria affect eligibility for Medicaid, impacting family financial planning.
Pediatric practices bear costs of unrecognized mental health work because of inadequate reimbursement.
Parents' financial stress increased by the lack of integration between medical and mental health services.
Complex insurance landscapes necessitate physician adaptability in operations.

[19:42 -29:58] Pediatric Practice Challenges

Mental health visits require more time but yield less reimbursement compared to physical ailments.
Physicians provide extensive unpaid follow-up care via phone calls and messages.
Insurance systems do not adequately support mental health coding for pediatricians.
Complexity in billing for mental health services creates administrative challenges.

[29:59 - 38:51] Economic and Qualitative Outcomes

Coordinated care allows pediatricians to manage comprehensive patient care plans.
Insurance company partnerships needed for sustainable pediatric mental health initiatives.
Effective systems require data to demonstrate long-term cost benefits and outcomes.
Organizations should engage with insurance companies to carve out necessary screening costs

[38:52 - 1:05:50] Advocacy and Reform Efforts

Reform needed in coding and billing processes to reflect the true nature of mental health support.
Integrated care models as a potential less visible, but essential cost benefit.
Engaging with insurance companies on mutual goals can lead to practice sustainability.
Systems must prioritize patient-centered care, integrating mental and physical health.

[1:05:51 - 1:13:48] TakeAways

Connect with our guests

Jenna Vallejo

Facebook,

Instagram,

LinkedIn

Dr. Jon Price

nationwidechildrens.com

Go to https://lifeaftercorporatepodcast.com/ for all episodes

166 Chronic Illness and Mental Health: The Roadmap Project

149 Management of Youth Depression: Beyond Medications

129 Adolescent Confidentiality: To Share or Not to Share

Tweetable Quotes:

"What happened during the pandemic is that with layoffs and economic disruptions, adults signed up for Medicaid themselves and then found out that their children were also eligible. And so that's how we got to half of all children in the United States, approximately currently covered by Medicaid."...Dr. Jon Price on the impact of the pandemic on the Health Crisis

"We are seeing just an incremental increase in anxiety, depression, eating disorders, and that the eating disorders have almost been taking over in our practice." Jenna Vallejo on the mental health crisis in children

**TRANSCRIPT AVAILABLE UPON REQUEST**

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230. Payment Challenges for Pediatric Mental Healthcare and Strategies that Work

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