Report outlines ways to expand, diversify Massachusetts’ workforce

By Susan Gonsalves
January 10th, 2023
Mindy Lipson, MPH, director, Manatt Health
Mindy Lipson, MPH, director, Manatt Health

Blue Cross Blue Shield of Massachusetts engaged Manatt Health to create a report that identifies ways to maintain, expand, and increase diversity in Massachusetts’ behavioral health workforce.

The resulting 62-page document entitled, “Creating a Robust, Diverse, and Resilient Behavioral Health Workforce in Massachusetts,” offers seven recommendations for the Commonwealth and other stakeholders to make policy, programmatic, and budgetary changes to reach that goal.

The process involved Manatt Health conducting interviews with experts including provider association representatives, academics, and state officials with experience in behavioral health, workforce development, and/or diversity, equity, and inclusion issues.

During these interviews, the Manatt team shared the “Health Workforce Policies Framework,” by Angela Beck and other health care workforce experts. Published in a recent “Health Affairs” article, the Framework identifies four pillars to reshape the workforce: production, distribution, maximizing potential, and resiliency.

Manatt also conducted a literature review of peer-reviewed articles; reports by university research centers, leading health care foundations, and industry associations; resources from federal agencies; and websites for state departments of mental health/SUD and Medicaid agencies.

“Providers working on the ground have the best understanding of the challenges facing the behavioral health workforce, and change will not be successful without their meaningful involvement.” --Mindy Lipson, MPH, director, Manatt Health

It also developed an inventory of existing behavioral health workforce programs in Massachusetts and across the country from which it could draw.

The seven resulting recommendations represent both short-term (one to two years), medium term (three to five years), and long term (more than five years) initiatives.

They are:

  • Conducting a baseline Workforce Needs Assessment that includes demographics and shows specific gaps to better understand the supply of the behavioral health workforce;
  • Establishing and maintaining a Behavioral Health Workforce Center with a charter to improve the workforce’s supply, distribution, competency, and diversity;
  • Ensuring that payment for behavioral health services is equal to payment for similar medical services across all payers in Massachusetts given the impact of reimbursement on the workforce;
  • Developing and funding a 10-year behavioral health workforce strategy to grow the behavioral health professional workforce pipeline and address the shortage and maldistribution of providers;
  • Pursuing a multipronged campaign to dramatically expand the paraprofessional workforce (e.g., peers, CHWs, recovery specialists), including ensuring that they are paid a living wage, have opportunities for career advancement, and can obtain insurance reimbursement;
  • Creating a system of social supports for all members of the behavioral health workforce; and
  • Funding an in-depth evaluation of the impact of telehealth on the behavioral health workforce.

According to Mindy Lipson, MPH, director, Manatt Health, the same week that the report was released, the Centers for Medicare and Medicaid Services gave state approval to make up to $20 million in Medicaid-funded investments in the Commonwealth’s behavioral health workforce over the next five years.

She said the loan repayments are targeted towards providers who have committed to working with a high percentage of Medicaid and uninsured patients for four years and certain types of providers must also commit to working in a community-based setting.

“Ideally, these investments will make it more attractive and financially viable for behavioral health providers to work with Massachusetts residents with the greatest need for behavioral health care,” Lipson said.

The Association for Behavioral Healthcare’s recent survey of Massachusetts outpatient providers indicated that 13,797 individuals were on a waitlist to obtain outpatient mental health services at one of the 37 surveyed providers in Fall 2021. The average wait times were 15.3 weeks and 12.7 weeks, respectively, for children/youth and adults to obtain ongoing therapy.

As Massachusetts advances efforts to build a more robust, diverse, and resilient workforce in the behavioral health field, Lipson said it is critical that psychologists and other mental health professionals participate in planning and providing their expertise.

“Providers working on the ground have the best understanding of the challenges facing the behavioral health workforce, and change will not be successful without their meaningful involvement,” Lipson said.

She noted the entire nation including Massachusetts is experiencing an unprecedented workforce crisis in healthcare. “That crisis is acutely felt in the BH delivery system,” Lipson said. “The pandemic has compounded the substantial stress that the behavioral health workforce faces day-to-day, and many key professionals in that workforce are not adequately compensated for extremely challenging work. Together, these factors create barriers to people entering and staying in the field.”

As of March 2022, the Human Resources and Services Administration (HRSA) identified a total of 57 Mental Health Professional Shortage Areas (HPSAs) in Massachusetts, indicating a need to improve the geographic distribution of providers.

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