Q&A: City of Charlotte Sees Value in Offering Behavioral Health Services

For years, the City of Charlotte struggled with rising healthcare costs while their employees’ health continued to decline. Something needed to change, and behavioral health services were needed.

In 2015, the city partnered with Marathon Health to provide its 17 departments — including the police and fire departments — with advanced primary care and wellness services, via a network of dedicated health centers strategically placed around Charlotte.

The free and low-cost health services were easy to access, and they quickly became a big hit for city employees and their covered family members. Christina Fath, the city’s Benefits Manager, says the city saw improvements in members with chronic conditions like diabetes, high blood pressure and high cholesterol, and also recouped considerable savings on their yearly health spend.

In 2019, the city added behavioral health services to the city’s suite of wellness offerings employees can access through Marathon Health — and just at the right time. COVID-19 arrived a few months later. Fath says city employees experienced increased levels of anxiety, depression, loneliness, substance abuse and PTSD, especially among first responders.

In a recent interview, Fath explains how the city’s decision to provide behavioral health services helps employees during normal and extraordinary times.

What is the City of Charlotte doing to expand access to mental health for employees, retireesand family members?

Christina Fath: Community access to mental health providers can be hard to navigate, and often you find the provider is out of network, which increases stress and financial strain. To support our workforce, we’ve enhanced health plan design for mental health benefits, increased the number of employee assistance program (EAP) sessions, added a full suite of mental health services to our Marathon Health Public Safety Occupational Health Clinic, and provided employees, dependents and retirees with behavioral health services, life coaching and healthcare navigation services.

During the pandemic when healthcare facilities went virtual, employees didn’t seek as many of our traditional services, yet we saw consistent utilization of behavioral health services. We actually had to add more providers to keep up with the demand.

We’ve received very positive feedback on the behavioral health and life coaching services. Whether navigating depression or challenging life decisions, the suite of services provide easy access to low- or no-cost providers and services.

How has working with a healthcare partner like Marathon Health resulted in increased health, specifically mental health, and how has that benefited the City of Charlotte?

CF: Providing locations where our employees, families and retirees can easily access mental health services at low or no cost is certainly a benefit. However, the real value is the connectedness of those services in the team approach of the physicians, other care providers and a care navigator within the clinic.

This team approach provides a continuum of care that focuses on the needs of the individual, without the barriers of navigating the healthcare system. If a physician sees an employee for a physical and substance-abuse issues present, we can immediately connect the employee to behavioral health services in the clinic — there’s no sending you home with a referral and hoping you call a list of providers that may not accept your insurance. Likewise, if an employee undergoes counseling and medication management becomes appropriate, the behavioral health provider can connect the individual with a physician down the hall.

You set up a whole suite of mental health services. What does that include?

CF: We have two suites. One is through the traditional clinic, where employees, dependents and retirees can receive one-on-one counseling. We have three behavioral health specialists that also come onsite and do workshops, webinars and other training as we need it. So, if they identify a pattern or something that they’re seeing in one of our departments, they can come onsite and do a workshop tailored to that topic. It’s helpful because we have 17 different departments, and they all have a different identity and speak their own lingo, and the behavioral health providers understand that and know how to connect with our employees, no matter where they work.

We have a life coach, which I think is a unique component. While the counseling is really helping employees and retirees with mental and behavioral health concerns, the life coach can help people going through marriage troubles, work challenges or those just needing help finding direction. The behavioral health staff and the life coach can work in tandem to address a wide variety issues that impact emotional wellbeing.

We also expanded our occupational health program for public safety to include mental health services. With COVID, racial injustice and all the other challenges of the last year, we are seeing more employees ask for help with substance abuse, depression and PTSD. This enhancement includes a behavioral health specialist that works specifically with public safety and understands their needs and the uniqueness of the job. What they see at work is vastly different from what I see at work. It’s a very specialized, hyper-focused mental health benefit for those employees, but it also provides a single point-of-contact solution for those employees in need.

Can you share any insights since launching behavioral health services?

CF: Looking at the data, utilization was very consistent. We saw demand drop around primary care due to COVID, but we didn’t see that same downswing in behavioral health. We saw more people because of grief, PTSD, stress, anxiety and relationship issues. Our 2020 annual report included a satisfaction survey with 20 pages full of positive comments. Members felt cared for, heard, advocated for, treated well and so many more positive comments. You don’t always feel that way in a healthcare setting, so our employees and retirees are telling us they value the care they receive from Marathon Health.

How is behavioral health integrated into member care, such as identifying someone who comes in for primary care but may need behavioral health services?

CF: From a primary care perspective, one initiative that we’ve done in the clinic is to incorporate depression screening in all types of visits. It helps identify the members that maybe don’t even realize they’re depressed, or identify others who might benefit from counseling.

It’s having that team approach, where the behavioral health specialist can work in tandem with other providers to help the member through their problems. When you go to a traditional primary care doctor, they don’t have the rest of the team. They send you to go find somebody else who’s going to help you with all that other stuff. And chances are, you’re not ever going to make that outreach. And if you do, it’s very complicated. In the clinic, where they’re having this multidisciplinary approach, I think it provides more holistic care.

We’re ultimately trying to create a benefit that is a one-stop shop for employees. And even if it can’t be serviced within this model, how do we help them navigate the more complex outside healthcare model? I think that’s the piece that has been most beneficial to our employees, especially from a mental health perspective.