A Gift for the New Year: Newfound Attention to Behavioral Health
Amid the joy and festivities of last month’s holiday season, many American families were coping with the reality behind quite sobering behavioral health statistics: almost 1 in 5 adults have a mental illness; 2/3 of them have 1 or more medical conditions as well. Comorbid mental disorders affect 29% of adults with chronic conditions. Eight percent of adults have a substance abuse disorder. This year, though, the health industry is offering up a long overdue gift—renewed interest and commitment to innovation to address this intractable challenge.
A wise CEO at a recent management retreat underscored why this is the right thing to do both for our communities and our organizations. He reminded his team of 2 facts. First, the prevalence of mental illness and substance abuse is increasing across every demographic segment in most markets in the country. Second, success in population health and value-based contracting is inextricably tied to addressing gaps in care. “In short,” he said, “we have no choice but to take this on. Our future growth and success depend upon it.”
Yet developing a behavioral health System of CARE strategy can be intimidating for even the most intrepid health system. Obstacles abound in overcrowded EDs and inpatient units, workforce shortages, historically poor payment rates, underfunded community services, and nonexistent patient transition and care integration models.
To prevent those issues from stalling efforts before they even get started, my colleague Jayme Zage, PhD, advised Sg2 clients to consider focusing early work on a target group. The behavioral health population comprises many types of patients with diverse needs. Depending on your specific market, it may be smart to focus on adolescents, the elderly or even cancer patients with behavioral health issues.
Those pursuing a more comprehensive initiative for behavioral health may find it helpful to evaluate offerings by illness severity. Sg2 uses a 4-stage approach that reflects symptom frequency, recurrence and impact on quality of life. The higher the patient stage, the more likely that they will need frequent and comprehensive services.
Health systems historically have tailored services to the most complex patients, those at stages 3 and 4. There is abundant need, however, to build out the System of CARE for patients in earlier stages. These patients primarily need community-based and lower-intensity care at physician offices and outpatient clinics. Improving your System of CARE for individuals in these groups likely will necessitate formalizing partnerships with schools and social service organizations, adding new screening and integrated care capabilities at primary care practices, creating access to behavioral urgent care, and adding infrastructure to help patients manage their own health.
Depending on your market, you may not be the key provider of care for these patients. But your participation in organizing and coordinating services can dramatically curtail their ED use and lower total cost of care.
There is newfound optimism among health professionals who have dedicated themselves to an area long relegated to the shadows. One behavioral health service line leader recently told us this was the first time in her career that senior leadership has truly embraced the need to provide and improve access. Similar to other areas of health care today, she said there’s a greater appetite for innovation and a willingness to deploy programs with demonstrated efficacy.
The truth is, much is working in behavioral health. Our list of successful initiatives and model programs grows weekly. For example, in a recent webinar we shared several examples of how health systems are improving care transitions for this vulnerable patient population, including:
- The psychiatric emergency services program at John George Psychiatric Hospital in San Leandro, CA, reduced ED length of stay by 80% and now discharges 75% of patients to home.
- The dementia medical home model at the Healthy Aging Brain Center, Indiana University and Eskenazi Health in Indianapolis, IN, used a mobile, nurse-led care team to cut ED visits by 50% and readmissions by 40%.
- The psychiatric access solution at Unity Health (now part of Rochester Regional Health System) in Rochester, NY, included an innovative referral model that cut wait times from 4 months to under 1 week for new patients.
It is heartening that behavioral health is moving to the top of many teams’ priority lists, alongside perhaps safer and sexier topics like virtual health (which we’ll return to early next year). Neither topic garnered much attention at all even 18 months ago. And yet both received considerable airtime at the management and board meetings I attended this fall.
That said, it would be imprudent to underestimate the amount of work that lies ahead for any organization looking to create, update or refine behavioral health strategy. Your approach will vary based on how quickly your market is adopting new payment models and the types of patients you serve.
And that brings us back to the theme of strategic execution, which shaped our perspective throughout 2015. Behavioral health may be one of those areas where many systems share similar strategies and equally audacious goals. Success today, however, has become less about what your organization does, and more about how and when you do it.
As we enter 2016, don’t just make a list of resolutions needed to ensure the health of your organization’s bottom line and of the communities you serve. Commit to the hard work to get it done. Time it thoughtfully. And know that we at Sg2 see it as our job and our privilege to ensure you achieve those goals.