The Growth Channel

Behavioral health care delivery: Innovative strategies for off-site service


Eric Cragun

Integrating behavioral health care with appropriate and cost-effective outpatient sites of service, such as partnerships and telemedicine, is becoming a bigger priority for hospitals. There is latent demand for behavioral health care—up to 30% of the population has a mental health condition but less than 25% of them receive appropriate care. In addition, the number of people eligible for and in need of behavioral health services will grow due to the Mental Health Parity law and increased coverage through health reform.

Historically, most hospitals have not focused on growing behavioral health services, and behavioral health service lines are rare. Since the inpatient delivery of behavioral health care is cost-prohibitive, any effort to grow behavioral services is better aimed by creating a broad spectrum of outpatient services. As service lines shift to include more consideration of settings beyond acute care and also embed themselves in efforts to improve population health, behavioral health services may find its place in the realm of service lines.

Collaboration with mental health specialists

Partnerships with local behavioral health agencies and government-funded organizations are advantageous, as they allow the hospital to expand its menu of services and fill in the gaps for behavioral health care not offered at the hospital. Many patients can be adequately managed through outpatient visits; referring them to community agencies for counseling and case management allows them to receive appropriate care in a less costly setting. The partnership is beneficial for community mental health providers because they have a source for referring their patients that require inpatient care for an acute event or need dedicated care from a specialist not available at the agency.

Hospital partnerships with community mental health providers are just beginning to be further investigated, with few hospitals having formed structured joint ventures and shared information sharing models. Once a hospital has developed joint privileges with local mental health providers, those providers can practice at the hospital, enabling the hospital to have an extended staff for mental health services. Similarly, physicians from this hospital are embedded at the local agencies and can provide their services on a contractual basis.

The service contract for hospitalists practicing at local agencies is typically drafted by a joint effort from the hospital’s legal office, risk management department, business management department, chair of psychiatry, and the local agency.

Research benefits for AMCs

This partnership model is especially beneficial for teaching hospitals and academic medical centers (AMCs) because residents will gain access to a greater volume and diverse mix of patients, thereby creating a more enriched learning environment. Partnerships also benefit AMCs by enabling them to meet their research goals. For AMCs performing clinical trials that require a large or targeted patient population, local agencies help provide referrals and access to diverse patients.

Telemedicine option for remote patients

Telemedicine is another way to expand off-site mental health services, as well as develop community relationships. In remote or rural areas, telepsychiatry has been helpful in providing counseling and therapy for patients that don’t have access to a hospital behavioral health program. Some hospital providers have worked to extend their roles by providing telepsychiatry services for pediatric populations or patients housed in prisons, due to the shortage of physicians dedicated to these populations. Embedding psychiatrists into school systems also increases access to children who have or are at-risk of developing serious behavioral health conditions, proving particularly helpful in reducing acute events.

Financial gain for associated agencies

From a financial perspective, many community mental health agencies provide outpatient care for Medicaid patients because they receive government funding from Medicaid. Hospitals usually receive adequate funding for inpatient care from Medicaid, but outpatient reimbursement for Medicaid patients has been slim. Therefore, these partnerships provide hospitals an avenue to refer their Medicaid patients to receive care at a cost-effective setting.

Win for patients and providers

Hospitals are identifying partnerships with community mental health agencies as a key strategy to providing behavioral health care to more patients – an imperative with health reform and parity. These partnerships are beneficial for both sides through increased referrals, capacity, and expertise. Hospitals that don’t have a diverse portfolio of outpatient services can refer their patients to outside agencies to receive outpatient therapy, case management, and other resources to manage their condition. The community agencies view the hospital as a resource for specialized physicians and management of acute events, as well as enjoying the reputation that comes from having a strong affiliation with a hospital.

For more information about strategy around behavioral health services, log in and access our recent webconference, “Behavioral Health Services Strategy.”