Patients with co-morbid behavioral health and medical conditions are at a higher risk for readmission. In fact, one Canadian study found that 37% of patients with a behavioral health disorder discharged from an acute care hospital were readmitted within a one-year period. This compares to the 27% of patients who are discharged without a behavioral health disorder.
Patients with these co-morbid conditions are often readmitted for a variety of reasons, including complications due to having multiple health issues, lack of a strong support system, and non-adherence to treatment regimens.
Not only are these patients readmitted more often, but their overall cost of care is much greater. In fact, research shows that monthly costs for a patient with one of 10 different chronic diseases and depression are $560 more than for a patient with a chronic disease without depression.
One way we’ve seen providers successfully meet the needs of their behavioral health patient population is through a more proactive approach to care.
Screen for behavioral health needs in the primary care setting
Cherokee Health System (Tennessee) has been integrating mental health into primary care for over 30 years. They do so by embedding a licensed behavioral health provider, such as a clinical psychologist or social worker, into the primary care team to help patients manage stress, depression, or make positive lifestyle changes.
Use care transitions to detect and support behavioral health
Bon Secours Hampton Roads Health System recognized that behavioral health conditions were going undetected in their ED and inpatient settings and addressed the issue through their Life Coach Program. These Life Coaches perform depression screenings and work to identify other behavioral health concerns. Once identified, the coaches connect patients to the support system required for ongoing management.
Collaborate to build a robust behavioral health continuum
Denver Health offers telephone-based support to patients with diagnosed or suspected behavioral health needs. Selected patients complete six counseling sessions by phone and are given a detailed plan for self-management and relapse prevention. Denver Health collaborates closely with PCPs to share this information and create continuity in care.
Our briefing, Managing Vulnerable Populations, profiles other organizations that have successfully managed patients with chronic conditions, including Project ECHO at Harborview Medical Center, which connects providers across five states to support rural primary care physicians caring for vulnerable patients, including those with behavioral health disorders.
For more information on managing behavioral health disorders, specifically under payment reform, check out the Marketing and Planning Leadership Council’s presentation, "Behavioral Health Services Strategy," which outlines seven strategies for managing behavioral health challenges. Specifically, the first strategy details the how to elevate access to inpatient behavioral health services of greatest need to high-risk co-morbid patient populations.