Prescription for Change

2 things population health leaders want CMOs to know about behavioral health management

by Sarah Evans, Serena Bernthal-Jones, and Clare Wirth

Behavioral health conditions are highly prevalent, often undiagnosed or untreated, and deeply entangled with chronic disease management, making them one of the most costly conditions today. Physician executives tell us they are increasingly concerned about behavioral health outcomes, but don't always know the answers.

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Since population health leaders often own behavioral health transformation, we spoke with our colleagues from the Population Health Advisor. Here's what population health leaders want CMOs to know:  

1. 'Unmet behavioral health needs impact your top system priorities.'

The gap between the demand and availability of behavioral health services negatively affects outcomes that CMOs are responsible for. These include:

  • Utilization: Patients with behavioral health needs tend to over-utilize acute services when their needs are not sufficiently met in primary care, resulting in increased length of stay and slower throughput. For example, a patient with a psychiatric emergency waits 3.2 times longer than a patient with non-psychiatric needs, blocking at least two patients from receiving more timely care.

  • Clinical quality: Patients with behavioral health needs experience worse clinical outcomes. As just one example, depression is consistently associated with increased risk of poor glycemic control, complications, and care utilization for diabetic patients.

  • Cost: Patients with a behavioral health diagnosis incur two to three times more cost than those patients without a diagnosis. On a national scale, this translates to $406 billion in additional costs associated with treating patients with mental illness each year.

2.  'Start by deploying crisis management in the ED.'  

Where CMO and population health leaders' priorities most overlap is with patients presenting to the ED with a psychiatric episode. In fact, one-in-eight ED visits is associated with behavioral health needs, yet less than 17% of ED physicians report having a psychiatrist on call to respond to psychiatric emergencies. Moreover, more than half of ED physicians say the mental health system in their communities has worsened in the last year. Managing this population's needs presents the greatest opportunity for CMOs to improve behavioral health utilization, clinical quality, and cost.

Here are two ways we've seen organizations extend access to specialized services for patients with serious and complex needs:

  • Introduce tele-psychiatry and remote consultation in the ED: Atrium Health established a centralized tele-mental services unit that links the ED with behavioral health experts. A licensed counselor or clinical social worker can perform a telephonic prescreen followed by a psychiatrist-led virtual visit. Despite the surge in ED volume by 37% between 2015 and 2017, median ED length of stay decreased by almost 2.5 hours.

    Want to learn more about tele-psychiatry? Register to join the Physician Executive Council's 2019 Roundtable on Quality and Patient Experience. We'll share win-win strategies to improve quality and experience for three patient groups, including behavioral health patients in the ED. Reserve your seat today.

  • Create a care environment tailored to behavioral health needs: To reduce ED wait times and increase quality of care, four major health systems in Portland, Oregon partnered to create the Unity Center for Behavioral Health. This 24-hour behavioral health services center includes outpatient psychiatric emergency services, which provides quick stabilization in a calming environment for patients experiencing a mental health crisis. Since opening its doors in early 2017, the Unity Center cut the number of hours that its partner hospital, Legacy Good Samaritan Medical Center, spent on ED diversion status due to overcrowding by 71%, resulting a contributing profit margin increase of $1.6 million. And this is all done efficiently—nearly 80% of patients treated in these units are stabilized and discharged within 24 hours.
 

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Our infographic explains how community paramedics can help extend the care team to prevent avoidable visits to the ED.

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