IN 2017, OUR CLIENT TREATED 180,332 PATIENTS IN THEIR EDS ACROSS 282,591 VISITS.
SLIGHTLY OVER 90,000 OF THOSE PATIENTS HAD DOCUMENTED EVIDENCE IN THEIR MEDICAL RECORD OF A BEHAVIORAL HEALTH (BH) DISORDER WITH A THIRD OF THESE PATIENTS (36,173) PRESENTING WITH A HISTORY OF SEVERE MENTAL ILLNESS/SU DISORDERS (SCHIZOPHRENIA, MAJOR MOOD OR PERSONALITY DISORDERS, CHRONIC SUBSTANCE USE).
APPROXIMATELY 3,000 OF 11,288 PATIENTS HAD TO BE INVOLUNTARILY COMMITTED RESULTING IN AN AVERAGE DAILY CENSUS OF 103 (11% OF CAPACITY) BEHAVIORAL HEALTH PATIENTS AWAITING PLACEMENT WITH AN AVERAGE LENGTH OF STAY (ALOS) OF 6.6 DAYS.
Hospital EDs and health care systems across the country are facing crippling demand from patients with behavioral health (BH) and substance use disorders. By building high performance accountable care communities we improve patient outcomes and reduce hospital admissions, readmissions and avoidable bed days.
Here’s what we learned in a recent implementation at a 1000-bed community safety net hospital:
The right care. The right environment. The right time.
In early 2017, our client launched a comprehensive strategy to help patients suffering from behavioral health and substance use disorders. The objective was to build a high performance, multi-disciplinary network of inpatient, outpatient, and community based organizations, creating a circle of support around each care transition. To be successful it required:
use of common screening and assessment tools;
mitigation of social and medical obstacles to treatment compliance;
application of best practice patient engagement techniques;
and coordination at all levels of follow up care.
Most importantly, all members of the network that was formed agreed to singularly and jointly measure network progress toward two key network performance measurements:
It Takes a Network
To lead a solution that improves care coordination, a network must be developed that is attractive to providers across a spectrum of care. In this instance, we were able to create an accountable BH community network that included primary care, behavioral health and Community Based Organizations (CBOs).
The network was then able to impact care and ROI by streamlining the care transition between acute and ambulatory care, bridging care gaps, and increasing access to both medical and CBOs. Internally, our client initiated a series of process improvements to better identify, triage, and expeditiously transfer BH patients to the appropriate level of care. These included:
Integration of Psychologists within the ED milieu, minimizing involuntary commitments and EMTALA.
Deployment of a standardized Community Transition Screening Tool within Epic to assess readiness for ambulatory discharge.
Integration of ambulatory/inpatient assessments and care plans to minimize prior-authorization delays to initiate BH services.
Deployment of an electronic health referral system to share referrals and clinical documentation, assign a “clinical home,” and track readmissions.
Further, Blaze Advisors built a referral decision support tool that translates patient needs into eligible BH services which then “cross-walked” to the providers who operate those services. This significantly minimized the patient bounce rate to other providers and lowers readmissions.
Social Determinants of Health (SDOH)
Our client now oversees a high-performance network of community based organizations to address the prevalent SDOH obstacles faced by many of our patients. We also introduced a platform that allows for electronic referrals and communication and shared patient/care plans. We then included the following Blaze-developed strategies:
CONVERT: This ED Opioid Detection and Intervention approach uses a novel software tool to query the Controlled Substance directory and create a banner alert in Epic. From there, an ED physician initiates a motivational interview to convert the patient for an on-site dependency evaluation. If positive, a peer support specialist will act as the patient’s transitional care sponsor to bridge the patient to appropriate medical and clinical treatment within the NABH to minimize treatment abandonment.
DETECT: Early BHSU Identification in Primary Care: On behalf of affiliate primary care physicians, the Network conducts online depression screenings for patients who suffer from diabetes and hypertension. Client data indicates over 50,000 of their patients are suffering from diabetes and estimate that 30% of those suffer from underdiagnosed depression/anxiety. Reviewing test results are a billable service for physicians.
FRESH FOOD FARMACY: Given the prevalence of polychronic depression/diabetes, the network is launching a Fresh Food Farmacy program in concert with the Connected Community. Modelled after the Geisinger program, physicians can write a prescription which can be exchanged for fresh food at a local food bank.
Generating Real ROI for Behavioral Healthcare
To buttress the network, the hospital’s foundation directed dollars to non-profit and community-based organizations essential to BH and SU treatment -- crisis responders, food pantries, homeless shelters, etc. With those organizations financially supported and thus better able and prepared to, medical providers could confidently direct patients to seek their services and support.
Blaze Advisors built the infrastructure to track the distribution of those funds to the CBOs, then tracked when those CBOs delivered services, and to whom and how often. Collecting that data allowed us to follow patients through the Network, where they encountered contributed dollars, what their outcome was and whether they stayed on-track or returned to the ED. Our data measured the ROI on the Foundation’s contributions and determined the real impact on real individual lives.
Results are in the Pudding
To date, the NABH has helped reduce avoidable bed days and state hospitalizations by nearly 60% with average length of stay dropping by 30%. Direct annualized savings in charity care and BH aide costs are estimated at $17-19M/annually. Total cost of care savings is estimated at $40-50M/annually.
If you’re interested in learning more about how Blaze Advisors can help your hospital achieve greater success for your behavioral health endeavors, visit www.blazeadvisors.com.
To lead a solution that improves care coordination, a network must be developed that is attractive to providers across a spectrum of care. In this instance, we were able to create an accountable BH.