This is the second installation of our Amplifying Success series, which explores how integrated behavioral health programs, amplified by technology, can help health systems and plans achieve the Quintuple Aim. In this installment, we’ll examine how integrating behavioral health into medical care can significantly improve clinical outcomes while reducing high utilization, particularly among patients with comorbidities.
The Aim
One of the goals of the Quintuple Aim is to Improve Clinical Outcomes. In the U.S. preventable deaths and healthcare costs are rising. The longstanding division between physical and behavioral health care and the barriers patients face in receiving access to care are large contributing factors to this phenomenon. COVID-19 has only served to amplify these trends. Integrating physical and mental health care plays a critical role in reversing these developments and helping healthcare organizations improve clinical outcomes.
The Problem
Behavioral health (BH) is closely tied to physical health (PH). Longitudinal review of claims data demonstrates the impact of untreated BH and PH conditions; 22% of patients with BH conditions drive 41% of medical spend largely due to comorbid PH conditions (Evernorth). Worse, half of patients with BH conditions receive no treatment, contributing to exacerbated BH and PH symptoms.
Without addressing both behavioral health and physical health needs, health systems are experiencing high rates of hospital readmissions, emergency department utilization, and medical spend. Milliman found that patients with comorbidities contribute to 2 to 6 times the healthcare costs than those without a behavioral health condition.
While integrated care is a clear solution, many health systems and plans have not fully embraced this approach because of the upfront costs and resources needed to implement it successfully. But, with the right technology, healthcare organizations can scale their programs, lessen provider workloads, and more quickly realize financial sustainability by automating key features of integrated behavioral health.
The Solution
Digital solutions eliminate many of the barriers to care integration that patients and providers face, empowering health systems to treat BH and PH conditions simultaneously. With digital technologies that are built to support integrated care models, providers can proactively screen for BH conditions in PH settings and provide resources to patients. This data feedback allows providers to collect population insights that inform resource allocation and identify opportunities within integrated care programs to grow and scale. By addressing underlying behavioral health needs in physical healthcare environments, providers can help patients better manage their holistic health and wellness.
Technology-augmented care allows for the automation of key components of integration like assessments, identification, and patient triage. Clinical tools built thoughtfully into provider workflows can significantly extend the reach of providers’ previously limited resources.
Increase Screening Rates
To integrate behavioral health and physical health care, providers must assess patients for behavioral health conditions. This is typically done during in-person appointments, but it can take time that many providers don’t have, and many patients don’t feel comfortable talking about their behavioral health in this setting.
With a digital solution, patients can take regular clinical assessments remotely on their phone or computer, in between appointments. Clinical assessments like the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder scale 7 (GAD-7) help providers track depression and anxiety symptoms. Regular, remote screening enables monitoring across a much larger population and identifies when individuals’ behavioral health declines. In this way, universal screening of patients allows for a preventative approach to care that supports care teams in intervening proactively and potentially preventing emergency department utilization or inpatient hospitalization.
Improve Identification & Triage
Many providers are overwhelmed with demand for BH services, so increasing identification of patients with BH needs may seem counterproductive. But implementing a technology that identifies needs early and connects patients to care can get ahead of worsening conditions that may otherwise have escalated to an ED visit.
Technology can analyze assessment data and other indicators, like mood and pain, to establish an individual’s behavioral health baseline and quickly identify when the patient falls below that baseline. Automated alerts can inform providers when intervention is needed and suggest next steps, like administering a Columbia-Suicide Severity Rating Scale (C-SSRS) or enrolling the patient in an integrated behavioral health program.
Triaging patients to the right level of care ensures patients receive care quickly before their conditions worsen. Insight into patient data over time allows providers to better allocate their limited resources to make a positive impact on health outcomes.
The Results
Lower Utilization
Integrated behavioral health programs can make a significant impact on healthcare utilization. A study conducted in Rhode Island analyzed claims data after implementing an Integrated Behavioral Health (IBH) program across 11 primary care practices. The program introduced universal screening for depression, anxiety, and substance use disorders. It also introduced behavioral health care managers who provided care to patients with behavioral health conditions and referred them to specialists as needed. After implementation, emergency department utilization declined 7% and office visits reduced 6%.
Jefferson Health saw an even greater decline in emergency department utilization after using NeuroFlow to scale its integrated behavioral health programs; Jefferson leveraged NeuroFlow’s self-care digital solution to regularly and remotely screen patients for BH conditions and provide relevant BH content. After implementing NeuroFlow, Jefferson conducted a 12-month retrospective and compared EHR data of patients who had access to NeuroFlow to those who received treatment as usual. Jefferson saw a 34% reduction in ED utilization among patients who used NeuroFlow during that time period.
Improved Behavioral and Physical Health
The Psychiatric Collaborative Care Model (CoCM), the most widely researched form of integrated care, has been proven to reduce symptoms for depression, anxiety, and substance use disorder more than treatment as usual.
Health systems that partnered with NeuroFlow to support integrated behavioral health care programs saw significant improvement in patients’ depression symptoms. On average, health systems using NeuroFlow helped 69% of patients with a clinically significant initial score achieve depression response. Depression response represents a 50% or greater reduction in PHQ-9 scores within 4-8 months.
Integrated care programs also impact physical health outcomes. Studies indicate symptom improvement for chronic conditions like diabetes and cardiovascular disease after organizations implement integrated care. For example, in 2018 Blue Cross Blue Shield Michigan (BCBSM) helped primary care clinics implement CoCM. BCBSM trained over 800 clinicians across 190 practices to speed the adoption of CoCM. The program is on track to reduce medical spending two to three times for patients enrolled in CoCM.
Considering that comorbid patients account for 90% of the U.S. medical spend, it’s more important than ever to find proactive, scalable, and effective solutions to improve clinical outcomes for these patients. Addressing underlying behavioral health conditions has proven critical to this effort and must be a top priority for health systems, provider groups, and health plans in the years ahead.
To learn more about how integrated behavioral health programs, powered by technology, help healthcare organizations achieve the Quintuple Aim, read our complete Amplifying Success series.
