Population Health Starts with Whole Person Care
For behavioral health, creating population health strategies that focus on whole-person care for large populations of patients can be challenging. But as the industry shifts toward patient-centered care, learning how to increase patient engagement and eventually cut healthcare costs will be crucial.
Build Partnerships to Increase Engagement
One major hurdle to overcome when looking to implement these strategies will be maintaining continuity of care between behavioral health providers and primary care providers.
“Behavioral health organizations have traditionally operated as silos in specialty care. Behavioral health clinicians and clinician leaders will need to learn to speak the language of primary care and have a better understanding of chronic and acute medical conditions that can cause or exacerbate mental health conditions,” said director of the Doctor of Behavioral Health program for the Cummings Institute in Phoenix, Cara English, in a July interview with Behavioral Healthcare. “Care coordination is particularly difficult when patients need a referral outside the practice. The burden of coordinating follow-up and communicating treatment and discharge summaries is entirely placed upon the patient and the family for the most part. Due to the stigma of seeking care, patients are unlikely to follow up on a behavioral health referral outside the primary care practice.”
Chronic health conditions can co-occur or lead to substance abuse or mental health issues. In order to create a complete picture of the patient’s health and history, establishing a partnership with primary care providers allows for an integrated health experience.
“Population health models that address both clinical issues and barriers to self-care are showing success in lowering costs and improving the health of patients. The true challenge is enabling the paradigm shift of how the present healthcare environment thinks about working with patients.” says Jordan Asher, MD, MS, chief clinical officer for Nashville, Tenn.-based MissionPoint Health Partners.
“We find that we have to address a patient’s anxiety and depression before we can expect them to actively engage in activities to better manage a chronic disease like diabetes or congestive heart failure,” Asher continues. “Unless a patient is in a medical crisis, we think about the behavioral dynamics as first order and clinical issues as a very close second order, which is often 180 degrees different than a traditional disease-based model.”
According to English, a working partnership between primary care and behavioral health providers is the first step towards successful whole person care. “Due to the stigma of seeking care, patients are unlikely to follow up on a behavioral health referral outside the primary care practice,” English says. “They are much more likely to present to their primary care provider with behavioral health symptoms and want to have care for that condition delivered by that same doctor that they trust. Unfortunately, primary care providers lack the training, tools and expertise necessary to address these issues, and few primary care practices hire behavioral health providers to consult with patients. Initiating new relationships with providers can be difficult for patients with depression, anxiety or serious mental illness.”
Creating partnerships with organizations outside of healthcare is equally important to affecting change across populations. Building relationships with schools, community-based organizations, faith-based organizations, and local law enforcement and government agencies provides opportunities to meet patients in a comfortable environment and explain how behavioral health services integrate into overall health.
Bridge Gaps with Technology
Another hurdle for behavioral health providers to overcome will be navigating interoperability issues that often limit care coordination between healthcare systems, but is necessary to make effective changes to population health.
“The electronic health record is something new to many providers, and navigating interoperability issues, ensuring HIPAA and 42 CFR Part 2 compliance and determining how to roll out new patient portals can be overwhelming for many experienced providers,” English says. “For a primary care physician to be able to access hospital or emergency department visit summaries, including behavioral health visits, it is up to the patient to get and bring those summaries back to the primary care provider. Having an integrated electronic health record is critical to patient engagement.”
According to Lonergan, many behavioral health providers are seeing increased patient engagement when using adjunctive online portals, assessments and tools that can also connect patients who have similar health issues. With Medicare, Medicaid and private payer reimbursement increasing for telehealth, possibilities to reach more patients remotely is also growing.
“There’s a real shortage of geriatric and pediatric behavioral health providers, so telehealth is a real solution to reach and engage patients in rural areas,” Lonergan says, who believes that low-cost solutions can assist with improving population health, such as the many free app choices currently available to patients. Plus, Lonergan says, some apps can link directly to providers, “Texting patients to remind them of appointments is very effective, especially with young people. Programs that help patients set smartphone alarms to commit to certain behavior changes, like exercising or taking medications, is another great way to use technology.”
Reimbursements for behavioral health services can vary from state to state, though grants are often available for pilot programs that test value-based reimbursement models. And when it comes to implementing population health, funding is often the barrier that limits population health progress and implementation.
“The good news is that as our nation shifts to alternative payment models and value-based payments, the door for innovations around how we work with patients—and how that work is reimbursed—is completely opened,” Asher says. “Under some of the new payment arrangements that enable providers to take risks, patient engagement services will become extremely valuable to both to the patient and to whomever is holding the financial risk.”
“We need to redesign care systems to be more patient-centered and tap into the opportunities presented by new funding streams, capitated fee arrangements and value-based contracts,” English says, noting that federal Meaningful Use incentives have not been available for independent behavioral healthcare providers or behavioral health organizations without a physician. However, grant funds that incentivize electronic health records initiatives are available.