The evidence is clear and widely publicized. Behavioral health conditions often lead to maladaptive outcomes, such as lack of care adherence, early death, and increased health care costs. Individuals living with mental health and/or substance use disorders are significantly more likely to go to an emergency room for care and be re-admitted to a hospital within 30 days post-discharge unnecessarily.
Health Leaders Media recently published an article outlining strategies and solutions that insurers are beginning to implement in response to this data. These practices include those that behavioral health providers have been engaging with for years such as:
In response to a lack of community based respite and transitional housing options that could help keep their members with mental illnesses out of the hospital, the Commonwealth Care Alliance (CCA) opened its own 10 bed transitional housing facility in Dorchester, MA, to which physicians can refer patients as they are leaving inpatient units to help them re-stabilize in the community.
Ian Shaffer, Executive Medical Director at Healthfirst, believes that “Healthcare is a team sport now,” so providers within the Healthfirst network are being encouraged to incorporate behavioral health screening and referrals into their workflow.
Integra ServiceConnect directly staffs Community Coordinators from its target neighborhoods, who outreach and engage beneficiaries where they live. Based on a per member per month rate, Community Coordinators have flexibility to meet each member’s unique needs, which may involve helping them schedule an appointment with a doctor, but may just as often involve taking beneficiaries to consignment shops to buy a winter coat.
It is clear that behavioral health providers have a lot to offer in today’s environment of health care reform driven by the Triple Aim of better health care, better population health, and lower cost. Community Based Organizations that are engaging in innovative and effective strategies to help keep those with behavioral health conditions out of the hospital and stabilized within the community should reach out to the Managed Care Organizations and private insurers within their community, in order to determine how their models of care can fit within the insurers benefits package. These presentations should include who within your organization is providing what service to which target population to what effect (outcome), and at what cost.
For a link to the full article from Health Leaders, click here.