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Consider the details when integrating behavioral healthcare

September 15, 2016

With more emphasis on performance and value-driven care, healthcare leaders are looking to integrate behavioral health into traditional settings, drive efficiency, reduce costs and improve patient outcomes.

While the big picture changes and transitions are important to a successful integration, the real areas that will determine success or failure can be found in the details such as resource management, organization policies, treatment planning and coordination of care.

The need for integration
According to a study from Health Affairs, mental disorders are the most costly conditions in the United States, totaling $201 billion in 2013. In fact, 70% of all primary care patient visits are related to behavioral health, and studies suggest one in five will be diagnosed with a mental health disorder.

We know that there is a behavioral health component to many physical health presentations and when a mental illness is mixed in, treatment costs can double or triple for patients with a medical condition. For example, Substance Abuse and Mental Health Services Administration (SAMHSA) data shows the cost of treating a patient with diabetes is $9,500 per year on average. When the diagnosis includes a mental illness, the treatment costs jump to just under $37,000 annually.

This staggering increase is counteracted by integrating behavioral health into traditional health settings. The Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) study found when behavioral health is integrated into primary care settings, patient outcomes improve and cost of care goes down. The data revealed investment in an integrated care model results in a $6.50 return on every $1 spent.

Value-based care models that incorporate behavioral health require a significant amount of teamwork across providers as well as with patients, and are known as collaborative care models.

Collaborative care model
The collaborative care model has evolved over the past 20 years to focus on reduction of symptoms and improved quality of life for patients. Today’s modern collaborative care model has been linked to many positive outcomes including:

  • Reductions in self-reported levels of depression
  • Reduced rate of high-cost medical visits
  • Improved intercommunication between clinicians
  • Improved treatment planning
  • Improvement in scheduled follow-ups

At the crux of a collaborative care model is the principle that all coordinating services align with the overall mission of the organization to meet the needs of the population served. Once behavioral health services are assimilated into operational alignment—with scope of services, goals and objectives defined—health leaders can start to focus on the details to guarantee a successful integration.

7 tips for integrating a successful collaborative care model

  1. Don’t Overlook Basic Resources: Facilities, Equipment and Staff

It’s important to have the physical tools in place to sustainably integrate behavioral health.

  • Facilities: Leaders should be mindful of the challenges of privacy that can arise from space limitations. Be sure to offer sufficient space to ensure privacy and confidentiality.
  • Equipment: Ensure that your technology can adequately support the requirements for clinical documentation, practice management and report generation. While these tools should comply with all patient confidentiality laws, those truly succeeding at behavioral health will often enact safeguards to guarantee privacy and adherence to institutional policy. For example, organizations may have policies on developing security settings, staff permissions and conducting audit tracking within the electronic medical record.  Regarding safety, examples would include the use of security cameras, panic buttons and other safety measures.  Their use should not compromise client privacy or confidentiality.
  • Staff: Design staffing patterns to meet patient needs in a timely manner. When assessing demand, consider questions like how long does a patient normally wait for the initial appointment? Can psychiatry services be obtained in a timely manner? How are caseloads assigned, monitored and managed? Is there a balance between direct service hours, administration time and case management?
    In addition, it is important for staff to receive ongoing training and professional development opportunities. Consider including training in cultural competence and suicide prevention to improve the patient experience and outcomes.
  1. Edit Organization Policies to Include Behavioral Health-Specific Issues for Adults and Minors

When rewriting your organization policies, consider the concerns that are unique to behavioral health, such as the safety and privacy of patients; appropriate staffing; security of data; a system for timely triage of patients to determine severity and acuity of symptoms; and initial and periodic assessment of alcohol and other drug use.

It is also important to draft written policies specific to the behavioral health treatment of minors and/or consultation services for your organization.

  1. Collect All Important Client Information from History to Scope of Treatment

Patient health records should be expanded to include behavioral health information. A comprehensive patient health record includes a complete behavioral and mental health history, substance abuse history, physical health history and any current concerns. Policies should also clearly define the type and scope of treatment.  The informed consent for treatment should include expectations and potential risks, and limitations to confidentiality, such as danger to self or others with imminent risk.

  1. Approach Treatment Plans with a Client-Centered Point of View

When developing a behavioral health treatment plan, make sure the objectives are client-centered rather than therapist-centered. For example, they will read “The client will…” rather than “The therapist will…” These goals should be measureable, achievable, time-specific and appropriate based on the needs of the client.

Clients should play an active role in their treatment plans, so collection of their feedback and participation is essential to success. This includes information on medication use and management such as patient response and reported side effects.

  1. Keep a Close Eye on Clinical Records

Ongoing coordination of care between primary care and behavioral health is vital to improving outcomes and reducing errors. One key component is confirming that the clinical record is tracking consultations, referrals and follow up between services, as well as updates on risk of harm to self or others; comorbidity disorders and if/how these have been addressed.

It’s also important to remember that collaboration doesn’t end when the patient is discharged from the facility. At discharge, clinical records should include discharge summaries as well as collaborative after-care plans and/or transitions to other services such as relapse prevention plans, plans to reduce stressors or emotional regulation plans.

  1. Think Beyond Your Walls

Behavioral health services often expand beyond the walls of a healthcare facility and branch out into the community. When integrating behavioral health services consider developing outreach activities in your community that focus on risk reduction, wellness and quality of life. To determine which ones are the best fit, examine data obtained through specific needs assessments in the community or from national data sources of similar populations.

  1. Assess Treatment Efficiency with Hard Numbers

Value-based care focuses on patient outcomes and relies on quantitative measures to assess treatment efficacy from initial patient presentation to discharge. To start the assessment, consider these questions:

  • How is patient satisfaction assessed and how often?
  • How well are goals being met? 
  • How is treatment effectiveness demonstrated?
  • Is a quality improvement study warranted?

From there, staff can actively participate in the organization’s peer review and quality improvement programs by offering input and feedback.

In Summary
Behavioral health requires unique resources and processes to provide high-quality care to patients. These specifications should be fully incorporated into a health organization’s makeup—from resources to treatment plans to service evaluations. A patient-centered approach to care will only improve patient satisfaction and outcomes by scrutinizing both the big picture and the finite details.

Joy Himmel, PsyD, PMHCNS-BC, LPC, has been an Accreditation Association for Ambulatory Healthcare surveyor since 2009.

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