Latest / Becker's Healthcare Behavioral Health / Better Behavioral Care Collaboration: An Integrated Ecosystem Approach to Care Starts by Empowering Providers

Transcript

Better Behavioral Care Collaboration: An Integrated Ecosystem Approach to Care Starts by Empowering Providers · Becker's Healthcare Behavioral Health

• 0:00
  Hello everyone. I'm Marcus Robertson,
• 0:02
  assistant editor with Becker's Hospital Review.
• 0:04
  Thank you for tuning in to the podcast Today.
• 0:07
  Mental health disorders are the costliest health conditions in the
• 0:12
  US with annual spending over 200 billion,
• 0:17
  and that's with fewer than 50% of those with mental health disorders accessing
• 0:22
  treatment per 2020 numbers.
• 0:25
  So today we're gonna be talking about how an integrated and collaborative
• 0:28
  approach with behavioral healthcare can improve outcomes and reduce costs at the
• 0:33
  same time. And we have a great slate of guests joining the conversation today,
• 0:38
  starting with Dr. Ben Z,
• 0:40
  who is the Chief Medical Officer for Point Click Care.
• 0:44
  We are also joined by three leaders from the University of Virginia Health's
• 0:48
  Medicine Home Program. We have Teresa Radford Clinical program coordinator.
• 0:52
  We have Dr. Amber and f Fuentes medical Director, and we have Guy Lucian,
• 0:57
  who is a licensed clinical social worker and psychotherapist. Together,
• 1:02
  they're all going to help us discover how the university is using technology
• 1:06
  to help patients with chronic medical and behavioral health conditions,
• 1:10
  get the care they need when they need it,
• 1:13
  to improve outcomes and decrease costs associated with unnecessary
• 1:19
  hospitalizations and readmissions. So thank you Dr. Z Theresa,
• 1:24
  Dr. Fuentes, and Guy so much for talking with us all today.
• 1:29
  You're so welcome.
• 1:30
  Thank you for having us.
• 1:32
  Super excited to talk about this.
• 1:35
  Beautiful. All right, well, let's dive in. I'll go ahead and, uh,
• 1:38
  actually I'll start with you as doctors in yellow.
• 1:40
  There is a ton of focus on mental health these days, um,
• 1:45
  but so many of the people right now who need behavioral health treatment just
• 1:50
  are not accessing it from a physician's perspective.
• 1:55
  What do you think is standing in the way for patients?
• 1:59
  Access is definitely the watch word here,
• 2:02
  and I think it's actually beyond simple access,
• 2:05
  but it's personalized access in the sense of mental health
• 2:09
  is not one size fits all.
• 2:11
  The type of care a person needs can depend very much on the, the patient,
• 2:16
  the particular, um, crisis or circumstance,
• 2:20
  and then ultimately the care setting they find themselves.
• 2:23
  So while I say access, it's not enough just to say, well,
• 2:28
  we have this, um, phone line, we have an emergency room.
• 2:32
  We need personalized access,
• 2:34
  access to providers that know you and can help you as a individual.
• 2:39
  The example I always use here is the emergency department,
• 2:42
  which is widely seen as the most accessible point of care,
• 2:45
  which is why many go there in moments of crisis. Um,
• 2:50
  sure it is accessible to everyone,
• 2:52
  but we need to make it more personalized so that when you go to the emergency
• 2:56
  room,
• 2:57
  it's not simply you are an undifferentiated patient seeing a new provider for
• 3:02
  the first time. We want them to be able to anticipate, uh,
• 3:06
  your needs and know about you,
• 3:09
  not just from that moment of crisis in the emergency room where it's really
• 3:13
  difficult to transmit information about yourself,
• 3:17
  but from all the providers that know you best, uh, in the,
• 3:22
  uh, in the wild side, the emergency room,
• 3:24
  and therefore be it a tailor your particular care to you,
• 3:29
  that crisis and everything that they then know about you. So again,
• 3:34
  I would focus on personalized access is one of the biggest opportunities we have
• 3:39
  in mental health.
• 3:41
  Personalized access. Specifically,
• 3:43
  you said we want to know about you as a patient to be able to anticipate your
• 3:47
  needs. Um, and obviously, you know,
• 3:50
  providers are gonna play a really important part in that,
• 3:52
  but how can sort of the broader care ecosystem come together
• 3:57
  to, to, you know, ensure that patients are getting the help that they need?
• 4:02
  Well, Marcus, I, I do think that programs like ours,
• 4:05
  like the Medicine Ho Home Program is one way to achieve that goal.
• 4:10
  I think as Dr. Z just pointed out,
• 4:13
  it's so important for a patient who shows up to a complicated
• 4:17
  large healthcare system,
• 4:19
  whether they enter through an outpatient clinic or whether they show up in the
• 4:23
  emergency department, um,
• 4:25
  to auto rival not have to, um,
• 4:29
  re-explain the entirety of their medical history, their mental health history,
• 4:35
  um, and to know that the person who's gonna be evaluating them,
• 4:38
  the doctor or nurse,
• 4:39
  has some sense of what their needs are really from before they meet them. Um,
• 4:44
  and so I think that, you know,
• 4:46
  one of the ways that we've worked to achieve that with our program is that we,
• 4:50
  um, develop individualized care plans, um,
• 4:54
  a concept that was introduced in the literature, you know, um, you know,
• 4:58
  a decade or so ago, and a lot of health systems use these, but, um, it's a,
• 5:03
  a, a document that lives in the E M R and then can be transmitted
• 5:08
  to help systems really across the state and even beyond through,
• 5:13
  uh, the, um, uh, health information exchange,
• 5:17
  utilizing things like point click care.
• 5:19
  And so that then becomes a document where, you know, a doc can, um, pull it up,
• 5:24
  get a really quick one page snapshot of who this person is, uh,
• 5:28
  what are the things that they frequently come to the hospital with,
• 5:32
  what is the best way to help care for them. Um, and, you know,
• 5:36
  complicated issues often that are in there related to behavioral health history,
• 5:40
  mental health history. In addition to that, in our team, you don't,
• 5:44
  you get more than just that individualized care plan. You also get,
• 5:49
  uh, um, people like Teresa Radford,
• 5:52
  our clinical nurse as well as Guy Luk, the social worker who, uh,
• 5:57
  know the person really,
• 5:59
  really well and can then connect directly with that emergency department nurse
• 6:03
  or doctor, um,
• 6:04
  can go meet the patient in the emergency room and kind of walk them through, um,
• 6:09
  their healthcare visit in a way that makes it feel, I think,
• 6:12
  very personalized and builds trust in our healthcare system.
• 6:19
  So not having to re-explain your entire,
• 6:21
  entire medical or mental health history, um, you know, yeah,
• 6:26
  it does sound like something that, that, uh,
• 6:29
  will kind of remove barriers to people accessing personalized care.
• 6:34
  So, you know, more than just providers, it's,
• 6:37
  it's gonna take a whole system to make all this happen. Uh,
• 6:40
  but that first step really often starts with community-based
• 6:45
  health systems, you know, local providers. So, you know,
• 6:49
  I wonder if we could get into some of the details of this program that's making
• 6:55
  such a big impact in Virginia. Teresa,
• 6:57
  could you tell us about the work you're doing to connect patients to the care
• 7:02
  that they need at the University of Virginia Health?
• 7:06
  Certainly.
• 7:07
  So our team really focuses on a person-centered model
• 7:12
  of wraparound care, um, that really seeks to, um,
• 7:16
  move through all the silos that are historically part
• 7:21
  of a healthcare system, I think. Um,
• 7:24
  and so we see and follow the patient wherever they are,
• 7:28
  whether that's in the emergency room or if they're admitted, uh,
• 7:33
  in a clinic, if they're seeing an outpatient provider in their home, um,
• 7:38
  if they are homeless on the street. Uh, and we connect,
• 7:42
  try to connect them with whatever resources are available in the community
• 7:47
  and to make sure they're connected to our internal providers as well.
• 7:52
  Um, our program, because we're under population health at uva,
• 7:57
  there's a vast degree of resources and people focused on
• 8:02
  providing high touch and individualized assistance to people. So,
• 8:07
  um, the behavioral health area, the community paramedicine team,
• 8:12
  um, we collaborate with our community partners, uh,
• 8:16
  fire and rescue people who work with people struggling with housing
• 8:21
  insecurity. Um, and so we just tried to provide, um,
• 8:26
  high touch person-centered care, uh,
• 8:30
  wherever an individual is.
• 8:33
  So you are not, not just simply, you know, treating what, what, uh,
• 8:37
  a patient comes in is and is presenting with,
• 8:39
  and then showing them the door and saying goodbye. It's not,
• 8:42
  it's not ending there.
• 8:44
  Well, so many of these individuals struggle with, you know,
• 8:49
  multiple chronic medical as well as behavioral health conditions, and there,
• 8:53
  there are many barriers to care, um,
• 8:56
  such as we'd already talked about homelessness or food insecurity,
• 9:00
  lack of transportation, um, and a lot of these, um,
• 9:04
  folks also struggle with mental health or substance use disorders. So,
• 9:09
  you know, there's never just one piece of,
• 9:13
  of what I think someone needs us to think about or address or,
• 9:18
  or, or care about in a, in an encounter with someone. So, um,
• 9:23
  just really important to see the whole person and really try to get a sense of
• 9:28
  really what they're dealing with in the moment.
• 9:31
  I think what I would add on to that, Teresa, I think you said it really well,
• 9:35
  is that a couple of issues I see in a large healthcare system,
• 9:39
  which most of them are now, right, is that is, is silos.
• 9:44
  And so the, you know, inpatient hospital-based,
• 9:48
  ed based case management and social work team is siloed from our outpatient
• 9:53
  teams. Um,
• 9:55
  and I think that that's something that programs under population health and
• 9:59
  we're just one of them.
• 10:00
  There are many other wonderful pop health programs at uva,
• 10:03
  but that's what they really are working against and to kind of, um,
• 10:08
  integrate across the continuum of care and to, uh,
• 10:12
  make it so that from the patient's perspective and to be very patient centered,
• 10:17
  uh, there it isn't siloed. It's all connected, it's all related.
• 10:22
  And so, um, our program, you know,
• 10:24
  doesn't matter where you are in the healthcare system or if you're at home,
• 10:28
  ideally we're still your team and that's something, you know,
• 10:32
  that we try to get across to our patients so that they know that it's not that,
• 10:36
  well if I'm, you know, in clinic, then I have this team. If I'm in the hospital,
• 10:40
  I have this team is really tear down those silos.
• 10:45
  Yeah. And I think that, um, there's another aspect in,
• 10:49
  in which our work kind of transcends the,
• 10:54
  the, the silo model, which is in, in looking at,
• 10:59
  at people, um, and, and meeting patients where they are,
• 11:03
  we have the flexibility to be,
• 11:06
  to address multiple things at once. In, in other words,
• 11:09
  they're not going to an appointment for a specific condition or,
• 11:14
  um, a a specific medication. They might be, um,
• 11:19
  they might be dealing with a whole host of problems and we can do
• 11:24
  in, in our touches, we are able to say, team up and,
• 11:29
  and go to a, a patient's home, um, together and,
• 11:34
  and deal with a, a range of issues, which I think makes them,
• 11:39
  oftentimes makes them feel a a lot more supported and, and,
• 11:44
  and that we can see the whole person and, and, and work to,
• 11:48
  to integrate all the, all these elements.
• 11:51
  Yeah, it makes a lot of sense to me personally. You know,
• 11:55
  a a bunch of different things can play into things like depression and,
• 11:58
  you know, the treatments, medication, talk, therapy, what have you. Um,
• 12:03
  you know, these things are great,
• 12:04
  but how much better are you going to get if you go home and you don't have food
• 12:08
  in the cupboard or, or you don't have a home to go to, you know?
• 12:12
  Right. Yeah. And even even navigating the,
• 12:17
  the healthcare system, I mean, for it, it,
• 12:20
  it helps that we often go to appointments with patients or we
• 12:24
  are helping them get to appointments and so forth. It, it takes a lot of the,
• 12:30
  the fear about, about the system and, and, and I think gives them,
• 12:35
  eventually gives them a, a sense of, of self-efficacy that they can,
• 12:40
  they can deal with a system on their own,
• 12:42
  but they usually need help in the, in the short term.
• 12:47
  I am a, uh, patient myself. I,
• 12:49
  I get behavioral health treatment and the system Yes,
• 12:53
  is dauntingly complex. Uh,
• 12:56
  and having someone to help me guide my way through it, uh,
• 13:01
  the initial time was very, very helpful. But Dr. Ententes,
• 13:05
  what role do you see technology playing here? How is technology helping you,
• 13:10
  you know, connect with clinics, primary care providers,
• 13:15
  medication assisted treatment facilities, health plan, care managers, you know,
• 13:19
  all, all of your partners in care?
• 13:22
  Yeah, great question. I'll give a couple of examples One way which, uh,
• 13:27
  you know, may be glaringly obvious three years into the pandemic,
• 13:31
  but is the wonders of virtual meetings, um, through things like, you know, zoom,
• 13:36
  WebEx, et cetera, and utilizing platforms that are secure. Um,
• 13:41
  I think back to our program's been in existence since 2018,
• 13:46
  and one of the really important things that we do is we pull together
• 13:50
  multidisciplinary team, uh,
• 13:53
  to sort of think about the patients that we enroll from all angles,
• 13:56
  whether that's the specialist involved in their care,
• 13:58
  their mental healthcare workers, social work,
• 14:01
  often the patient themselves and their loved ones.
• 14:04
  And we try to get all of those people to the table in a single meeting or more
• 14:09
  than one meeting to really, uh, brainstorm what,
• 14:13
  what better would look like in their care to talk about the elements that would
• 14:17
  go into that individualized care plan. Um, and, and pre covid,
• 14:21
  that was always an in-person meeting.
• 14:23
  We didn't have things like Zoom and WebEx or they existed,
• 14:25
  but I didn't use them. So we were reflecting even yesterday as a team,
• 14:29
  as we had one of these complex care meetings where we had our, um,
• 14:34
  local director of the rescue squad agency.
• 14:38
  We had a community health worker there to actually, uh, we had,
• 14:43
  um, you know, obstetrics physicians, er, I mean,
• 14:46
  we had this huge team of people that were we not utilizing
• 14:50
  technology, we wouldn't have all been able to be, you know,
• 14:53
  we're all in different places doing things in different spaces.
• 14:56
  So that's one of the biggest ways we use it honestly,
• 14:59
  is to coordinate complex care meetings and to be able to have those to wrap
• 15:03
  around our patients. The second example,
• 15:06
  of course I'll use is point click care and utilizing, um,
• 15:09
  the platform through which we share information through the health information
• 15:14
  exchange.
• 15:15
  We recently enrolled a patient who had had all of his care
• 15:19
  in West Virginia prior to very recently.
• 15:23
  And without the ability to go into that system and see what hospitals
• 15:28
  he'd been at and connect with those hospitals and get some records, uh,
• 15:32
  it would've taken us a lot longer to get up to speed in his care and to be able
• 15:36
  to help him and help move his plan of care forward.
• 15:40
  And I think we see u utilizing that a lot in our patients where it's
• 15:45
  helpful for us to be able to know what other healthcare systems they're
• 15:50
  touching and collaborate and coordinate with those, um, healthcare systems.
• 15:55
  It's also helpful for many of our patients who can show up to another
• 15:59
  emergency department and say, I have an individualized care plan.
• 16:04
  Um, can you please look for that?
• 16:07
  And they can mention Teresa's name and we can coordinate things electronically
• 16:11
  through that platform. And that's been, um,
• 16:14
  a real game changer for our program over the last few years.
• 16:17
  Seems like that could really speed things along process-wise.
• 16:22
  It is. One thing that, um,
• 16:23
  we do that's fairly novel with the Point Click care platform is that,
• 16:28
  um, Teresa actually gets real-time alerts. So she gets, uh,
• 16:33
  kind of a, you know,
• 16:34
  an email push notification whenever any patient enrolled in our program
• 16:39
  registers at an emergency department that's on that helpful information
• 16:43
  exchange. So it really does facilitate, uh, the ability to care,
• 16:48
  coordinate and manage and work with our patients in real time and know
• 16:53
  that they've, you know, entered another healthcare system.
• 16:56
  Absolutely. Um, well, guy, you are, you know,
• 17:00
  obviously you are a psychotherapist, uh,
• 17:03
  with the Medicine Home program we're talking about.
• 17:06
  What results are you seeing right now?
• 17:09
  I, I, I guess I would say we're not explicitly treating,
• 17:14
  um, patients for their, for their mental health, um, diagnoses.
• 17:19
  Um, other than, you know, maybe depression and,
• 17:23
  and anxiety in general. In general. Um, I think it's more,
• 17:28
  um, getting patients accustomed and,
• 17:32
  and maybe more comfortable or more reconciled to the,
• 17:37
  the complexities of their,
• 17:39
  of their physical conditions and to help them. I mean,
• 17:44
  behaviorally this means that they're gonna be,
• 17:47
  they're going to be better consumers of, of the medical, you know,
• 17:51
  medical system and, and, and learn how to use it to their advantage.
• 17:57
  Um, but I think, I think it's really, um, mostly,
• 18:02
  mostly just, uh, you know, getting them adjusted, um, to,
• 18:06
  you know, what they have to face with with their medical conditions. And I,
• 18:11
  but, but I do feel like, uh, you know, over a period of,
• 18:16
  of pretty intensive touches that, that our team makes with,
• 18:21
  with these patients,
• 18:23
  we get them more comfortable with dealing with the system and,
• 18:27
  and more confident and, and we eventually, you know,
• 18:31
  can kind of, I think, sort of launch them. Although I,
• 18:36
  we don't really have statistics for that. Um, but so,
• 18:40
  so I I think it's a little bit,
• 18:42
  a little bit amorphous how we're helping them. Um, it's not in,
• 18:47
  um, and, and our care plans apart from the, the,
• 18:52
  um, the cohort of our patients who are, who have addictions, um,
• 18:57
  and with, with those people, I would say, um, there, there is help.
• 19:02
  We, we have had a,
• 19:04
  a reasonable amount of success in getting people into, um, um,
• 19:09
  inpatient and outpatient substance abuse treatment more
• 19:14
  rapidly or more, um, efficiently than,
• 19:18
  than would've occurred without our, without our navigation. So,
• 19:24
  um, and, and that, that I think is, there's probably a direct, um,
• 19:29
  a more direct benefit of, of what we've done.
• 19:33
  Seems, uh, yeah, unequivocally beneficial. And so, but just so, so I, uh,
• 19:38
  making sure I'm understanding the successes that you, you are, you know,
• 19:42
  seeing efforts, you're,
• 19:43
  these are a lot of times in ways where the numbers are going to show up in a
• 19:48
  variety of, you know, other areas potentially. Is that fair to say?
• 19:53
  Yeah,
• 19:53
  I think that one of the real challenges of complex care programs is measurement
• 19:58
  and it's, it is hard,
• 20:01
  I think because it's a small population often,
• 20:06
  and they're very high needs and their needs are individualized.
• 20:10
  It's really hard to come up with the right metrics and outcomes.
• 20:14
  And so I do think that what, what I hear guy describing,
• 20:18
  which is hard to measure,
• 20:20
  is that we've seen with so many of our patients who feel
• 20:24
  very stigmatized,
• 20:26
  who are marginalized or often dealing with mental substance health use
• 20:30
  disorders, as well as homelessness or other housing instability,
• 20:35
  that they are so mistrustful of the healthcare system.
• 20:39
  They feel very stigmatized that their receptivity to
• 20:44
  recommended treatment plans or engaging at all is really low when we start
• 20:48
  working with them. And that over time, and it's gradual often,
• 20:53
  but over time,
• 20:54
  through that really high touch method that we've described with just
• 20:59
  lots of engagement, kind of doing what you say you're gonna do,
• 21:02
  showing that to the patient, committing to them,
• 21:06
  that they become kind of more receptive, more open, more trusting,
• 21:11
  and they start to engage more in their own care, um,
• 21:15
  that doesn't necessarily translate to me saying, you know,
• 21:18
  now 40% of our patients are compliant with mental health visits or
• 21:23
  on medication assisted therapy, right? So it doesn't easily translate to that.
• 21:29
  Um, but we do,
• 21:31
  I think we are the team that then the patient looks to as their ally
• 21:36
  and for many of these patients, they never had anything like that before. Um,
• 21:40
  but that's hard to measure.
• 21:42
  Helping people be more present and like more actively,
• 21:47
  uh, you know, involved in their, in their episode of care is,
• 21:51
  is really valuable I think. So whether, whether, um, you know,
• 21:54
  it shows up in numbers or not. Uh, well,
• 21:57
  any final parting thoughts here from any of our guests?
• 22:01
  Well, for my part, I'm really inspired by everything I've heard.
• 22:04
  I think there is kind of great opportunity here,
• 22:07
  but also some really good work that's already happening.
• 22:10
  So excited that people are ki sharing this in this format, and ideally speaking,
• 22:15
  we can get, uh, more, more people doing this. Thank you.
• 22:19
  Thank you, Larry. I have it. I want to, uh, thank you Dr.
• 22:24
  Zello as well as Dr. Fuentes and, uh,
• 22:27
  Teresa and Guy all for your time and the really,
• 22:31
  really great conversation we had today.
• 22:34
  Well, thank, thank you for having us.
• 22:36
  Thank you. Absolutely.
• 22:39
  And we also want to thank our podcast sponsor point,
• 22:42
  click Care for our audience.
• 22:44
  You can tune into more podcasts from Becker's Healthcare by visiting our podcast
• 22:49
  page at becker's podcasts.com.