Mike Hogan, former Mental Health Commissioner of New York, predicts that in 45 years, distinct public mental health systems with state-operated and state-funded specialty services will no longer exist in their current form. He says, “Almost all the new service models unleashed by the Affordable Care Act — from Medicaid health homes to accountable care organizations (ACOs) to patient-centered medical homes — cannot succeed without integrating behavioral and general medical care…Yet the mainstream is not prepared. They need our help.”
Being part of the mainstream will mean offering all health care anywhere and anytime the customer needs it. How often have you wished you could just text or email your doctor for a quick consultation? Imagine the savings, and the convenience for all.
Community behavioral health organizations have led the way by pursuing all avenues for integrated care delivery — thoughtful engineering of staff roles, intensive community outreach, exploration of public and private and funding options, and creative collaborations and partnerships.
If we consider where “the mainstream needs our help,” behavioral health offers three distinct advantages.
First, we know more about person-centered care and patient engagement. Behavioral health providers spend more time with each patient than primary care providers, building relationships, nurturing trust, and helping them navigate life in the community. We build customized, long-term treatment plans with patients based on their preferences and with the involvement of family and caregivers. We’ve modeled care that extends beyond clinic walls, into the community and into people’s lives (such as assertive community treatment).
Second, we know that partnerships and collaborations are crucial to success. To factor in all the social determinants of health, behavioral health providers collaborate with a range of community institutions and systems — criminal justice, hospitals, schools, faith communities, homeless shelters, supported housing and employment, veterans services, child welfare, and more.
Third, the roles and responsibilities of community behavioral health staff have primed them for population health management. Care managers are in demand in the world of population health, and they’re really just taking on existing case management skills and integrating them with health care. They’re becoming experts in health behavior change and building relationships.
However, we are not lacking in areas for improvement. If behavioral health organizations want to be effective in population health management, we must focus on building strengths that have traditionally not been high on our priority list. Here are three ways we can do better.
First, we need to focus on public education and on prevention/early intervention. We need literacy and early intervention programs like Mental Health First Aid to touch every community, every home, every school, and every corporation in America. And we need the spread of initiatives like the Felton Institute’s Prevention and Recovery in Early Psychosis program, where early intervention and targeted treatment for schizophrenia achieve dramatic results — more than half of people in the program are employed or in school by the sixth month of treatment.
Second, we must embrace measure-based care. Henry Chung, the chief medical officer at Montefiore notes, “There’s too much treatment inertia in all of healthcare. We keep doing the same thing over and over again. When we don’t measure, how can we tell if we’re really helping the patient or not? We must have goals, and when we don’t meet them, we must look at what else we can do.”
Third, we must capitalize on the power of technology to extend the reach of staff, empower self-management, and offer the customer centric experience technology can deliver. Consider for instance the Health Buddy — a simple clock radio-sized device designed to help individuals manage their physical and mental health needs on a daily basis in the comfort of their homes.
We’re driven by the desire — and need — for one-stop care, instant access, informed choices, reasonable prices, good quality, and discernible results. Chris Murphy, editor of InformationWeek, argues that health care providers should benchmark their online engagement against other industries. He quips, “How come a retailer such as Amazon or Apple can remember I bought an Ace of Base recording the last time I visited, but the people who help keep me alive or healthy have to ask about my allergies every time I show up at the doctor’s office? Why can I book a flight, hotel and car from three different companies on one website but not schedule doctor appointments online and see all of my upcoming medical visits in one place?”
Behavioral health can lead the way in population health management if we think from the outside in. If we commit to building the Amazon Prime experience for the millions of people who depend on us for better health and better lives.
