Positioning Behavioral Health Services For Future Success Howard Gershon Steven Mirin MD
Learning Objectives Determine the impact of regulatory and clinical advances on the future delivery of behavioral health services. Discover how successful organizations are developing innovative responses to these changes. 2
Agenda A Challenging Landscape Implications Provider Opportunities Critical Success Factors 3
Challenging Landscape Mental health affects One out of every 5 hospital stays 9.4 million stays (2008) 6 of every 10 stays paid by Medicare/Medicaid 1 of every 10 stays uninsured Average length of stay is greater 4
Organizational Challenges Negative revenue from inpatient & ambulatory lack of highly reimbursed procedures poor payer mix disposition and LOS problems low RVU-based productivity Maximizing revenue per square foot Physician coverage stretched to the limit 5
ACEP Study: Psychiatric patients in ED 79% of total respondents 90% board weekly 60% stay over 4 hours after decision to admit 62% did not provide psych services in ED 85% said ED wait times would improve with better psychiatric services 6
Other Challenges Workforce shortages Limited expertise among PCPs Lack of financial incentives Patients perceptions and fears create barriers Co-morbidities of mental health disorders with physical illness and substance abuse Racial and ethnic disparities Healthcare system structure restricts integration 7
Current System Not Working Behavioral health patients admitted to Medical & Surgical units Mentally ill boarded in ED Increase of mentally ill in jails/prisons 8
Our ability to deliver care in the same model that we have today is going to be very tightly constrained if not impossible. ~ C. Martin Harris, MD, MBA CIO Cleveland Clinic 9
Reform Passes 10
Will Reform Help? Bundled payment/acos Consider behavioral health aspect of healing/health Treating whole person, prevention and early intervention Medical homes Emphasis on prevention, early treatment Coordinated care Increase need to integrate with primary care Reimbursement More coverage under reform initiatives Medicaid paying for IP, OP and other supportive services Parity laws could improve coverage 11
There s no part of American life right now that is more in need of imagination and new ideas than Healthcare. Colin Powell 12
Foundation for Redesigned Service System Person Centered Integration Individual Control Quality 13
Opportunities for Providers Expand the Continuum Engage in Neurosciences Embrace Technology 14
Behavioral Health Continuum 15
Inpatient Opportunities Gero-psych PTSD Dual Diagnosis Women s Programs Consultation & Liaison Service 16
Outpatient Opportunities Medication Management Individual Therapy Groups ECT 17
Crisis Services Emergency Services 23 Hour Observation Mobile Services Crisis Residential Telephone Support 18
Opportunities Expand the Continuum Engage in Neurosciences Embrace Technology 19
Engage in Neurosciences 20
Integrated Neurosciences Cross departmental programs (i.e. psychiatry, neurology, neurosurgery) organized around disease-focused specialties or patient populations: Dementias TBI/stroke Psychiatric disorders (depression, OCD, others?) Epilepsy Parkinson s, other movement disorders Multi-disciplinary, cross-departmental collaborations in care delivery (clinical assessment, acute interventions, care management) Participants share space, staff and technology Cross disciplinary initiatives in clinical and translational research and teaching 21
Opportunities Expand the Continuum Engage in Neurosciences Embrace Technology 22
Electronic Medical Records 23
Telemedicine 24
Embrace Technology Imaging Procedural interventions ECT Deep Brain Stimulation Transcranial Magnetic Stimulation Pharmacogenomics 25
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Characteristics of Successful Behavioral Health Systems 1. Continuum of care 2. Clinical services integration 3. Clinician organization integration 4. Primary care integration 5. Partnerships & affiliations 6. Market identity/image 7. Market development 27
Characteristics of Successful BHS Continuum of care Access to full continuum (beyond inpatient to include partial hospital, general and specialized ambulatory services, mobile crisis, ED and urgent care, ACT) No need to own them all. Some provided by community partners Key considerations include Consistency with organizational mission Organizational capabilities (clinical and administrative leadership, available time and resources) Anticipated financial performance 28
Characteristics of Successful BHS Clinical services integration Service line management structure that crosses departmental lines A unified model of care across practice sites and programs Inpatient and ambulatory integration including the ED Access to case management and other community services Focus on clinical process improvement patient-centered care Commitment to advancing quality and outcomes 29
Characteristics of Successful BHS Clinician organization integration Hospital- physician relationships come in many flavors- attending staff model, affiliated/contracted group practice, medical directorships, co management model, employed physicians As do strategies for aligning physician-hospital incentives joint contracting, pay for performance, risk sharing, gain sharing Key decisions include: Role of physicians and non-physicians in care delivery Physician deployment (across inpatient/ambulatory or in hospitalist model) Departmental vs. service line organization of care Role of physicians in site-specific, programmatic and system-level management 30
Characteristics of Successful BHS Primary care integration Co-location of behavioral health services and primary care inside the medical home Education and consultative support for primary care providers Behavioral health services integrated into routine care Easy access to generic and specialty behavioral health care outside the medical home when needed Protocols to guide referrals and clinical decision making Metrics to measure access to care, quality and clinical and financial outcomes 31
Characteristics of Successful BHS Partnerships & affiliations Hospitals/health systems cannot solve all of the behavioral health issues in their communities Partnerships with other organizations can include: Community Mental Health Organizations Clinician groups Residential providers County & state agencies Schools 32
Characteristics of Successful BHS Market identity/image Improve your market position and obtain more favorable contracts with payers and employers by: Improving customer service Providing centralized access Pursuing quality measures/ outcomes Developing other differentiators 33
Characteristics of Successful BHS Market development Continue to look for opportunities to expand markets and services. Expand geography through satellites Pursuing mergers/ acquisitions Contract management Assuming risk Developing niche programs 34
Behavioral Health Systems Benchmarks 0 5 10 Continuum of Care (# services offered) 0 3 5 Clinical Services Integration (# methods employed) 0 3 5 Clinical Organization/Integration (# models in use) 0 3 5 Primary Care Integration (# methods employed) Partnership & Affiliations (# partners) 0 5 10 0 3 5 Market Identity/Image (# approaches employed) 0 3 5 Market Development (# strategic initiatives) 35
We cannot solve the problems we have created with the same thinking that created them. Albert Einstein 36
Questions 37
Contact Steven Mirin, MD, Director Navigant Consulting Phone: 978 509 5407 steven.mirin@ navigantconsulting.com Howard Gershon, Principal New Heights Group, LLC Phone: 505 986 1570 howard@ reach-newheights.com 38