Meeting the Needs of Complex Patient Populations Through Care Collaboration

On June 2, 2020, Deborah Jean Parsons, Ph.D., Director of Integrated Care at Aspire Health Alliance and Brian Patel, M.D., F.A.C.E.P, Chief of Emergency Medicine at Sturdy Memorial Hospital presented a HealthLeaders webinar on making the critical connections needed to support complex and vulnerable patients. While you can watch the recording here, below you’ll find a summary of the conversation.

The State of Behavioral Health & Key Problems

Parsons discussed five major problems surrounding mental and behavioral health:

1. While mental health conditions and substance use disorders (SUD) are common, most people don’t receive the care they need
2. Inadequate collaboration between behavioral health and primary care
3. Behavioral health disorders are the main driver of overall healthcare costs
4. Behavioral health disorders are associated with higher rates of emergency department (ED) visits and hospitalization
5. Individuals with behavioral health disorders die 20-25 years earlier due to untreated physical illness

Parsons went on to share how these challenges have been exacerbated by the COVID-19 pandemic. One Kaiser poll reports that the mental health of 45 percent of US adults has been negatively impacted by COVID-19.

The Role of the Emergency Department

Patel discussed the role of the ED in addressing the behavioral health shortage, particularly the last of resources at Sturdy Memorial Hospital where 5 percent of all ED patients are seen for behavioral health concerns. He shared that of these, 50 percent require inpatient psychiatric care and 60 percent of those board in the ED for an average of 55 hours while waiting for placement at an inpatient facility.

Additionally, the pandemic has further complicated care as fewer beds are available, community resources are shut down or limited, and some physiatric hospitals are unable to accept new patients due to concerns surrounding the spread of COVID. Sturdy Memorial is anticipating and preparing for an even greater number of patients with behavioral health needs as we move to a post-pandemic world.

Patel shared four issues that fuel recurrent ED utilization:

1. Lack of outpatient resources to get routine evaluations and mediation management
2. Poor compliance among patients
3. Lack of transportation to get to outpatient appointments
4. Financial challenges that prevent access to outpatient care

Sturdy Memorial tackled the problem by assigning each patient with patterns of high utilization to a care coordinator who could help that patient schedule appointments, assist with transportation, help navigate insurance complexities, and serve as a point of contact before patients go to the ED. This helps break a cycle of a patient presenting to the ED, being seen by a clinician, discharged home with a concrete plan which can lead to patients not getting proper follow-up care, and ultimately end up in the ED because they had no one to go to or call.

Bridging the Gap from the ED to the Outpatient Setting

Parsons discussed the importance of having community partners to help bridge the gaps between EDs, behavioral health, and primary care. Community partners are experts in serving people with complex behavioral health and social needs and can provide care coordination to the most complex patient populations.

Parsons shared six key community partner program elements

1. Integration of medical, mental health, and social needs into one person-centered treatment plan
2. A strength-based, holistic perspective of a patient
3. Working directly medical providers and hospitals and ensuring that primary care providers are involved 
4. Team approach led by licensed clinicians, registered nurses, and care coordinators
5. Collaboration with care team members and providers across healthcare spectrum
6. Prioritizing the voice and choice of members in all healthcare decisions

Using real-time notifications, Aspire care coordinators can meet patients where they are and engage them. Patients are often more open to working with care coordinators when they’re met in the ED during an acute crisis. They’re also more likely to call the care coordinator first the next time they’re in crisis. By meeting patients where they’re at, Aspire has seen a significant increase in primary care appointments, patients actively seeking community resources, engagement rates, and in completed care plans.

Ultimately, prevention is the best and most cost effective medicine. By understanding behavioral health challenges, involving every member from the patient’s care team, and bridging the gap between acute and outpatient settings, providers can help complex patients achieve better health outcomes.