Commentary: I recently led an effort to organize four health systems into one Accountable Care Organization collaborative with the ambitious goal of delivering value-based care to approximately 80 percent of the population in Vermont, New Hampshire and Maine. As is common in other ACOs, we relied on some of the most advanced tools and analytics I’ve seen in my career to stratify populations, track outcomes and improve care coordination.
From our initial efforts, I eventually realized that the historical divide between the physical and behavioral healthcare delivery systems results in siloed and suboptimal care, and that was a leading contributor to poor outcomes. This suboptimal care contributes to a much higher incidence of physical health conditions, and vice versa, and the compounding effect is astronomical.
We find that that 20 percent of the population has a diagnosed or undiagnosed behavioral health condition and account for more than 55 percent of total medical costs. Those who have a chronic physical health and behavioral health condition have total costs that are two to three times for those who have physical health conditions alone. Importantly, this finding crosses all physical health conditions.
To make quality-driven, value-based care a reality, providers must be better equipped to treat behavioral health conditions in concert with physical conditions, and collaborate with one another to treat the whole person. We must apply the same amount of analytical rigor that has become the rule in other areas of healthcare to the often overlooked but critically important area of behavioral health. And we need analytically-driven technology to truly cross the physical health-behavioral health divide.
Our data suggests that of the 20 percent of the population with a behavioral health condition, 7 percent of patients treated by primary care providers have an underlying behavioral health condition that is the “disguised” reason patients are seeking care in the first place. Patients whose mental health or substance use disorder has not been diagnosed often have clear patterns that indicate an underlying behavioral health issue is present. They get care for their many general medical symptoms--such as chest pain, palpitations, headache, and abdominal pain--but not for their underlying behavioral health issue that is driving these visits.
Despite the growing recognition that mental healthcare data is a necessary piece of the population health puzzle, most organizations lack the infrastructure and information exchange capabilities between primary and behavioral health providers to makes this collaboration possible. It’s no secret that the industry as a whole has struggled to interoperate, but beyond that, behavioral healthcare hasn’t been offered incentives to adopt electronic health records technology the way other specialties have.
CMS’ recently proposed rule is a step in the right direction, as is the ONC’s recognition that both public and private stakeholders need to step up their interoperability games. But proposed rules and roadmaps do not fix the mounting cost and quality issues that need a technology intervention and data fix now.
In addition to the push to include behavioral health providers in CMS’ Incentives Program, federal attention also is being paid to digitizing behavioral health information. ONC and SAMHSA are both advocating for the industry to leverage new technologies and integrate behavioral health data into electronic records, either by providing legal protections to this information or updating the rules to better accommodate the legacy technology. This information is necessary to ensure providers are treating the whole patient and can employ an all-encompassing population health management strategy.
With our sophisticated analytics capabilities, we can uncover the patterns that alert providers to the presence of behavioral health issues, and match patients with the right behavioral healthcare they need, whether that is a face-to-face visit with a behavioral health provider, a telephonic visit, computer-based therapy, or virtual peer support.
At the end of the day, we need to give patients and their providers the infrastructure to collaborate, the tools to scale themselves, and the data to optimize care and improve quality. Each of these elements is necessary for population health management in today’s digital health environment, but none will make a dent unless behavioral health is brought to the forefront.
Dr. Wennberg leads Data Science and Analytics for Quartet Health, a health technology company in New York that helps providers and patients better understand and care for behavioral health illnesses.
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