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Why Behavioral Health Drives Population Health Strategies at City Block, Boston Medical Center, Eleanor Health

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In the wake of the pandemic, there has been a renewed interest in behavioral health by public health agencies and the medical community at large.

Historically, behavioral health has been a side note in population health strategies. But the new focus on integrated and holistic care, along with the development of data collection capabilities, could push behavioral health to become a larger part of population health strategies in the future.

Population health differs from traditional care because it focuses on large groups of people rather than individual interactions with the patient.

“In Substance Use Disorder (SUD) … we think about someone becoming clean or abstaining,” Corbin Petro, CEO of Eleanor Health, told Behavioral Health Business. “At the time when we should really be thinking about how we can make this whole number better than it was last year. How do we move them along the chain? Because otherwise you’re going to hit the cherry pick.”

Eleanor Health is a dedicated mental health and addiction care provider built on population health deployments and value-based payment models. It has approximately $82 million in funding.

Incorporating behavioral health into a population health strategy may also make financial sense. Although behavioral health accounts for only about 5% of total health care spending in the United States, 45% of costs are driven by behavioral health, Pietro noted.

“The population health strategy has to include addressing behavioral health because you will see the effects across the population in other areas where you are kind of setting the right amount of spending,” Petro said. “So I think it has to be a part of — and for many populations, it has to be the main intervention and the main relationship.”

Supporting a behavioral health strategy

The “data revolution” of the twenty-first century has brought new insights into healthcare. Analytics now allow stakeholders to pull health and outcome data from specific population groups.

These insights can help providers identify pain points for a particular demographic.

“I am forever grateful to our intelligent analytics team that is pulling those really big pictures somewhere,” Deborah R. Goldfarb, MD, director of behavioral health at Boston Medical Center (BMC), told BHB. “He. She [helps] Someone like me, who at the end of the day is a doctor, drives the strategy. We look at psychiatric inpatient readmission rates, and [if] We have a subset of people who have fast readmissions. What resources can we provide for this subgroup? “

Boston Medical Center is a 514-bed academic medical center. The health system reports that about 75% of its patients come from underprivileged populations. It is part of the Boston Responsible Care organizations and provides care for MassHealth patients.

These resources also help providers understand the needs and preferences of a particular group of patients.

“If we’re running a population, which we do in our business, or we’re tasking the population with payers, we first get all the data that we can really understand who we’re managing and how we’re dealing with the health care system,” Petro said.

BMC used its analyzes to identify populations at risk. Having done this, it then connects individuals in that population with relevant services.

“We are able to quantify the risks and then provide more targeted resources to people with higher risks,” Goldfarb said. “The intensive care management program is offered to our patients who have the highest risk. There, we bring together behavioral health professionals, usually the social worker, community nurses, health workers, all of whom work together on a team.”

Analyzes have come a long way in the past decade, but behavioral health providers are known to be behind physical health providers in implementing electronic health records (EHRs). In fact, only 6% of behavioral health providers have electronic health records.

Sometimes this can be an obstacle to behavioral health which plays a leading role in population health management strategies.

“It has been a major issue — and remains… a major issue — especially from quality improvement and some kind of quality control attitude,” Jonathan Portel, associate professor and director of policy research at New York University’s School of Global Public Health, told BHB.

The physical, mental and societal needs of the population

Many providers and agencies are beginning to look at population health from a holistic perspective.

This means addressing a population’s physical health, behavioral health and social determinants of health (SDoH) simultaneously.

“I think there is a desire to achieve behavioral health [into population health], but because our system is so fragmented historically—medicine is different from behaviors, behavior is often different from substance use disorder—it’s very difficult to bring them all together,” Dr. Michael Tang, Chief Behavioral Health at Cityblock, told BHB. We have integrated medical, behavioral and substance abuse contracts. So we have it all together from a financial perspective, so we can think of the individual as a whole person.”

Social determinants of health, which include economic stability, housing, education, food security, and other factors, can affect the behavioral health of a population.

“What are those non-clinical things that really affect the behavioral health of individuals? For us, that focuses on the social determinants of health,” Goldfarb said. I call it more social factors of behavioral health. We spent a lot of time and resources at BMC on this piece, understanding things like housing and transportation, food insecurity, and possibly getting involved in the criminal legal system, education and employment. This really affects behavioral health outcomes.”

BMC has internal and external resources to help patients address SDoH.

For example, a health system has its own pantry and community garden. She has also forged partnerships with community resource centers where she can then mentor her patients.

Front door “right”

Often, primary care physicians act as the front gateway to health care. This means that in the future, primary care can be tasked with testing and measuring the mental health, as well as the physical health of the population.

“If we are going to hang our hat on primary care in this country as a mechanism for achieving health outcomes, primary care needs to be held to screen, manage and get people to the right places,” Petro said. “Some people won’t get that in primary care. And that begs the question, ‘Is this the right relationship for every type of patient?”

Although primary care can be an entry point into behavioral health services, it may not be the right course for all categories of patients. BMC is looking to treat SUD patients in the community.

For example, the provider has placed some of the less obstructive addiction treatment centers near the shelter system. It also provides behavioral health services in community health centers.

“The idea is to create endless doors to be able to access services. For some people, going to primary care makes a lot of sense,” Goldfarb said. “But some people do not participate in primary care or do not want to engage in primary care.”

No matter the front door, relationships are key.

“I think it’s really important to think about different groups and different segments of the population and who they have a relationship to within the healthcare ecosystem,” Petro said. Then derive the value from that relationship. A low-income Medicaid member who is not inhabited may gain the most value from a community health factor.”

Schools offer many of these relationships to their children’s population.

In July, the Biden administration pledged nearly $300 million to expand mental health services in schools. Specifically, the funding will go toward strengthening the school’s mental health provider pipeline and providing more behavioral health services at the school.

“Schools are the primary source of mental health services for children,” Portel said. Schools are often referred to as the de facto mental health system for children, but this makes them the pinnacle of the children’s mental health system. I think we need to make sure that schools have the resources to deal with this appropriately. It’s serious stuff, and schools have a lot on their plate. I think if there is policy action around getting schools to address behavioral health more, we need to make sure there are resources, training, support, and people dedicated to that so it can be done well.”

The role of public health authorities

Traditionally, federal and local public health agencies have had a large role in caring for the health of the population. But the bulk of these efforts fall under physical health.

“Inside the government in the country [and] At the local level, often not always, there is another public entity responsible for behavioral health.” “But these behavioral health agencies generally really focus on providing clinical services, clinical services usually for people with really severe needs, which is critical, And their work is very important. But no one really thinks so much about prevention, or really has the bandwidth to think about prevention in a population-dependent way.”

Partnerships between public health agencies and behavioral health stakeholders can be key to making behavioral health a part of population health.

“I also think that public health departments that are used to thinking … about populations rather than individuals can help behavioral health agencies that are used to thinking a lot in terms of individual clinical encounters, because that is how they are usually funded, through Medicaid and reimbursement existing systems. I think there is a lot of room for partnership out there.”

The federal government has begun taking steps to integrate behavioral health into public health.

For example, the federal government has introduced the 988 Crisis Response Line. In addition, the Biden administration has pledged $700 million in fiscal year 2023 to staff local crisis centers.

“988, I think, is kind of indicative of a more paradigm shift toward valence and behavioral health raising as something that is really taken up as a focal point as being primary rather than secondary,” Purtle noted.