Addressing the Behavioral Health Crisis During a Pandemic and Beyond

Even before COVID-19, behavioral health demands were crippling the U.S. health system. Now, with the world gripped by a global pandemic, the demand has grown even more dire. In fact, recent research from Well Being Trust, a national foundation focused on mental, social, and spiritual well being, indicates that up to 75,000 people will die from suicide and substance misuse over the next nine years. It’s been given a name…“Despair death.” Part of the collateral damage of COVID-19.

Between the opioid crisis and now the looming forecast of increased deaths of despair, the reality that behavioral health is an ‘every person’ disease has never been more clear. Unfortunately, so is the deep chasm that exists between our medical and behavioral health providers. This moment in time offers us a unique opportunity to make significant advancements toward closing that gap and accelerating access to appropriate care for those in need of behavioral health services. 

But how ‘doable’ is this? Closing a chasm that’s been in existence for over 50 years in the middle of an unprecedented global pandemic seems a bit unrealistic. There’s no question that an “all hands on deck” approach to the pandemic is in order, but couldn’t this also be the best time for forging new strategies and partnerships? 

Reduce ED Boarding and No Show Rates

Now more than ever our healthcare system is being reminded of the need for a team approach to care. With many of our hospitals operating at max capacity with COVID-19 patients, we simply can’t continue the practice of ‘boarding’ behavioral health consumers in the Emergency Department (ED). Currently, ED boarding ranges 6-8 days on average, taking up as much as 25% of hospital bed capacity. And with increasing behavioral health care demands, our outpatient behavioral health specialists can’t be wasting time weeding through misplaced or inappropriate referrals. Our behavioral health specialists, and most importantly, our behavioral health consumers both deserve better.

What does a team approach to behavioral health care look like? Imagine a person walking into an Emergency Room or any clinic whether it be a primary, specialty or behavioral health clinic and the staff is immediately able to assess and treat or assess and make a warm handoff to a clinician who’s 1) already committed availability based on need and 2) the right fit for that person. That’s the beauty of a community-wide network of behavioral health and substance use disorder providers. Whether the individual has a behavioral health issue or a medical issue, the team works to ensure the right care occurs in the right location when it’s needed. The consumer doesn’t have to wait for an appointment. Nor, tell his or her story over and over to numerous different providers in a quest to find a provider with the right skills to treat that individual. Behavioral health ambulatory providers significantly reduce their ‘no show’ rates and avoid wasting time on evaluations that aren’t the right fit for their service. And hospitals reduce ED boarding and avoidable bed days. It’s a triple win for everyone involved.

Building a High Value Behavioral Health and Substance Use Disorder Network

So how does one begin the process of forging new partnerships? My answer is simply ‘raise your hand.’ Having worked for a number of years helping to launch and support self-governed, high performing networks, I can honestly say that all it takes to get started is one person. One provider to get involved and say, “I’d like to champion this. I’d like to be the founder of a network.” Then, choose three to four like minded providers who are willing to stand beside you as the nexus of a network covering all aspects of care for behavioral health and substance use disorders. 

From there, I recommend engaging a consulting firm that has deep roots in both the medical and behavioral health delivery systems combined with experience in network management. Ideally, the firm will be able to provide your network with the following three key assets:

1. Expertise in value-based performance networks. This is perhaps the most important qualification when selecting a consultant. Your ultimate goal is to build a cohesive network with executive level and clinical level partnerships with both the hospital and primary care community. These relationships are critical to success in entering into a pay-for-performance contract where you can participate in shared savings.
   
2. A technical infrastructure that complements the existing operational systems (or lack thereof) of you and your network members. Make sure the consultant has both a clinical and technical understanding of what is needed to support the operational processes and workflows of the network. Being able to measure your processes, procedures, and outcomes in real time is vital for your success.
3. A portfolio of successfully launched networks. Ask to see the data. On the behavioral health provider side, you’re looking for metrics specific to no show rates and appointment wait times. On the hospital side, you want to see a reduction in avoidable bed days and hospitalizations, average length of stay (ALOS), and behavioral readmissions. You’ll also want to take a look at total cost of care savings. 
   

Our team is currently partnering with behavioral health providers across the country who are interested in forming a behavioral health network with their local health system or Accountable Care Organization (ACO). If you’re interested in launching a behavioral health and substance use disorder network in your area, email me at jfrancis@infinaconnect.com, and let’s schedule a time to talk.