Healthcare spending is skyrocketing in America, reaching a whopping $3.5 trillion in 2017 and projected to rise another 5.5 percent annually over the next decade. As the industry seeks to contain these costs, providers are shifting their focus from the quantity to the quality of care they deliver – and that’s where value-based care comes in.
In contrast to the traditional fee-for-service model, the value-based approach rewards providers for efficiency, as well as patient health outcomes. Reducing expensive – and sometimes avoidable – acute care episodes is integral to the success of this approach, which is why mental health is an important part of value-based care. By identifying and resolving behavioral health issues earlier, healthcare organizations can keep patients healthier – a win-win for patients and providers.
In our ongoing Sector Spotlight series, we focus on how telepsychiatry can help value-based care providers access mental health services that benefit their patients and their bottom lines.
Why is mental health care integral to the value-based care approach?
The value-based care model focuses on preventative care that treats the whole patient, and mental health is key in that equation. One in five Americans experience a mental illness annually, according to the National Alliance on Mental Illness (NAMI). Having the clinical resources necessary to recognize and treat symptoms early reduces complications for the patient while also reducing healthcare costs over time.
Oak Street Health is one example of how the right approach to mental health can help organizations meet the triple aim of value-based care: high quality care, better population health and lower costs. The value-based provider operates under a globally capitated model, which means it assumes the financial risk for each patient. With one-third of its patients experiencing a mental illness, bringing telepsychiatry into the fold made perfect medical and financial sense for Oak Street Health. Being able to treat a mental health diagnosis upstream can help avoid a larger, potentially more troubling set of symptoms later on, reducing costs for Oak Street and improving outcomes for patients. When fully integrated into a healthcare facility, research shows that the return on investment of providing mental health services is 6:1 -- meaning that for every $1 spent in behavioral health care, there’s a $6 benefit by reducing future medical costs.
“Behavioral health was our first, most expansive outside specialty,” says Katherine Suberlak, Oak Street Health’s vice president of population health. “It was a perfect fit because not only was it the right thing to do for patients, who have a high need, but also because it ensures a high quality of care of our patients, and there’s strong evidence that it reduces costs over time.”
How is telepsychiatry helping value-based care providers care for patients more effectively?
Nearly 60 percent of the 43.8 million American adults who experience mental illness each year did not receive treatment last year. Many of these Americans are living in rural areas and remote correctional facilities, where access to mental health services are difficult to access because of proximity and convenience. Telepsychiatry brings the behavioral health specialist to the population in need while helping facilities make the most of their resources. For example, Oak Street Health has two Regroup telepsychiatrists serving 17 sites across Illinois and Indiana – an area two on-site psychiatrists would never be able to cover.
Stigma or the hassle of travel can also deter many patients from making the trip to see a behavioral health specialist. When integrated into their primary care facility, patients just make a trip to their regular doctor, encouraging more of them to receive the specialized care they need.
For Oak Street Health, an integrated approach to telepsychiatry has helped lead to measurable improvements in outcomes and cost efficiencies. The organization employs an on-site integrated behavioral health specialist at each location, who works with the teleclinician and primary care providers to develop patient-specific care plans. In one instance, a patient returned to an Oak Street Health facility after being hospitalized because he had not taken his anti-psychotic medicine. The primary care physician was prepared to send them back to the hospital, but the behavioral health specialist recognized that a hospital readmission wouldn’t help the patient, since the issue was with medication adherence. The specialist connected the patient with the telepsychiatrist, who helped identify the patient’s fear of the medication and coached him through taking the first dose successfully.
“We’re not looking to avoid hospital admissions at all costs, but we know a majority of ER visits for mental health patients don’t produce the best results,” Suberlak says. “Avoiding one hospitalization results in $1,500 savings. Imagine what could happen if we replicated those results with many patients over time?”
3 keys for a successful telepsychiatry implementation
• Get the technology right. Bandwidth issues, spotty audio, and other technological hiccups can derail an otherwise successful and positive experience for the patient.
• Commit to continuous improvement. In this rapidly evolving field, organizations should continually monitor and update practices as needed for the best results. For example, adopting e-prescribing has helped Oak Street Health streamline the prescribing process for the facility, the psychiatrist and the patient.
• Team-based care. Oak Street Health has 20-minute daily huddles with its Regroup telepsychiatrists and on-site providers. These check-ins allow the clinical team to discuss best practices and develop care plans for each patient, so that all parties can provide the most efficient and effective care every single day.
To learn more about how telepsychiatry is helping Oak Street Health deliver value to its patients and organization, read our case study.