As the healthcare landscape moves to patient-centered models, it is imperative that whole-person care—which includes creating strategies for large populations of patients—be an integral part of behavioral health. However, creating population health strategies for the specialty has its challenges.
“Behavioral health organizations have traditionally operated as silos in specialty care,” says Cara English, director of the Doctor of Behavioral Health program for the Cummings Institute in Phoenix. “Behavioral health clinicians and clinician leaders will need to learn to speak the language of primary care and have a better understanding of chronic and acute medical conditions that can cause or exacerbate mental health conditions.”
Continuity of care between primary care providers and behavioral health providers continues to be a struggle, though technological advances aim to cure some of those issues.
“Care coordination is particularly difficult when patients need a referral outside the practice. The burden of coordinating follow-up and communicating treatment and discharge summaries is entirely placed upon the patient and the family for the most part,” English says. “Due to the stigma of seeking care, patients are unlikely to follow up on a behavioral health referral outside the primary care practice.”
Though challenges arise, it is essential that behavioral health providers create population health strategies to increase patient engagement and eventually cut healthcare costs.
“Population health models that address both clinical issues and barriers to self-care are showing success in lowering costs and improving the health of patients,” says Jordan Asher, MD, MS, chief clinical officer for Nashville, Tenn.-based MissionPoint Health Partners. “The true challenge is enabling the paradigm shift of how the present healthcare environment thinks about working with patients.”
Partnerships that increase engagement
Population health is viewed by many as a strategy for primary care providers, but behavioral healthcare plays an intricate part. Often chronic health conditions co-occur or can lead to substance abuse or mental health issues, and working with primary care is important to create a complete picture of patients, says Asher.
“We find that we have to address a patient’s anxiety and depression before we can expect them to actively engage in activities to better manage a chronic disease like diabetes or congestive heart failure,” Asher says. “Unless a patient is in a medical crisis, we think about the behavioral dynamics as first order and clinical issues as a very close second order, which is often 180 degrees different than a traditional disease-based model.”
Partnering with primary care providers to develop screenings and tests for a more integrated health experience is one way to destigmatize behavioral health, English says.
“Due to the stigma of seeking care, patients are unlikely to follow up on a behavioral health referral outside the primary care practice,” English says. “They are much more likely to present to their primary care provider with behavioral health symptoms and want to have care for that condition delivered by that same doctor that they trust. Unfortunately, primary care providers lack the training, tools and expertise necessary to address these issues, and few primary care practices hire behavioral health providers to consult with patients. Initiating new relationships with providers can be difficult for patients with depression, anxiety or serious mental illness.”
Creating partnerships with organizations outside of healthcare is essential to affecting change across populations, says Beth Lonergan, director of behavioral health services for the University of Wisconsin Hospitals and Clinics (UW Health) in Madison, Wisc. She adds that building relationships with schools, community-based organizations and faith-based organizations are ways to meet patients in a comfortable environment and explain how behavioral health services integrate into overall health.
“World Mental Health Day, on October 10, is a great opportunity to build capacity and awareness of behavioral health services in a community. Anti-stigma campaigns can normalize behavioral health issues, which helps get patients through the doors,” Lonergan says. “It is also important in building relationships with teachers, clergy and those on the ground level who can learn how to identify issues and get people help.”
Outreach can also extend beyond community organizations. With the rise of opioid misuse and other substance abuse crises, it is important to partner with local government agencies to be a part of strategies that include law enforcement and the judicial system.
“At UW, we have efforts to create county health ratings and develop strategies to improve health. We also evaluate how our organization can support existing efforts in law enforcement, social services and schools,” Lonergan says.
Technology barriers and solutions
Interoperability issues between clinical and behavioral healthcare systems limit the care coordination that is necessary to make effective changes to population health, English says.