Transforming Behavioral Healthcare

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Presentation transcript:

Transforming Behavioral Healthcare

the most disabling disorder before age 50 11.4 M Americans 35% did not receive mental health services in past 12 months Medicaid FY17 spent $576B with $282B spent in State managed care 20% of Medicaid beneficiaries have a BH diagnosis and 50% of the expense

poor outcomes driven by lack of measurement RELAPSE RATE Lack of outpatient care and follow-up places burden of care on patient leading to over utilization of urgent care and hospitalization (Olfson et al, Arch Gen Psych, 2012) COMORBIDITY COST Lack of objective diagnostic measurement leads to inadequate treatment of mental illness and increases cost of managing medical condition (Hogan, Psych Serv 2003) FAILURE TO DIAGNOSE Lack of detection in high-risk groups leads to failure to treat with long-term disability (Addington et al, Psych Serv 2016)

digital phenotyping a new kind of biomarker RAW FEATURES DIGITAL BIOMARKERS Machine Learning Pattern Identification Feature Extraction DIGITAL PHENOTYPE Passive, objective, continuous assessment of mood and cognition Signatures for prediction and preemption

tracking brain health in a 48 year old woman under care for bipolar disorder with psychosis

detecting deterioration to prevent crisis I'm doing a lot better. I was experiencing a lot of auditory hallucinations. They made it difficult to sleep which made things progressively worse. I checked myself into the hospital. They adjusted my medications, gave group therapy, and monitored me. I believe I slept for 12 hours each night 3 days in a row. What a relief! The hallucinations finally subsided.

crisis services continuum Outpatient Provider Family & Community Support Crisis Telephone Line Peer Support Mobile Crisis Team Walk-In Clinic Hospital Emergency Dept. Crisis care is an expensive way to deliver care It does not support recovery goals and community tenure The long-term outcomes tend to be poor Crisis Services Continuum Crisis Planning Detox Intensive Outpatient Prog Hospitalization Crisis care is focused on respond-and-stabilize

FURTHER DETERIORATION crisis prevention services what if we could detect deterioration before it became a crisis? DETERIORATION DETECTION ESCALATION & INTERVENTION IMPROVEMENT CRISIS RESPONSE BH VISIT OR TELEPSYCHIATRY FURTHER DETERIORATION

why it works Integrated care delivery is essential in reducing crises in SMI and SED Today’s models coordinate provider workflows that are health-system centric and an obstacle to accessing care Early access to integrated services can reduce symptom burden, avert crises and to safely navigate patients to appropriate county services Coordinated Care Co-Located Care Integrated Care We bring integrated care to the patients, in their journey, where and when they need it

Mindstrong continuum of care integration Bridge care between clinic visits, move integrated care to where patients live Between Visits CARE PLAN ADHERENCE 24x7 CARE TEAM ACCESS PROMOTIONG RECOVERY GOALS Care Collaboration Care transitions are vulnerable times for patients and anxious times for providers Care Transitions SAFELY NAVIGATE TRANSITION MEET HEDIS MEASURES ACCESS AND MONITORING EARLY DETECTION Bring medical/behavioral care to the patient, in their journey, when and where they need it “CARE IN PLACE” CLOSE GAPS IN CARE CARE PLAN ALIGNMENT WITH PCP CARE PLAN ALIGNMENT WITH BH (where there is established care)

MEDICARE ADVANTAGE PATIENTS passive detection of clinical severity show results comparable to clinical assessment MEDICARE ADVANTAGE PATIENTS Age (mean ± std) 50 ± 11 years Age range 29 – 79 years M : F 16 : 45 MDD : BP : SCZ 30 : 26 : 5 Rural : Urban 46 : 15 2018 ER visits per patient 3.1 2018 IP admits per patient 0.8 A psychiatrist in your pocket Will digital phenotyping lead to better health outcomes?