1. Transforming Behavioral Healthcare

2. 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

3. 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)

4. 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

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

6. 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.

7. 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

8. 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

9. 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

10. 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)

11. 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?