After the pandemic, there has been a renewed interest in behavioral health from public health agencies and the medical community at large.
Historically, behavioral health has been a side note in population health strategies. But a new emphasis on comprehensive, holistic care, coupled with advanced data collection capabilities, could push behavioral health to be a more important part of population health strategies in the future.
Population health differs from traditional care because it focuses on large groups of people rather than one-on-one interactions with patients.
“In substance use disorder (SUD), … we think of someone who is clean or abstains,” Corbin Petro, CEO of Eleanor Health, told Behavioral Health Business. “When really we should be thinking about how do we make this entire population better than last year. How do we move them along the continuum? Because otherwise you will find yourself with the selection of cherries “.
Eleanor Health is a mental health and addiction care provider built around implementing population health and value-based payment models. has more or less $82 million in financing.
Integrating behavioral health into a population health strategy might also make financial sense. Although behavioral health only accounts for about 5% of total health care spending in the US, 45% of costs come from behavioral health, Petro noted.
“A population health strategy needs to include addressing behavioral health because you will see the impacts on populations in other areas where you are right-sizing spending,” Petro said. “So I think it has to be a part, and for many populations, it should be the leading intervention and the leading relationship.”
Driving a behavioral health strategy
The “data revolution” of the 21st century has brought new insights into healthcare. Analytics now allow stakeholders to extract health data and outcomes from specific populations.
These insights can help providers identify pain points in a given population.
“I am eternally grateful for our really smart analytics team that brings those really big views together in one place,” Deborah R Goldfarb, director of behavioral health at Boston Medical Center (BMC), told BHB. “It’s [helps] someone like me, who at the end of the day is a clinician, drives the strategy. We looked at the readmission rates of psychiatric inpatients and [if] we have a subset of people who have rapid readmissions. What resources can we provide to that subgroup?”
boston medical center it is an academic medical center with 514 beds. The health system reports that about 75% of its patients come from underserved populations. It is part of the Boston Accountable Care Organizations and provides care to MassHealth patients.
These resources also help providers better understand the needs and preferences of a specific patient population.
“If we are managing a population, what we do in our work, or we are assigned a population by payers, we first get all the data we can to really understand who we are managing and how they are engaging with the health system,” Petro said.
BMC has used their analyzes to identify populations at risk. After doing so, it connects people in that population with relevant services.
“We can measure risks and then provide more targeted resources to people who are at higher risk,” Goldfarb said. “Our patients who are at highest risk are offered an intensive care management program. There, we pair behavioral health specialists, usually a social worker, with community nurses, health workers, all working together as a team.”
Analytics has come a long way in the last decade, but behavioral health providers are notoriously behind physical health providers in implementing electronic health records (EHRs). In fact, just 6% of behavioral health providers have EHR.
This can sometimes be a barrier to behavioral health playing a leading role in population health management strategies.
“It’s been a major problem, and it still is … a major problem, especially from the quality improvement stance and the quality control type,” said Jonathan Purtle, associate professor and director of policy research at the New York University School of Global Public Health. BHB.
The physical, mental and social needs of populations
Many providers and agencies are beginning to look at population health through a holistic lens.
This means addressing the physical health, behavioral health, and social determinants of health (SDoH) of a population all at the same time.
“I think there is a desire to bring behavioral health [into population health]But because our system is historically so fragmented — medical is different from behavioral, behavioral is often different from substance use disorder — it’s very difficult to bring them all together,” Michael Tang, MD, told BHB. head of behavioral health at Cityblock. “At Cityblock, we have combined medical, behavioral and substance use contracts. So we have it all together from a financial perspective, so we can think of the individual as a whole person.”
Social determinants of health, including economic stability, housing, education, food security, and other factors, can also affect the behavioral well-being of a population.
“What are those non-clinical things that really affect people’s behavioral health? For us, that is focusing on the social determinants of health,” Goldfarb said. “I call it more social factors of behavioral health. We spend a lot of time and resources at BMC on that piece, and understanding things like housing and transportation, food insecurity, maybe involvement in the criminal justice system, education and employment. That really affects behavioral health outcomes.”
BMC has internal and external resources to help patients address SDoH.
For example, the health system has its own pantry and community garden. He has also partnered with community resource centers where he can then direct his patients.
The ‘right’ front door
Primary care physicians often serve as the gateway to medical care. This means that in the future, primary care could be charged with administering tests and measuring the mental health, as well as the physical health, of a population.
“If we’re going to hang our hat on primary care in this country as the mechanism to drive health outcomes, primary care needs to be subject to screening, management, getting people to the right places,” Petro said. “Some people won’t get that in primary care. And that begs the question of, ‘Is that the right relationship for each type of patient?’”
Although primary care can be an entry point to behavioral health services, it may not be the right path for all patient populations. BMC seeks to treat SUD patients in the community.
For example, the provider has located some of its lower barrier addiction treatment centers near the shelter system. Also provides behavioral health services at community health centers.
“The idea is to create infinite doors to be able to access services. For some people, going through primary care makes a lot of sense,” Goldfarb said. “But some people are not engaged in primary care or don’t want to be involved in primary care.”
Regardless of the front door, relationships are key.
“I think it’s really important to think about different cohorts and different segments of the population and who they have a relationship with within the healthcare ecosystem,” Petro said. “And then drive the value of that relationship. A low-income Medicaid member who is homeless can get the most value from a community health worker.”
Schools provide many of those relationships for the pediatric population.
In July, the Biden administration promised almost $300 million expand mental health services in schools. Specifically, the funds will go toward bolstering the school-based mental health provider pipeline and providing more school-based behavioral health services.
“Schools are the main source of mental health services for children,” Purtle said. “Schools are often referred to as the de facto mental health system for children, but that makes them a premier mental health system for children. I think we need to make sure schools have the resources to handle this properly. It’s serious business, and schools have a lot on their plate. I think if there is going to be political action to get schools to address behavioral health more directly, we need to make sure there are resources, training, support and people dedicated to it so that it can be done right.”
The role of public health agencies
Traditionally, federal and local public health agencies have played an important role in the health care of a population. But most of these efforts have fallen on physical health.
“Within the government in the state [and] At the local level, often not always, there is some other public entity that does behavioral health,” Purtle said. “But these behavioral health agencies are usually focused on providing clinical services, and usually clinical services for people with really serious needs, which is very important, and their work is critical. But there really isn’t anyone who thinks about prevention that much, or who really has the bandwidth to think about prevention in a population-based way.”
Partnerships between public health agencies and behavioral health stakeholders could be key to making behavioral health part of population health.
“I also think that public health departments that are used to thinking … in populations rather than individuals could help behavioral health agencies that are more used to thinking in terms of individual clinical encounters, because that’s how they’re typically funded, through Medicaid and reimbursement. -based systems I think there’s a lot of room for partnership there.”
The federal government is beginning to take steps to integrate behavioral health into public health.
For example, the federal government has launched the 988 crisis response line. In addition, the biden administration has pledged $700 million in fiscal year 2023 to staff local crisis centers.
“I think 988 is kind of indicative of a paradigm shift more toward parity and elevating behavioral health as something that’s really approached as a focal point that’s primary rather than secondary,” Purtle said.
