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As the general population ages, the need for mental and behavioral health services continues to increase. By 2009, almost 20 percent of adults in the United States had suffered from a mental health condition at some point in their lives.
Mental illness is a significant source of comorbidity in the chronically ill, particularly for patients with diabetes or cardiovascular disease. Diabetes patients, for instance, are twice as likely to suffer from depression as the general population. Mental illness is also associated with higher rates of substance abuse. Twenty percent of people over 55 suffer from a mental disorder. Yet, less than 3% of older adults report seeing a mental health professional for their problems. In 2010, approximately 23 million people ages 12-64 reported symptoms of substance use disorders, while only 11 percent received treatment at a specialty facility.[1]
Elders account for only 7 percent of all inpatient psychiatric services, 6 percent of community mental health services, and 9 percent of private psychiatric care. Less than 3 percent of all Medicare reimbursement is for the psychiatric treatment of older patients. It is estimated that 18 to 25 percent of elders are in need of mental health care for depression, anxiety, psychosomatic disorders, adjustment to aging, and schizophrenia. Yet, few seem to receive proper care and treatment for these mental illnesses. It is also a distressing reality that the suicide rate of the elderly stands at an alarming 21 percent, the highest of all age groups in the United States. Every day 17 older individuals kill themselves.[2]
Ensuring patients have timely access to clinically appropriate, coordinated and cost-effective behavioral health services requires standardized clinical documentation and an affordable, intelligent resource matching care coordination technology that is shared among general health providers, care managers and behavioral health providers.
Coordinating care for behavioral health patients faces unique challenges for physicians and care managers and behavioral health providers:
Mental health and addictions disorders are frequently intertwined with other co-existing health conditions such as diabetes, hypertension, heart disease and kidney & liver failure. The current mass of disconnected behavioral health care delivery arrangements requires numerous patient interactions with different providers, organizations, and government agencies.[3] Very few of these providers share technology platforms, which allow flow of patient information and referrals. As a result, a diverse array of providers often fail to detect and treat (or refer to other providers to treat) these co-occurring problems and also fail to collaborate in the care of these multiple health conditions—placing their patients’ health and recovery in jeopardy.[4] This poor communication and lack of shared information among clinicians blocks knowledge about which behavioral health programs are most clinically appropriate and available for a patient and how a chronic medical condition should be factored into the patient’s behavioral health care transitions.
In addressing these challenges the implementing of a web-based, intelligent care coordination solution for behavioral health services would see the following effects:
Improved Quality of Care Coordination Promotes clinical interoperability with improved continuity and coordination of care through access to shared information across services Optimizes care provision in a distributed care model Increases effective management of client safety-risk issues by shifting to synoptic reporting from largely free-text based documentation Improves capacity to judge appropriateness of clients referred for services in real time Better and Timely Access to Care Supports more appropriate timing in the initiation of care, especially for high need/high risk clients Reduces the likelihood of inappropriate referrals, using client/service matching logic to guide choices Improves the transition of clients between care providers by informing decision-making and care coordination Increases transparency of system bottlenecks by capturing intervals along the referral process Increased Productivity Reduces the time to process incoming referrals through synoptic reports that provide clinicians up front with the requisite information about client need and risk, enabling eligibility decisions to be made without time-consuming follow up. Optimizes flow between services, resulting in shortened length of stay Leverages existing technologies to streamline data capture via integration Adoption of health IT is critical to support care coordination, patient engagement and access to care, and ultimately health reform.[5] However, behavioral health clinicians currently have limited adoption of interoperable information systems. In a recent Office of the National Coordinator for Health Information Technology study, just over 20 percent of 505 behavioral health organizations surveyed indicated that they had fully adopted an EHR.[6] Behavioral health providers are often challenged to implement health IT solutions due to prohibitive EHR costs, lack of IT support staff and concerns over federal privacy laws for behavioral health patient information.[7] Not all behavioral health providers are eligible for federal Meaningful Use financial incentives; cloud-based EHR and health IT solutions may be affordable options, especially for smaller behavioral health providers.[8]
[1]Behavioral Health Roundtable: Summary of Findings; Office of the National Coordinator for Health Information Technology, U.S. Dept of Health & Human Services, September 2012
[2] Mental Health Association of Southeastern Pennsylvania
[3]Garfield, Zuvekas, Lave, Donohue, “The Impact of national health care reform on adults with severe mental disorders”; Am J Psychiatry; 2011; 168; 3:A42
[4]ibid
[5]Behavioral Health Roundtable: Summary of Findings; Office of the National Coordinator for Health Information Technology, U.S. Dept of Health & Human Services, September 2012
[6]ibid
[7]ibid