How ChristianaCare Overhauled its Behavioral Health Referral Process – PatientEngagementHIT.com

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August 27, 2020 -A patient sitting in the emergency department for eight hours waiting for a psychiatric care referral is not likely to ultimately get that care. That much became apparent to the leadership at ChristianaCare as they and other healthcare providers worked to revamp the mental and behavioral health referral process.

Whats more likely, the stakeholders found, is the patient will become frustrated with the process and leave before getting treatment. And its that very outcome thats hampers overall patient wellness in various Medicaid populations across the country.

The Medicaid Transformation Project, launched two years ago by former CMS head Andy Slavitt and health tech firm AVIA, sought to change that and other healthcare problems. The project aims to address the most pressing social health needs for vulnerable patient populations, beginning with the Medicaid population.

The Medicaid Transformation Project partners with health systems to close the most pressing gaps in care in individual states, so far with much success.

For the providers at the Delaware-based ChristianaCare Health System, that culminated in a closer look at mental and behavioral health access.

READ MORE: How Behavioral Health, Primary Care Integration Boosted Operations

Behavioral health is truly an underlying need that drives total health, according to Erin Booker, the vice president of Community Health and Engagement at ChristianaCare.

If we do not do a good job in our community, really recording people's mental health needs and substance use disorder needs the outcomes, their full wellbeing and health is poor. It's really important that we are actively working around access to behavioral health services and understanding what those gaps were and what those needs were.

The state of Delaware took a look at the different levels of care that were available in the healthcare space and the process for patients to get connected to care. What came from that was a big emphasis on the referral process, which Booker said was extremely fragmented.

There wasn't great full-circle communication between the referral, she explained. So oftentimes, for us in our health system, if someone came into our emergency room, we didn't have behavioral health crisis support in our emergency room. And if someone came in and we were doing what we needed to do to connect them into more intensive treatment, the process had a lot of delays, a lot of gaps, and people could end up in the emergency room for multiple days while we tried to find the right setting for them. There was just a lot of bottlenecks in the process.

And its those bottlenecks that can be dangerous for the patient. Like that patient who has to wait eight hours in the emergency department to receive mental healthcare. According to Booker, thats simply too long.

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The provider runs the risk of the patient getting tired of waiting, becoming discouraged, and foregoing care altogether. And that, naturally, leads to even more healthcare risks and poorer outcomes.

ChristianaCare was able to play a hand in Delawares development of OpenBeds, a platform that coordinates mental and behavioral health referrals across the state.

Whether it's referring someone into acute psychiatric hospitalization or inpatient substance use disorder care or into outpatient treatment, those referrals are done digitally, Booker outlined. We also now do referrals to recovery housing through this system. The documents all go through this secure platform and you can literally track the process of it through that.

Crucial to the OpenBeds design is the ability for providers to refer patients based on their specific needs and the resources at hand. Referral is based on the medical and psychological symptom criteria and the level of care the patient needs, Booker said.

The platform also helps ChristianaCare and other users track the care journey for the patient. Clinicians are able to see that someone started in the emergency department, went into acute hospitalization for psychiatry, got referred out from there to inpatient or partial hospitalization, and then stepped down to the outpatient care level.

READ MORE: Care Coordination May Improve Behavioral Healthcare Access

And the outcomes have been exceptionally positive, Booker added. In July alone, ChristianaCare has had almost 300 referrals from the health system into the behavioral health network, she reported. The coordinated referral system has also decreased referral time, increased accountability for treatment providers, and helped clinicians gain insights about patient reasons for declining care.

This new system just gives us a lot more data, Booker stated. And with that data, we've been able to begin to understand where the community needs to increase access or maybe where we've had more access than needed and how to shift those resources as a statewide behavioral health network.

But moving forward, some challenges remain. Although ChristianaCare and the network of mental and behavioral health providers has streamlined the referral process, there are still some capacity opportunities.

For example, Delaware only has one stabilization center.

A stabilization center is for someone who is in need of getting put on medication-assisted treatment, Booker explained. For example, for an opioid use disorder, we have one place in our state where a patient can go 24 hours a day and have 23 hours or 24 hours of care to get them onto their medication, make sure that they safely get inducted, and then be evaluated for what the right next level of care is.

Thats a pretty big capacity issue, considering the pressing opioid crisis impacting the US.

By and large, those are ChristianaCares next steps. Where is there a patient access need, and how can the state expand on that model of care? That is going to be a team-based effort enlisting partners across the state, Booker pointed out.

This is a true partnership with all behavioral health providers and our state, she concluded. So it is clearly an all-health-system effort because every health system in the state is on this platform as well. We have a really great opportunity in Delaware because we are a smaller state to have a much more cohesive response and approach.

Correction 08/27/2020: A previous version of this article suggested the Medicaid Transformation Project partners with Medicaid agencies. It only partners with healthcare organizations.

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How ChristianaCare Overhauled its Behavioral Health Referral Process - PatientEngagementHIT.com