Last week, my colleague George Braunstein pointed out that the framework and approaches for delivering a continuum of behavioral health services had some real legs as population health management tools (see Bend The Cost Curve? We Need Behaviorally-Led Health Systems). Most physical health care delivery systems have outpatient clinic services and acute inpatient care—with little in between to support consumers in the community. Intensive community-based supports, more typical in behavioral health, offer great promise in supporting other chronic conditions.
That article brought a response that takes the argument a step further. Not only is the behavioral health service continuum framework a good model for population health management, but some of the behavioral health evidence-based practices (EBP) could be (and should be) adopted for managing the care for consumers with chronic diseases. That was the conclusion of my colleague Bob Dunbar, OPEN MINDS Senior Associate and former Executive Director for Adult & Child Mental Health Center, Inc. He pointed out that using behavioral health EBP for broader population health management created new opportunities—not just with the more robust non-facility based continuum, but also by routinely addressing social determinants, and engaging and leveraging consumers and caregivers.
On the continuum issue, the behavioral health system has developed, over a period of years, a more robust community-based continuum of outpatient services. He explained, “What health plans and ACOs need to do is rethink their continuum care. It’s a matter of decreasing emphasis on inpatient care—and increasing their investment in ambulatory and community-based services.”
Behavioral health evidence-based practices, such as supported employment and supportive housing (see Supported Employment Evidence-Based Practices (EBP) KIT and Permanent Supportive Housing Evidence-Based Practices (EBP KIT)), address social determinants of health. And, Mr. Dunbar also noted that health systems “could make greater use of case management services linking consumers to community supports that address social determinants of health.”
Finally, many behavioral health EBPs—like Illness Management Recovery (IMR) and person-centered planning—are designed to engage consumers and leverage their ability (and the ability of their caregivers) to understand and self-manage their illness. Behavioral health provider organizations have traditionally created partnerships with consumers to increase their understanding of, and self-management of, their illness by use of person-centered planning, education, and peer support.
Physical medicine could replicate the Illness Management Recovery (IMR) model (see Illness Management and Recovery Evidence-Based Practices KIT and The Illness Management and Recovery Program: Rationale, Development, and Preliminary Findings) that is used to educate people with behavioral health disorders. IMR brings both education about their condition and the tools required to self-manage illness. The IMR model also utilizes peer support, an approach that is not common for people with serious physical illnesses such as cancer and heart disease – but should be.
As the management teams of specialty provider organizations look ahead to managing care for the “whole person” in new value-based arrangements, creative adaptation of traditional behavioral health EBPs should be part of their service line development planning.
For more on meeting these challenge, join my colleague Joe Naughton-Travers, Senior Associate, OPEN MINDS on June 5 at The 2018 OPEN MINDS Strategy & Innovation Institute for the session, “How To Develop A New Service Line: Building A Diversification Strategy & Conducting A Feasibility Analysis,” featuring Teri Herrmann, MA, Chief Executive Officer, SPARC Services and Programs and Eleanor Castillo Sumi, Ph.D., BCBA-D, Vice President of Research and Program Development, Uplift Family Services.
And, join me on August 16 at The 2018 OPEN MINDS Management Best Practices Institute for my plenary address, What Is A Best Practice? Exploring The Role Of Evidence-Based Practices, Practice-Based Evidence & Big Data.