Hello once more from sunny Florida, where yesterday we wrapped up The 2015 OPEN MINDS Performance Management Institute with a gathering of 400+ energetic executives focused on the tools and best practices to improve organizational performance. Arthur C. Evans, Jr., Ph.D., Commissioner, Philadelphia Department of Behavioral Health & Intellectual disAbility Services opened our meeting on Thursday with A New Future For Behavioral Health: Using Public Health Models To Manage Population Health. His comments made me think in a new way about the potential for public health models to “move the needle” on population health management (see Moving Beyond The 10% To Be A ‘High Value’ Organization).
Dr. Evans highlighted many examples of initiatives they have launched in Philadelphia – from stigma reduction, to community-based youth services, to mental health screening kiosks in supermarkets, to Philadelphia’s much-acclaimed mural arts program. Three programs that caught my attention included:
Enhanced day treatment program – Philadelphia enhanced their outpatient treatment and counseling program services with a focus on consumer recovery. Of the 611 consumers who participated in the enhanced program for at least one year, there was a 36% decrease in their use of crisis services and a drop in the cost of their inpatient psychiatric services, from $982,895 to $561,011.
Recovery-Oriented Cognitive Therapy – Recovery-oriented cognitive therapy was added to the clinical programs in Philadelphia’s extended acute inpatient units. The therapy, designed for consumers with the most severe mental illnesses, prioritizes consumer engagement in and attainment of personally-set goals. Thus far, the program has reduced lengths of stay by half, reduced assaults by 60%, lowered use of restraints by two orders of magnitude, and reduced the use of intramuscular PRN medications by two-thirds.
Housing vouchers – Since 2012, the City of Philadelphia has invested in housing vouchers, and has placed 792 individuals into permanent housing (94% of which remain housed). The initiative generated over $8 million in savings in two years, and reduced per member per day costs from $88 to $21.
I think executives involved in this “brave new world” of population health management should consider public health strategies like these as a strategy to compete most effectively. But to make this shift, requires some new thinking – including these seven essential competencies:
- Working at the community and group level – Most clinicians (and the management that were once clinicians) have been trained to deal either with the individual, or small family groups. It will take new training to deliver interventions to large groups of people.
- Working upstream – Waiting until someone has a diagnoses is often starting too late for maximum intervention effectiveness. It takes new levels of screening to reach people before they have a clinical interface.
- Broad set of strategies – Traditional therapies and case management are ineffective for serving large, community-sized groups. This translates to a need to both new training, and new evidence-based interventions.
- Working with non-diagnosed populations – The current treatment system is predominantly (75%) people who aren’t diagnosed, but may either already be on the continuum of possible disorders or substance abuse, or are at risk. Population health management means finding these people before they reach higher levels of acute care.
- Deliver health promotion interventions – Delivering health promotion interventions is more than just treating symptoms, it’s means helping people take ownership of their own health status.
- Working in community and other non-clinical settings – Facility-based care has a place, but it isn’t the solution for every population. Organizations need to think outside the box in terms of where services can be delivered.
- Health activation approaches and empowering others – The big question of the day, “How do you empower whole communities?”
For more on the role of public health in population health management, check out this publication, Transformation Practice Guidelines for Recovery and Resilience Oriented Treatment, published by Philadelphia Behavioral Health Services. And for more on the 2015 OPEN MINDS Performance Management Institute, check out our archived coverage on Twitter @openmindscircle with the official institute hashtag #OMPerformance; and check out pictures live from the event on our Facebook page.