Patients with serious mental illness who participated in a behavioral health home (BHH) program saw significant reductions in emergency department visits and psychiatric hospitalizations along with more preventive screenings for diabetes, according to a new study published by Psychiatric Services. The study was conducted by researchers at Cambridge Health Alliance, which launched its behavioral health home in 2015.

Cambridge Health Alliance’s BHH integrates medical services and care management with mental health care to offer more comprehensive, team-based care in an outpatient mental health clinic, offering a more comfortable environment for patients with serious mental illness than traditional primary care practices. The pilot included: (1) adding on-site medical care, health promotion activities (e.g. smoking cessation and healthy lifestyle groups), care coordination, and peer-to-peer engagement; (2) new electronic health record tools to track hospitalized patients; (3) addition of a medical nurse practitioner, care manager, and program manager to the interdisciplinary care team; and (4) a clinical paradigm shift toward integrated team-based care and  chronic disease prevention and monitoring, and population health management.

“Adults with serious mental illness have shockingly poor health outcomes compared with the general population,” said lead author Miriam Tepper, MD, an attending psychiatrist at Cambridge Health Alliance and a faculty member at Harvard Medical School. “It is critical that the healthcare community address this health disparity in a way that accounts for the interplay of medical, psychiatric, and social factors. Our healthcare system is hard to navigate for the healthiest among us—creative approaches are essential to ensure that people with serious mental illnesses are able to access the care they deserve.”

Cambridge Health Alliance’s behavioral health home concept meshes well with current thinking on behavioral healthcare in the commonwealth. The Behavioral Health: Unfinished Agenda of Reform (BHUAR) initiative that MHA convened outlined three pillars to advance the vision of a strengthened mental health system in the state. One such pillar calls for strengthening the community-based continuum of care along the lines of Cambridge’s BHH so that commonwealth patients receive the right care, at the right level, when they need it, in the most cost effective and least restrictive setting possible. The BHUAR plan calls for ensuring that handoffs between services and providers are seamless, and also ensuring that funding is adequate and effectively allocated to promote a sustainable, truly integrated continuum of community-based care.

The other two BHUAR pillars call for improving inpatient capacity and access and boosting the workforce to meet the needs of an integrated behavioral health system. BHUAR is chaired by MHA’s President & CEO Lynn Nicholas, FACHE, former Tufts Health Plan CEO James Roosevelt, and retired District Court Judge Rosemary Minehan.

The Boston Globe had an interesting article last week on the rise of inpatient psychiatric beds in Massachusetts and the problem hospitals are having in recruiting psychiatrists to staff them.

The August 8 article – State sees boom in number of psychiatric beds – noted that Massachusetts has added 531 new inpatient psychiatric beds since 2009, including the construction of three new psych hospitals.

MHA’s Behavioral Health: Unfinished Agenda of Reform (BHUAR) initiative (see previous story) determined that workforce shortages in the behavioral health field is a major concern. One of BHUAR’s three pillars calls on stakeholders to work towards boosting the workforce to meet the needs of an integrated behavioral health system to provide high-quality, accessible behavioral health services across the full continuum of inpatient and community-based care to reflects the diversity of those requiring care, and to support the system’s ability to deliver services to those needing them in the commonwealth.

The Executive Office of Health and Human Services (EOHHS) has contracted with Massachusetts Health Quality Partners (MHQP) to conduct statewide patient experience surveys of people insured through the state’s Medicaid program, MassHealth, and participating in the new Accountable Care Organization (ACO) and Community Partners (CP) programs.  The contract spans three years and will focus on three areas in which MassHealth members commonly receive care and services: primary care, behavioral health, and long-term services and supports.

MHQP already conducts the only statewide patient experience survey in the primary care setting for Massachusetts patients insured through employer-funded commercial insurers – or about 50% of the population in Massachusetts. The MassHealth contract expands MHQP’s survey coverage to approximately 70% of the state’s population. It will also enable state agencies to empirically compare the experiences of these two core segments of the healthcare market. 

Data will be captured about patients’ experiences with their primary care providers at the medical group level, so medical practices will be able to compare their performance with others in their area.

“The success of the new ACO and CP programs relies upon our members receiving quality, coordinated care,” Ipek Demirsoy, chief of payment and care delivery innovation, MassHealth, said in an MHQP media release. “Our contract with MHQP will allow us to measure the quality performance of our ACOs and CPs. We are excited to partner with them to achieve this central goal.”

The contract calls for MHQP to measure patient experience in primary care in 2017, 2018 and 2019, and with behavioral health and long-term support and services in 2018 and 2019.

2017 Lean in Healthcare Certificate Program at Lahey Health

Starting: Thursday, September 21, 2017
(8 sessions total); 8:30 a.m. - 4:30 p.m.
Lahey Health, Burlington, Mass.

In this program, participants will learn the fundamentals of continuous improvement in a classroom setting. They will then work in teams to apply the principles and tools of continuous improvement in an actual healthcare process at Lahey Health in Burlington, Mass. Each day participants will be introduced to appropriate best practices to address the challenges facing healthcare professionals. This learn-by-doing method will prepare students to return to their own workplaces with the confidence to implement continuous improvement methodologies. This essential program was developed to provide the healthcare professional with the knowledge and experience needed to effect positive change within their own organizations. The program will be held Lahey Health so that a combination of classroom instruction and learning by doing can take place.  Visit here for details.