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.