Caregivers cannot treat the body and not the head, or vice versa. The result is a devastating "mortality gap" seen today, where people with severe mental illnesses die decades younger than the general population, needlessly, from untreated chronic illnesses, which are aggravated by poor health habits.
The goal at Arizona's Partners in Recovery is to close that gap and to see that people with mental illnesses get the regular access to primary care and other medical care they need.
Arizona's state Medicaid agency reimburses an additional 10 percent to integrated clinics – behavioral health clinics with on-site primary care services. Three of Partners in Recovery's clinical sites have both a primary care provider and psychiatrist on site, with one of these clinics also having a pharmacy and a gym.
"This is a meaningfully convenient offering for members to be able to see their behavioral and mental health providers in one visit, especially those with limited transportation options," said Leanette Henagan, MD, chief integration officer at Partners in Recovery. "It also frees up tremendous time for case managers and clinical coordinators, who otherwise would be making repeated calls to schedule a barrage of appointments with different providers."
However, behavioral health, primary care and other specialist providers also need technology that connects them, helps them coordinate patient care together, and presents a whole, integrated picture of a patient's physical and mental healthcare activity.
"To date, those have been unprecedented capabilities from any technology, but which we now get with the HealthBI care coordination and care management platform," Henagan said.
First and foremost, the platform provides actionable data – information Partners in Recovery can act on in time to make a difference to its members. It aggregates data from providers, payers, state health information exchanges and other sources to collectively present a comprehensive real-time picture of whole patient health.
"Here's just one example," Henagan explained. "Historically, if a member went to the emergency department, we wouldn't know for weeks or months, if at all. Because the HealthBI platform also aggregates data from the Arizona state HIE, we can get alerts soon after a patient goes to the emergency department. We can then make sure the patient gets follow-up primary care to avoid a readmission."
In another example, the platform identifies patients in need of various services, such as screenings, blood sugar readings, lab tests, medication counseling and so on. These may sound like routine, even mundane services, but they are exactly the ones that people with mental illness experience difficulty accessing, Henagan explained.
"And over time, this impacts their mortality," she said. "This is the sad legacy of centuries of stigma attached to mental illness. Transportation is also a frequent issue that prevents access to primary care; together, the two factors are significant drivers of high utilization of the emergency department."
Between the real-time, actionable information from the platform and Partners in Recovery's integrated clinics, the provider organization is making inroads into changing this longstanding paradigm.
"The platform is largely used by our clinical directors and care coordinators, who use the platform for the above described risk stratification and care coordination with other providers," Henagan said.
Partners in Recovery has replaced by 75 percent the time-consuming use of spreadsheets to track patient physical health. It has reduced from months to days or even hours its awareness if a patient has been to the emergency department. And it has seen a 32 percent increase in educating members on physical care needs and scheduling and completing wellness activities. These latter include diabetic eye exams, colorectal screenings, mammograms, HbA1c3 labs and more.
Technology is essential to behavioral population health management, and integrated physical and mental healthcare, Henagan said.
"First, consider the cost standpoint," she said. "Medicaid is the primary payer for severe mental illness, and we all know that Medicaid funding is constantly under threat. The platform roots out sources of overutilization in time to act."
In just one example, she added, the platform identified a young member who frequently visited the emergency department. From there, Partners in Recovery discovered that the 19-year-old was depressed and using the emergency department as a socialization avenue.
"We were able to work with her to find alternatives," Henagan said. "Before using the platform, it would have been months if ever before we learned she was making such use of the emergency department. It would have depended on notification from Medicaid."
And Henagan said that it is important to keep in mind that physical healthcare and behavioral healthcare have long taken two sharply divergent paths.
"As such, so did the respective technologies used by the two separate disciplines," she said. "But we can't treat the head and the body unless we integrate and connect these disciplines. The HealthBI platform enables exactly that."
While the market for software that merges physical and mental healthcare data is scant, there are many vendors of care coordination software. These include Cureatr, Ensocare, eQHealth Solutions, Imprivata, Netsmart, Oculus Health, pMD and Tribridge.