Integrated care at home: an answer to the behavioral health crisis?
Perspective: Better care, lower cost | Capability: Behavioral health | By: Carelon
For individuals with complex needs, innovative healthcare leaders are addressing behavioral health by taking a whole-health approach – and reimagining where the individuals can receive integrated care.
To take on the behavioral health crisis today, many healthcare leaders are asking an important question: are there ways to solve this challenge beyond the status quo?
The question comes at a critical time. An increase in mental health conditions and substance use disorders (SUDs) in the aftermath of COVID-19 has increased the calls for integrating behavioral health in primary care. As the need for these behavioral health services continues to rise, providers , payers , and policymakers have all identified integrated care as a key part of the solution.
Integrating behavioral health services in primary care settings is a well-established approach supported by decades of research and experience. However, as healthcare leaders consider the impact of behavioral health on systemwide costs and outcomes, many are looking more broadly at where that care takes place.
For many individuals, especially those who are chronically ill or face social and economic barriers to accessing care, even services available in their local doctor's office may be out of reach. Addressing behavioral health among these people requires bringing care out of the clinic and into the home.
Integrated care: What is it? And why is it needed now?
A primary care office is typically the first stop for people seeking help for mental health or substance use concerns. For many individuals, their primary care physician or pediatrician is their only source of behavioral health support. More than 20% of patients who are referred to a behavioral health clinician skip or defer care because of a range of challenges, including high out-of-pocket costs and a lack of available in-network providers.
Integrated care models can include coordinated care across multiple facilities and seamless collaborative care under one roof. They close gaps in care by removing barriers to access and navigation and reducing the stigma of seeking behavioral health support. A growing body of research suggests these models can improve outcomes, reduce costs, and deliver a better patient and provider experience.
Carelon has embraced this whole-health approach. In outpatient clinics during the 1990s, Carelon's advanced primary care business (originally known as CareMore Health) began providing integrated value-based care to Medicare and Medicaid members with chronic illness. These care centers, which offer behavioral health services alongside primary care, disease management programs, nutrition guidance, and wellness classes, have proven successful at reducing avoidable ER visits and hospitalizations.
During that same era, clinicians had come to realize that their highest-needs patients — many of whom are managing mental health and SUDs in addition to chronic conditions, such as diabetes — were rarely visiting the care centers. In fact, they almost never left home. To reach these homebound patients, the clinicians began bringing care directly to them in 2017.
Meeting patients where they live
Carelon's home-based care teams — made up of primary care physicians and behavioral health clinicians, as well as specialists, nurses, pharmacists, social workers, and case managers — provide the same care available in outpatient clinics and office-based visits, but with an important distinction.
Both involve regular behavioral health assessments, but as these home-based care teams have discovered, in-home visits help build trust and strengthen the patient-provider relationship. Meeting patients wherever they call home enables providers to pick up on subtle social, emotional, and environmental factors that impact whole health, such as loneliness and social isolation, and identify opportunities for intervention or support.
One patient, highlighted in a 2020 study in the American Journal of Managed Care, illustrates the transformative effect a whole-health approach can have on individuals — and on the system as a whole. The patient, a 58-year-old woman with hypertension, diabetes, anxiety, and PTSD (among other conditions and complications), was a frequent visitor to the ER for substance use and mental health needs. Using a trauma-informed approach, Carelon clinicians gained her trust and eventually persuaded her to see a psychiatrist and enroll in an SUD treatment program.
In her first year receiving care, the woman had just one ER visit — compared to 11 the year before — and her total medical expenditures decreased by $72,367.
Connecting care, digitally
Digital technology has played an essential role in scaling the impact of home-based care. It’s also playing a critical role in solving the behavioral health challenges that the country faces today, connecting the care a patient receives at home and in brick-and-mortar primary care settings.
Spurred on by the massive pivot to telehealth in the early days of the pandemic, providers and health plans have steadily expanded the range of virtual and hybrid care options available to patients. Powerful, adaptive digital technology enables seamless care that follows the patient from their home to the outpatient clinic — and if needed, to hospitals and skilled nursing facilities — and ensures the patient has access to behavioral health support no matter where they are.
Looking beyond the clinic
The shift of healthcare into the home shows no signs of slowing down. As the behavioral health challenges in the U.S. continue, at-home support will evolve as new opportunities and needs emerge — such as integrated palliative care and in-home support for children and families with behavioral health concerns.
