As one of New Jersey’s three Medicaid Accountable Care Organizations (ACOs), the Camden Coalition works with the city’s 15 primary care practices to provide better care at lower cost to Camden’s 38,000 Medicaid patients. Every quarter all of the practices come together at the Camden Coalition ACO Provider Dinner to discuss how the collective work is going, and where the ACO should go from here. At last month’s dinner we talked about behavioral health.

Behavioral health, which combines mental health and substance use disorders, is underaddressed throughout the region. Here in Camden, it has emerged as a central concern for the population of emergency department (ED) high-utilizers.

The Camden Coalition ACO has been working to connect ED high-utilizers to primary care, under the assumption that people frequently use the ED when they don’t have a strong relationship to a primary care provider. However, through our primary care reconnection efforts we have learned that many ED high-utilizers are already connected to primary care, and that the root cause of their frequent use of the ED is often a behavioral health issue such as anxiety or substance abuse.

At last month’s ACO Provider Dinner, we surveyed providers about their capacity to address the behavioral health issues that lead to overuse of Camden’s emergency departments. Providers were ready and willing to care for their patients’ behavioral health needs, and in many cases are already doing so, but agreed that they needed support and resources to be able to do so more effectively. As one provider said in their survey response, “Sometimes I feel comfortable and then other times I don’t know where to always refer the patient.” In Camden, as in many communities, there often is no place to refer patients. Our goal is for Camden providers to feel as comfortable and confident managing behavioral health concerns as they are in managing common physical health concerns like diabetes or high blood pressure.

We will be exploring in the upcoming months how to better support primary care providers to provide behavioral health care in our ACO practices, as well as how to ensure that the needs of ED high utilizers are being met outside of the emergency department. This may include training for providers and clinic staff, case conferencing, ensuring the availability of mental health specialists to consult with practices, and more.

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