A movement toward health and recovery
By Amy Yuen
South Jersey’s major health systems shift toward patient-centered care
Mental health and substance use treatment — commonly grouped under behavioral health — exist separately from health care and social services in a fragmented, inefficient system that often prevents patients from accessing the right care at the right time. Patients who experience frequent hospitalizations, in particular, are turning to the emergency department for primarily behavioral health needs at increasing rates. Here in South Jersey, the number of patients who visited the emergency department with a primary behavioral health diagnosis jumped 40 percent between 2010 and 2016.
To develop a better model for delivering behavioral health services to all patients in the region, leaders from the five major health systems of South Jersey came together in 2014 in partnership with the Camden Coalition and the New Jersey Hospital Association to form the South Jersey Behavioral Health Innovation Collaborative. The Collaborative — composed of Cooper University Health Care, Inspira Health Network, Jefferson Health New Jersey (formerly Kennedy Health System), Lourdes Health System, and Virtua Health System — aims to improve the quality, accessibility, capacity, and coordination of behavioral health services for South Jersey residents.
Laying the foundation for change
Since 2014, the participating health systems in the Collaborative have committed significant time and resources, with the goal of shifting toward integrated, patient-centered care. To gain a better understanding of current challenges within the system, the Collaborative commissioned the Camden Coalition to research the impact of rising mental health and substance use diagnoses on the emergency departments and inpatient units in South Jersey. The initial findings released last April revealed the results of a behavioral health system ill-equipped to provide the right care at the right time: there was a substantial increase in the number of patients who used all five hospital systems between 2010 and 2016, and of these patients, approximately 80 percent had a mental health or substance use diagnosis.
The health systems participating in the Collaborative have built their capacity to serve the growing population of patients with behavioral health needs. This includes adding sections in their emergency departments specializing in behavioral health treatment, embedding behavioral health staff into their emergency departments and medical floors, adding short-term care beds, building new services, and standardizing protocols for care. The Camden Coalition has also piloted a case conferencing intervention with the Collaborative that enables hospitals to share care plans for their most complex patients.
Staff from across all five participating health systems are also sharing best practices and learning about innovative psychiatric care models. To increase the region’s capacity for housing patients experiencing chronic homelessness — most of whom experience behavioral health disorders — the health systems have also contributed to our Housing First pilot in Camden and the Cumberland County Housing First Collaborative.
This past year, four community providers — Cumberland County Guidance Center, Legacy Treatment Services, NewPoint Behavioral Health, and Oaks Integrated Care — joined the Collaborative to work alongside the five health systems on developing innovations to the region’s behavioral health system. “It’s truly a cross-hospital collaboration along with community providers,” said Emily Spector, Senior Program Manager of Strategy and Information for the Camden Coalition. “None of this success would have been possible without regional collaboration among the hospitals and the partnerships forged with other local partners. We’re excited that the hospitals are developing a regional roadmap for improved behavioral health care delivery.”
Building on regional innovations
The Camden Coalition is continuing to help the hospitals share their expertise in the areas of complex care planning and patient root cause analysis to better serve patients with high emergency department and hospital utilization patterns. To follow up on our findings last year, we are now completing second round analyses that link claims data from all five health systems from 2010 to 2016. The research will allow us to provide an updated view of the evolving behavioral health landscape in the area.
We are also supporting the Collaborative’s effort to build out a regional case conferencing intervention. To better understand the behavioral health patients with the highest hospital utilization across the region, each hospital conducted a root cause analysis of one of their frequently hospitalized patients, covering the person’s medical and social history over the last ten years. The hospitals then individually presented their patient stories to the Collaborative, who together discussed each case, the primary drivers for the patient’s high utilization patterns, and the best plan of care. Each hospital is now drawing from those discussions to develop a care plan in a multidisciplinary team, and will eventually present the care plan to the patient. “The goal is for each patient to get person-centered care from providers who are knowledgeable of their medical and social history so that they are ensured the right care at the right time,” said Spector.
An innovation we have produced for the Collaborative is a Regional Behavioral Health Dashboard to monitor behavioral health utilization at the hospitals and evaluate the impact of the Collaborative’s interventions. Six scorecard metrics have been created from patient claims data aggregated across the five health systems from 2010 to 2016. Although the Camden Coalition currently shares the dashboard with the health systems periodically, we hope to eventually establish a real-time feed of data to each of the hospitals.
Corey Waller, Senior Medical Director of Education and Policy for the Camden Coalition, said that the development and implementation of the dashboard will serve as an important step toward measuring our progress and better understanding and serving our patient population. “While it is commonly used in fields such as cardiology to monitor population health outcomes, dashboarding is less common in behavioral health care,” said Waller. “This puts the participating health systems in the Collaborative at the forefront of approaching behavioral health service delivery in a data-driven way.”