As behavioral health crises drive prolonged emergency department boarding and staff burnout, health systems are adopting targeted strategies to ease the burden and improve care transitions. From building dedicated billing teams to integrating technology into daily workflow, behavioral health leaders want to engage with patients even earlier and more consistently than before.
Here are six approaches and examples of health systems employing them:
- Integrating psychiatric assessments early in the ED visit to reduce delays
At Mercy, based in Chesterfield, Mo., the system built a virtual behavioral health division to enable the rapid evaluation of behavioral health patients and reduce unnecessary inpatient admission in the emergency room and other hospital units.
It uses a standardized Epic referral process to alert the behavioral health virtual team, with an evaluation beginning within 60 minutes. Patty Morrow, vice president of behavioral health services, told Becker’s that 85% of this care is delivered through virtual solutions.
“Last year, we served 37,000 people through that department, and most of those individuals are people that would have never had access to a behavioral health specialist or a psychiatric nurse practitioner, or a psychiatrist,” she said.
- Embedding peer navigators and care coordinators in ED teams to support transitions
Hampton Roads, Va.-based Sentara created a behavioral health navigator role to complement existing emergency psychiatry teams. Currently, the system has one manager and 10 full-time navigators placed in each hospital.
“[Navigators] are behavioral health therapists,” Tracey Izzard, vice president of behavioral health services, told Becker’s. “They understand all of the behavioral health needs, but they also focus on population health and the social determinant of health needs.”
Before the navigator role was implemented, the average emergency department length of stay was 2,740 minutes. In the first few months after implementation, it decreased to 2,090 minutes. Thirty-day readmission rates also fell from 14.1% to 7.3% when navigators were engaged before discharge. Without navigators, 26.2% of patients returned; with navigators, the rate dropped to 14%, Ms. Izzard said.
- Partnering with local behavioral health providers, mobile crisis teams and housing agencies
At Aurora, Colo.-based UCHealth, the system partners with nine law enforcement agencies, with more than 85% of 14,000 behavioral health calls having been resolved without arrest or emergency department visits.
Elicia Bunch, vice president of behavioral health, told Becker’s this reflects the reality that behavioral health crises are fundamentally health issues.
Models such as these need payer support to be sustainable long term, including for crisis response, mobile services and follow-up care, she said.
- Leveraging tech-enabled workflows to reduce burnout and increase efficiency
At Cleveland Clinic, the system has rolled out an AI scribe to assist providers in the daily documentation process, allowing them to connect with patients through direct eye contact and body language that can reveal nuances about their mental health.
“It’s been transformative,” Leopoldo Pozuelo, MD, center director of adult behavioral health at Cleveland Clinic, told Becker’s. “And I don’t use that word lightly.”
A study found that for clinicians who used an ambient AI scribe for 30 days, burnout dropped from about 52% to 39%, while time spent on documentation outside of working hours fell by nearly an hour a week.
“There’s the ROI in interventions such as this,” he said. “You retain that individual by reducing their burnout and increasing their satisfaction. I would not be surprised that this becomes the norm for documentation across the board.”
- Connecting substance use disorder care across settings
Columbus-based OhioHealth recently launched its Addiction Medicine Program based at OhioHealth O’Bleness Hospital in Athens, integrating hospital-based care with outpatient treatment, counseling and community resources.
“These partnerships allow people to access care from multiple points, not just through the emergency department, but from community agencies where many individuals first seek support,” Christopher Meyer, DO, an addiction medicine specialist at O’Bleness Hospital, said in a news release. “People don’t always just walk into a clinic when they need help.”
- Reducing denials by creating dedicated service lines and billing teams
Marlton, N.J.-based Virtua Health is bringing behavioral health intake and insurance authorization in house, driven by persistent prior authorization challenges, limited transparency and denial risk tied to how behavioral health patients move through emergency, medical and psychiatric settings, according to Russ Micoli, vice president of behavioral health services at the system.
“To unsort and work with the insurance companies, ‘Yes, the patient was admitted Monday, but they were transferred today. We’ll cover this and this day we won’t’ was pretty messy and we were experiencing, at least for our stomachs, more denials than we needed,” he told Becker’s.
Virtua expects to reduce denials, improve throughput efficiency and better understand the true cost of caring for behavioral health patients across settings through this practice.
