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 nine approaches and examples of health systems employing them:
- Partnering with schools to deliver mental health services as an upstream approach
At New Hyde Park, N.Y.-based Northwell Health, the system has partnered with school districts across New York City’s suburbs to support children before a behavioral health crisis escalates to an emergency department visit.
The system operates a network of behavioral health centers located near school districts that function as regional hubs. The center provides same- or next-day assessments, care navigation and crisis intervention.
“When you break it down to the specific districts … the numbers have significantly decreased — an average of 60% consistently … through the openings of the centers and the new districts joining,” Vera Feuer, MD, vice president of child and adolescent psychiatry for the behavioral health service line said, referring to a decrease in emergency department visits for students with psychiatric-related concerns. “Despite the national significant increase, our ER volume from those districts stayed the same or decreased a little bit.”
In many cases, Dr. Feuer said, children do not need the emergency department care but instead need access to behavioral health services earlier.
- Developing bundled behavioral health strategies across care settings
Cincinnati Children’s operates the nation’s largest inpatient mental health hospital for children and adolescents, positioning the system to address pediatric behavioral health needs upstream through a bundled care strategy, Laurel Leslie, MD, director of the hospital’s mental and behavioral health institute, told Becker’s.
The system identified three levels of care for intervention: level 1 integrates behavioral health and primary care; level 2 expands intensive outpatient care and day programs; and level 3 redesigns emergency department intake and triage.
Level 3 addresses emergency department strain by creating a psychiatric intake team for families and schools to call to identify therapeutic alternatives and determine whether the child needs emergency care.
Cincinnati Children’s also focused on reducing barriers between physical and mental healthcare through data integration.
“We’ve found a way for outpatient mental health providers that are not in [Cincinnati] Children’s to be able to link into our EMR, and then they can track if kids have come into the emergency department, if they’ve been hospitalized, etc.,” Dr. Leslie said. “We can also see if they have openings available.”
- Creating behavioral health urgent care to ease ED capacity constraints
At St. Louis-based SSM Health, high demand for psychiatric beds has contributed to prolonged emergency department wait times. The system has the highest capacity of psychiatric beds in Missouri.
“That has been a little bit of a challenge for us, because the emergency department is becoming so overloaded,” Becky Dvorak, MSN, RN, regional vice president of behavioral health. “There are days where we can have 10 to 15 patients sitting in the ED waiting on an inpatient psych bed.”
To address part of the issue, the system developed a behavioral health urgent care separate from its emergency department. The site is staffed by psychiatric nurse practitioners, nurses and social workers.
“Getting into a psychiatrist could take months,” she said. “This helps meet the need early on, instead of waiting four months and turning it into a crisis that ends up in the hospital.”
- 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.
