While behavioral health and physical health have historically been thought of (and treated) as completely separate areas of care, the simple fact is there just aren’t as many healthcare professionals who specialize in the mind as there are who treat the body.
But nearly 70 percent of American adults who have a behavioral health condition also have a medical co-morbidity, which led the Bronx, New York-based Montefiore Health System to begin integrating mental health treatment with primary care. It’s a model that has been embraced under mental health parity laws, but typically requires having co-located mental health services at the clinics. So Montefiore is working around the specialist shortages by implementing digital tools, funded by a grant from the Center for Medicare and Medicaid Innovation (CMMI). The most recent example is their 238 patient pilot with Valera Health, makers of a smartphone app and platform to improve treatment of anxiety and depression.
Primary care physicians retained their role as leaders of the patient’s care, but care managers – typically bachelor’s degree-level employees – acted as the main contact for the patients. By using the Valera app and platform, care managers were able to assess patients for anxiety and depression (and score them from mild, moderate or severe), and engage them in secure, two-way text messaging, tailored educational content and appointment reminders. The results were higher patient engagement, improved symptoms or even remission of anxiety and depression in patients, and an increase in the number of patients care managers could handle.
Dr. Henry Chung, who is the chief medical officer of Montefiore’s Care Management Organization as well as the executive project director of the Behavioral Health Integration Program, said the technology was able to increase engagement more than triple the number they had seen in regular integrative approaches, which often resulted in a never-ending game of phone tag between patients and care managers.
“This is really exciting stuff because we have working with integrating primary care and behavioral health for the past five years, and with the federal grant, we really started looking at the sustainability of our program. That brought us to really look at technology like Valera’s,” Chung told MobiHealthNews in an interview. “We were still a little concerned because we know there are lower technology adoption rates in low literacy and relatively economically poor populations, but the patients really took to it. It exceeded our expectations.”
Chung said in many Medicaid populations – which makes up the majority of Montefiore’s Bronx clinic patient population – tech adoption is usually less than 30 percent, but the Valera Health pilot saw engagement up to 68 percent. Over a period of three months, patients and care managers touched base an average of 14 times, versus three times in the same period with basic phone call strategies.
“It also really increased the efficiency factor for care managers. They can handle up to 120 people, and it doesn’t put a burden on them because the technology makes it so easy,” Chung said.
Valera Health, which was part of Texas Medical Center’s TMCx accelerator last year, has been reaching out to a number of ACOs and payers to facilitate more integrated behavioral and primary care programs like Montefiore’s.
“There are a lot of people with mental health conditions who are not getting the care they need, because there aren’t enough providers. Ironically, the mental health parity act, which is a good thing, actually compounds it because there are even fewer mental health specialists to go around to keep up with all the demand,” Valera Health CEO Dr. Thomas Tsang told MobiHealthNews. “Looking at the gold standard of the IMPACT model from the University of Washington, we started out asking ourselves how we could address and mitigate this issue of need and access and keep up the quality.”
Valera’s approach is not to provide an all-inclusive platform to facilitate integrated care programs, but to support existing programs with data analytics, communication channels and other patient engagement tools. Eight months with Montefiore translated to 54 percent of patients reporting they had seen improvement in their symptoms of anxiety or depression – the IMPACT model was at 45 percent – and 27 percent remission (IMPACT had similar results).
“The idea is to really understand patients where they are; who has severe conditions, and who could be helped with engagement and link them to the appropriate level resource and care,” said Tsang. “In a way, it’s really opening the bottleneck in mental healthcare access, because some patients don’t necessarily need to see a psychiatrist or even psychologist. They can actually be treated more promptly by a level of care more appropriate.”
For Chung, whose system employs just a handful of social workers, psychologists and psychiatrists relative to their patient population, a tool like Valera can really help them make their case that integrated care models are sustainable. They plan to extend the pilot and enroll up to 1,000 patients.
“This model is so difficult to sustain because it doesn’t work in a pure fee-for-service way and that is traditionally what would make it tenable. So to make it tenable, you would need more case loads, but if you still don’t have enough specialists, that can’t happen unless you have another way of reaching patients,” he said. “Technology gives us that ability and shows a stickiness of a program working.”