Analytics for Whole-Person Care: The Rise of the Connected Behavioral Health Network

Earlier this week, Arcadia announced a partnership with Innovative Management Solutions (IMSNY), a joint venture between two behavioral health organizations that work to improve the quality of life for New Yorkers with serious mental illness, substance use disorders and/or chronic health conditions, children with serious emotional disturbances, and those impacted by social factors such poverty, inadequate housing, and food shortages.

We wanted to share more about why we’re so eager to tackle these critical issues with the team at IMSNY and founding organizations Coordinated Behavioral Care (CBC) and Coordinated Behavioral Health Services IPA (CBHS). 

Behavioral health, substance use disorders, and social factors can have a huge impact on health outcomes

For too long, the conversation about “health care” has focused on physical health. Behavioral health, substance use disorders, and social determinants of health were left on the periphery.  However, these diagnoses and challenges can have an enormous impact on quality of life, physical health and overall health outcomes.

On average, 46% of the adult population is struggling with mental health issues and 60% of them never seek treatment from a provider. Meanwhile, 70% of adults who suffer from a behavioral health condition have comorbid medical conditions.  Patients with primary or secondary behavioral and mental health conditions typically have poorer physical health outcomes and higher medical utilization.

Four historic challenges blocking integrated whole-person care under the fee-for-service model

Many healthcare organizations have struggled with four historic challenges to providing whole-person care, where physical health care is integrated with behavioral health care, substance use treatment, and organization-driven or community-driven efforts to improve social determinants of health and issues of health equity.   These four challenges have been:

  • Funding programs under a fee-for-service payment model
  • Provider comfort and ability to deal with behavioral health issues raised during visits
  • Access to information that would help identify the needs of an individual and at the population level
  • Patient access to behavioral health providers, ambulatory substance abuse treatment and community-based social services

Funding programs under a fee-for-service payment model

Under traditional fee-for-service payment models, healthcare organizations had limited financial incentive to invest resources in programs that address behavioral health, substance use, or social determinants of health.  

Provider comfort and ability to deal with behavioral health issues raised during visits

This deficit left providers ill-equipped to respond to patients who raised these concerns during visits: Providers might have difficulty navigating a fragmented behavioral health and substance use treatment market to provide appropriate referrals.  Providers often don’t have the resources within their practices required to effectively engage and care for patients in crisis.  And without the support of a care team, providers might struggle to manage high risk complex patients while also seeing patients under the traditional fee-for-service model with often grueling schedules. Access to information that would help identify the needs of an individual and at the population level

Access to information that would help identify the needs of an individual and a population

Meanwhile, providers lacked key insights about the needs of their patient populations in these areas. Data about social determinants of health might not be consistently recorded or accessible for analysis.  Behavioral health and substance use disorder information might be stored in silos disconnected from physical health information.  And while health plans received claims from across all points of care, behavioral health and substance abuse disorders are often not shared with the provider.

Without a comprehensive picture of the issues impacting their patients, healthcare organizations would have a hard time designing and building a financial case for services in areas other than physical health.

Patient access to behavioral health providers, ambulatory substance abuse treatment and community-based social services

Finally, traditional fee-for-service models provide limited incentives for health plans and providers across the care continuum to share information about patients for better care coordination.  Integrating behavioral health care has been especially challenging, given a fragmented provider market and concerns about data-sharing. 

Value-based payment models bring new opportunities for whole-person care

The move to value-based payment models align incentives and presents opportunities for healthcare organizations to collaborate on whole-person care initiatives. 

  • Incentives reward healthcare organizations for delivering high-quality care while managing utilization – meaning that healthcare organizations are incentivized to address broader drivers of health outcomes.
  • Flexible global budgets enable healthcare organizations to invest in programs that address those drivers, from chronic and complex condition care management to community partnerships.
  • Organizations can support physicians with services such as; behavioral health care management, transportation and housing assistance, legal resources and care coordination services.  

Complex organizations entering value-based payment models (like ACOs and CINs) need connective infrastructure to support network-wide performance.  This includes underlying technology to aggregate and analyze data from a range of sources across the network including EMRs,  laboratory results, claims-based payer feeds and real-time ADT notifications.  Advanced analytics capabilities create new possibilities for whole-person care.

  • Physical, behavioral and social determinants of health, and substance use data can be aggregated and presented in a 360-degree patient view
  • Organizations can analyze the needs of the communities they serve and determine how to invest resources and develop partnerships with community-based organizations.
  • Population health management platforms that support care coordination across a continuum can be extended to behavioral health providers.

The rise of the connected behavioral health network

One of the most exciting developments associated with the move to value-based payment models is the rise of the connected behavioral health network.

Physical health providers were incentivized to adopt EHRs under Meaningful Use, but behavioral health providers were not.    Many behavioral health providers were not considered eligible providers under Medicare program rules, and the original design of the program and its measures were not well-aligned with behavioral health practice.    In the absence of the financial incentives associated with Meaningful Use participation, behavioral health providers were much less likely to implement EHRs.

A handful of forward-looking health care systems supported the integration of their behavioral health providers into their EHRs (building custom templates to support them) but the majority of behavioral health practices have not been not digitally connected.

Value-based care brings new incentives for behavioral health providers to capture clinical information digitally and to integrate physical and behavioral health data and operations to support population health management.  Pioneers in this space are using data to reimagine behavioral health care delivery. 

Connected behavioral health networks like IMSNY will use transformational technology and innovative strategies to improve the quality of care delivered to patients with serious mental illness and substance use disorders, minors with serious emotional disturbances, and chronic health conditions.

We’re proud to provide the analytics infrastructure that will support the innovative team at IMSNY.  To learn more, please read our joint press release

Heather Trafton, MBA, PA-C

Heather Trafton, MBA, PA-C is the Chief Operating Officer at Arcadia. She oversees every aspect of the Arcadia customer experience, from technical implementations to innovative partner programs.  Heather brings in depth knowledge of value-based contracts and population health strategies with a proven history as a strong leader at a nationally integrated health system. Her experience will enable Arcadia to provide customers the support they need to drive value and achieve success in value-based contracts .  Heather trained as a physician assistant in surgery and critical care and has thirteen plus years of clinical experience.  The combination of her clinical and business backgrounds gives her valuable knowledge and an in-depth understanding of how to succeed under risk-bearing contracts.

Previously, Heather was the Senior Vice President and COO of National Operations at Steward Health Care Network (SHCN).  SHCN remains one of the largest Risk-Bearing Provider/Accountable Care Organizations in the country, operating in 11 states with 5500 contracted physicians serving 2.1 million paneled lives.  SCHN also operates a Health Plan for 400K lives covered by four products in two states.   Heather led network-wide performance at Steward to high value in risk based contracts.

At SCHN, Heather drove operations across six states for both the ACO and Health Plan. She led a team of over 500 employees in a complex and matrixed organization, where she was responsible for provider engagement and field operations, clinical programs for both physical and behavioral health,  population health programs, performance improvement in quality, risk adjustment and patient experience. Heather guided operational performance improvement for payer-based risk contracts, driving the critical linkage between budget drivers and organizational efforts to improve quality, reduce risk and reduce unnecessary and preventable resource expenditures for both the ACO and Health Plan.  She also developed operational strategies in collaboration with business unit leads to achieve yearly budget and performance metrics, and worked to improve overall quality across payers, leading the network in identifying and closing gaps in care.

Heather joined Arcadia as an accomplished and well-regarded clinical leader with years of experience in operating under value based care, extensive experience operating a managed services organization, and a hands-on understanding of how to use the Arcadia Analytics platform to drive outcomes at a massive scale.  She led a partnership between Arcadia and SHCN to develop new capabilities and oversaw the rollout of Arcadia Analytics across a massive network.  Her initiatives to implement new technology and improved workflows at the site of care improved overall risk adjustment across populations, and her initiatives around care management, care coordination and transitions of care across populations and across sites of care supported improved health outcomes, lower unnecessary utilization and improved patient experience.    She looks forward to working with other innovative Arcadia customers across the country.

Heather has an MBA, Healthcare Concentration from George Washington University and an MS in Physician Assistant Studies from Northeastern University. She earned an undergraduate degree in biochemistry from Bridgewater State University.

November 8, 2019
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