Council Discussion: Overcoming Healthcare Division: Unveiling Practical Understandings to Embrace Comprehensive Patient Care
Executive leader of Bamboo Health. Driving innovation and growth in the healthcare sector with previous roles at Lumeris and CVS Health.
Despite the U.S. spending twice as much per capita on healthcare compared to other wealthy nations, it lags behind in critical health indicators like life expectancy and infant mortality. The reason? A failing to acknowledge and treat the essential aspect of health: behavioral health.
Many healthcare providers feel they lack the resources to manage underlying mental health issues, resulting in a healthcare system that reacts to illnesses rather than preventing them through holistic care.
The Hidden Issue: Untreated and Neglected Behavioral Health Conditions
Consider a diabetic patient frequently seeking emergency department (ED) treatment. While each visit alleviates immediate symptoms, mental health problems like depression or substance abuse disorders remain unaddressed. This situation is unfortunately frequent.
Intriguingly, around 20% to 30% of the Medicare and Medicaid population struggles with behavioral health issues. More alarmingly, individuals with both diabetes and severe mental illness have a 28% higher hospital admission rate. Providers often overlook these mental health conditions due to a lack of tools to identify and treat them, perpetuating a cycle of inefficiency, escalating costs, and widespread misery.
The Price of Inaction
People requiring behavioral health care face 2.8 to 6.2 times greater treatment costs than other patients. UnitedHealth Group's 2022 analysis reveals that engaging these individuals in primary or urgent care settings, before they resort to crisis services, could prevent 18 million unnecessary ED visits and save $32 billion in healthcare expenses.
Wasted Opportunities for Intervention
According to the Centers for Disease Control and Prevention, 65% of the 109,000 drug overdose deaths had a chance for intervention. Yet, our healthcare system remains reactive, missing these crucial intervention opportunities, as clinicians work in a fragmented environment and lack prompt, actionable information. Moreover, without a holistic perspective of a patient's health background, including both physical and behavioral health, providers cannot intervene effectively during the crunch moments.
Utilizing Technology to Connect the Dots
In a world where technology guides us to new locations and monitors our sleep patterns, why doesn't healthcare embrace similar innovations more extensively? Imagine if doctors could access a live view of a patient's health journey directly within their workflow. This degree of insight would allow healthcare providers to intervene effectively during key moments, improving outcomes and minimizing costly readmissions.
The Influence of Technologically-Driven Care
Consider the hypothetical case of Ruth, a 73-year-old woman battling substance abuse after surgery, also suffering from kidney disease, diabetes, and depression. After an overdose, she is rushed to the ED. Typically, she would receive life-saving care and then be discharged, only to return again. However, what if the ED physician had real-time insights, seeing Ruth's history of ED visits, controlled substance use, and mental health status?
In this situation, the physician could refer Ruth to a behavioral health provider during this critical care moment, schedule her appointment, and enroll her in a care management plan with regular monitoring. This proactive approach to whole-person care would help Ruth manage her challenges and minimize future ED visits.
Essential Questions for Enhancing Care Coordination
To leverage technology effectively, healthcare providers should ask themselves:
- Are we capable of identifying patients at risk of becoming high-cost and high-need, and connecting with them during critical, pivotal care moments?
- Do our care teams have access to real-time insights and notifications about a patient's health journey?
- Are we integrating both physical and behavioral health information into a unified, single view?
- For individuals with behavioral health conditions, do we possess a reliable method for engaging them, prompting behavior change, and directing them to the appropriate next step?
- Can we monitor ongoing adherence?
If the answers are negative, organizations may continue to invest heavily in care coordination, focusing on common chronic conditions and comorbidities but neglecting underlying behavioral health challenges and missing out on beneficial real-time insights when they are most needed.
From Reactive to Proactive: The Future of Healthcare
By wisely implementing technology when necessary, we can transform a reactive healthcare system that tackles health issues only after they escalate. This means integrating interoperable systems that provide actionable insights, enabling clinicians to provide comprehensive, whole-person care, encompassing both physical and behavioral health.
Technology alone cannot solve healthcare fragmentation but is a vital tool for supplying the real-time, actionable insights essential for improving care coordination, specifically for high-need, high-cost patients with behavioral health issues.
By embracing technological innovations and focusing on whole-person care, we can enhance patient outcomes, reduce unnecessary costs, tackle the root causes of inefficiency in our healthcare system, and improve the lives of those in our communities.
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In the context of improving healthcare coordination, Jeff Smith, the executive leader of Bamboo Health, could collaborate with other tech-savvy executives like himself in the Technology Council to integrate real-time insights into workflows and address behavioral health conditions more effectively, potentially reducing hospital admissions and saving healthcare expenses.
Given his background in driving innovation at Lumeris and CVS Health, Jeff Smith's insightful perspective and leadership role in the Technology Council could significantly contribute to overcoming the fragmented healthcare environment, allowing clinicians to make prompt, informed decisions about high-need patients struggling with both physical and behavioral health issues.
