OIG Series 6: Addressing Behavioral Needs and Social Determinants of Health

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Value-based care practices are not afraid to stray from convention if it means patients have better access to care and avoid emergencies. The above and beyond mentality that accountable care organizations (ACOs) center on is finding the reason for noncompliance in their beneficiaries. Often, behavioral health and social determinants of health (SDoH) are to blame for an inability to attend regular appointments before a hospital admittance occurs. The sixth Office of Inspector General (OIG) study strategy is confronting the behavioral needs and social determinants that prevent patients from receiving proper courses of treatment. The 20 high-performing ACOs achieved significant positive outcomes by recognizing and addressing both of these challenges, and all ACOs can benefit from additional tactics. 

Behavioral Health

The Acting Inspector General of the Department of Health and Human Services, Joanne M. Chiedi, separated behavioral health and SDoH into separate categories. Research indicates a connection between behavioral health and the overutilization of emergency services. Behavioral health encompasses a series of mental health disorders that can drive sufferers to participate in behaviors detrimental to their outcomes. To address behavioral health head-on, these ACOs:

  • Recruit behavioral health providers to join their organization
  • Use data to target behavioral health beneficiaries
  • Add behavioral healthcare practices into primary care

Recruiting behavioral health providers is a successful tactic for several of the ACOs. Their expertise is invaluable, so much so that the ACOs want primary care physicians to better spot signs of behavioral disorders in their patients, screen for them, and even prescribe treatment to more common conditions. One ACO also utilizes telemedicine so that behavioral health professionals in neighboring states can treat the organization’s patients, allowing a greater radius for care.

Claims data insights help several of the ACOs identify beneficiaries with a history of mental health diagnoses or related medications to mental health treatment. The only barrier that the ACOs cite is that there is a limited amount of usable data, and many states require patient consent to release them. To combat these data challenges, the ACOs use screenings for drugs, alcohol, and the like to help fill in any gaps.

Including behavioral health protocol into primary care settings is highly beneficial for several of the ACOs. Notably, one ACO is developing several all-encompassing clinics to offer primary care, behavioral care, and social work under one roof. ACOs that combined these forms of care have greater collaboration, enhanced productivity, and patients are easier to monitor for physicians when it comes to appointments and medications. Where the incorporation of behavioral health especially makes a difference is in the lives of complex care patients through the creation of global care plans.

Social Determinants of Health

Social determinants of health have become more of a priority in the healthcare industry. According to HealthyPeople, SDoH is a person’s education, their environment, their economic stability, their access to healthcare, and their community context that impacts their health and their ability to receive adequate care. Fortunately, these factors are not going unnoticed, especially in the ACO community. Chiedi determines that proactivity and convenience lead to success in confronting SDoH; the strategies they use include:

  • Bringing in case managers and other non-medical staff to address needs
  • Targeting beneficiaries predicted to be in need

Since SDoH often lead to noncompliance, Chiedi remarks that affected beneficiaries are at an increased risk for developing chronic conditions and overutilizing medical care. The decision to incorporate non-medical staff not only physically benefits patients in the ACOs, but offers added convenience and less self-consciousness for whatever their disposition is. Non-medical staff primarily consists of social workers and case managers to connect patients to the right channels. These generally include medication guidance, transportation, food, and housing.

The way these ACOs determine who may be lacking first is starting with their dependent groups. ACOs took different approaches to find groups that are likely to have unmet social needs. One ACO began with high-risk patients who also have complex care needs to see if there was any intervention required. Others started with emergency department (ED) high-utilizers or patients who had trouble adhering to their prescription instructions. The core of SDoH are that patients lack in some way; it may be for food, which they can get in the ED, or a place to sleep. The final point Chiedi makes about these ACOs’ challenges with SDoH is the fact that efforts are generally not reimbursed by Medicare, so funding is often a challenge.

Join us next time as our Chief Technology Officer, Mike Hoxter, covers the final OIG strategy to end this series.

The full study can be found at https://oig.hhs.gov/oei/reports/oei-02-15-00451.asp

Read more from Kelly Kolepp, an Advisor at Lightbeam.

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