December 4, 2020
In the primary care setting, physicians are constantly faced with the challenge and opportunity to care for patients who bring numerous and diverse needs into the clinic.
Behavioral health is one particular challenge that can make providing value-based care difficult. A recent report from the Commonwealth Fund highlighted this challenge and noted that high-need adults with a behavioral health condition struggle to receive adequate care, yet, at the same time, these patients have much higher health care costs.
Aledade understands the importance of integrating behavioral health care into the primary care setting. By striving to understand and meet all of the needs our patients have, we successfully help them receive higher quality care at a lower cost.
In fact, recently, I saw the importance of our behavioral health care coordination in action. A patient of Dr. Annil Sawh of the Orlando Medical Group in Aledade’s Florida Central ACO was utilizing the Emergency Department (ED) at a very elevated rate. This patient was abusing prescription opioids, and when she ran out, went to the ED to seek more medication.
Some people suggested Dr. Sawh should ‘fire’ the patient due to the high ED utilization, but Dr. Sawh was committed to providing her with the care she needed. Dr. Sawh tried setting up a “contract” with the patient, gradually limiting the number of pills she could receive. However, the patient ultimately continued drug-seeking behavior with other providers. She attended a drug rehabilitation program, but as is often the case with opiate abuse, she relapsed quickly after release from the program. Refusing to simply drop the patient from his care, Dr. Sawh turned to Aledade for some additional guidance.
The Aledade Central Florida ACO Executive Director, Sheila Fuse, suggested that Dr. Sawh request a consultation with me. I recommended that Dr. Sawh try treatment with Suboxone, an FDA approved medication for opiate dependence.
This intervention was highly successful. Before being treated with Suboxone, the patient conducted seven ED visits over the span of three months, but she has since avoided ED visits altogether over the past few months.
This patient broke the self-destructive and costly cycle of abusing opioids and making too many ED visits. She now works with Dr. Sawh to help a family member, with a similar set of problems, improve her life situation and break the cycle as well.
Aledade’s impact goes beyond the regular discussions we have with our physician partners.
Each month, I visit with care managers at the Green Spring Internal Medicine, one of our ACO partner practices in Maryland, to discuss psychiatric issues that come up in their care setting. During these visits, I provide advice and learn important lessons from the care managers at Green Spring that I can then take to Aledade practices across the country.
The Aledade depression toolkit is another example of how we help providers understand how to manage behavioral health conditions. This toolkit includes a comprehensive packet on how to treat depression, information on how to manage medicines, and guidance for care managers when psychiatric conditions arise.
Following the recent, serious flooding in Louisiana, Aledade was able to recommend resources for trained disaster relief counselors. Another small success was helping to facilitate better communication between a community mental health center and one of our Aledade practices in Kansas, to improve the referral process for primary care patients needing mental health treatment.
In the upcoming year, some upcoming initiatives involving behavioral health will include supporting our primary care providers in their efforts to offer advance care planning so that patients can face terminal illness in a manner consistent with their wishes and values, and we also aim to increase behavioral health-specific care management throughout our network of providers.
By placing a focus on quality behavioral health care, Aledade is giving providers and patients the tools necessary to manage these issues in the primary care setting. It’s a pleasure to work with physicians like Dr. Sawh and the providers at Green Spring as we all strive to ensure our patients receive the best possible care. Together, we will continue to develop effective ways to keep patients engaged and give them the health outcomes they deserve, while reducing the challenge of treating behavioral health issues in a primary care setting.