We now recognize that Behavioral health has a central impact on healthcare systems. 10-15% of the patients that come into our emergency departments are there for behavioral health concerns and 30% have a past behavioral health diagnosis. However, in the past, Behavioral Health was viewed as an adjunct concern. At WakeMed, we had eighty (80) care locations yet no organized behavioral health programs or services. This meant that people coming to our hospitals with behavioral health, psychiatric or substance abuse concerns were put in acute care beds and often waiting long periods for behavioral health concerns to be addressed. Not only does this impact patient experience and suffering, but it also increases the total cost of care to the healthcare ecosystem.
This situation requires a team effort
The solution cannot be found within the bounds of one health system. Behavioral health concerns are multi-faceted and healthcare systems do not have all the resources needed to solve all the contributing issues in our communities. For example, some people come to the emergency department because they are cold or hungry and have underlying behavioral health conditions. To address the root problems, we need to look at the social determinants of health as well as conditions.
We need the entire community to acknowledge and embrace the whole person, not just their presenting illness, and come together to solve them. We need government, communities, inpatient and outpatient care providers and nonprofits all involved in a big team effort. This is why we established the Network for Advancing Behavioral Health (NABH), a coordinated outpatient care system across Wake, Johnston and Durham counties. This team is made up of 80+ healthcare locations, three (3) hospitals, and a “social determinants of health network” with more than thirty (30) partners including nonprofits such as homeless shelters, and our inpatient network representing almost one thousand (1,000) beds. Overall all three (3) networks totaling over thirty (30) organizations form the WakeMed Behavioral Health Network (WMBHN).
How our team works together
WakeMed has an emergency department staff that includes physicians and nurses that is supported by behavioral health consultants available 24/7 including licensed social workers and clinical psychologists. Together, these teams conduct assessments to better understand the patient’s holistic needs.
To ensure we have the right resources and follow up care accessible for every patient, we rely on our WMBHN partners. During our evaluations, we establish the risk level and needs of the patient. The risk level informs whether the patient needs to be treated in inpatient care or if they can be discharged with an outpatient follow up or community resource. We match outpatient and community resource needs to our care partners using our bi-directional referral platform. This platform knows what services each of our network partners offers and their specialties. An algorithm in the platform matches a partner organization with a patient based on their individual clinical need and on their geography so the appointment is close to home. The platform also informs us whether a patient accesses the resources they need after discharge. Before, if we referred a patient to a food pantry or to an outpatient therapy appointment, we did not know if they attended. Now we have a digital referral platform in place that tracks appointments and attendance. If a patient does not show up, case managers receive an electronic alert to follow up. Plus, when that person arrives at the community resource, if they then have a behavioral health crisis, that can be relayed back to the care team. This closes the feedback loop to ensure the patient is receiving the care and resources they need.
By transforming our approach, our patients now are able to get timely access to the care they need and deserve much faster (actually 80% faster than pre-WMBHN). For patients who previously were in acute care beds waiting to be treated, we have seen a 60 percent drop in average length of stay. There has been a 38 percent drop in behavioral health readmissions which suggests that patients’ needs are being met, decreasing their likelihood of returning to crisis.
Investing in emerging technology
Behavioral Health patients are among the most complex and it can be difficult to understand what their true needs are. The earlier we can identify those foundational issues, intervene, and wrap care around a person, the better chance this person has at a better life. To support earlier and accurate detection of issues, we are investing in our team by providing them training and emerging technologies. We believe that innovation in technological solutions including artificial intelligence, automation and analytics can help empower our teams to deliver better care at lower costs in the longer term, and ultimately provide upstream intervention versus our current crisis-built system.
As a health system we have an enormous responsibility – to protect and enhance the wellbeing of everyone in the community. By improving how we assess the true needs and by taking the lead to put care pathways in place beyond the hospital, we can help people get through their moment of crisis and not return to crisis. By partnering with our outpatient behavioral health and community organizations, and by investing in our teams with training and technology, we are supporting longer term solutions that improve care and improve lives. The transformation as a team and as a community is what delivers the long-term results.