Behavioral health is a top concern for hospital CEOs in 2024 — and for good reason, as health systems face persistent challenges in meeting demand and lack adequate funding to address widespread mental health issues.
What's more: Behavioral health affects every aspect of a patient's health. Individuals with mental health diagnoses often have other chronic conditions, such as diabetes or heart disease. To promote positive patient outcomes, holistic care is critical.
To learn more about how and why health systems need to change their approaches to behavioral health, Becker's Healthcare recently spoke with Jim Horst, DO, national medical director, acute behavioral health at TeamHealth.
Healthcare must reassess where + how patients access behavioral health services
Based on his experience, Dr. Horst sees several major challenges related to behavioral health services delivery, including place of service, access to care and quality of services. The greatest amount of behavioral health treatment occurs in emergency departments. Most patients don't have robust outpatient treatment opportunities.
"Without an integrated care model, we see significant bounce-backs to inappropriate placements, including emergency rooms," Dr. Horst said. "Ultimately, that results in poor outcomes and significant increases in costs."
New approaches are needed to address these pervasive challenges.
TeamHealth offers a new model of behavioral health support for health systems + communities
When it comes to integrating behavioral health into post-acute facilities or health systems, no one size fits all. TeamHealth partners with organizations to achieve a fully integrated care model that addresses patient needs and fulfills the community's needs for behavioral health services.
TeamHealth's board-certified psychiatrists, psychiatric nurse practitioners and psychologists collaborate with a partner organization's medical team, using their knowledge and skills to expertly treat the whole patient. Individualized treatment plans include psychotherapy, behavioral interventions and behavioral health medication management.
TeamHealth recently partnered with a large, multi-site health system in Texas to develop a new model of inpatient psychiatric care
At this health system, TeamHealth developed an acute inpatient psychiatry service for the organization's behavioral health programs. TeamHealth fully staffed over 20 full-time-equivalent team members, including full-time specialists, full-time psychiatric certified advanced practice clinical (APC) professionals and additional part-time clinicians to provide weekend and holiday coverage. These clinicians are cross-credentialed across multiple facilities, providing the system with greater resiliency.
TeamHealth has a presence in nearly all of the organization's emergency rooms, five inpatient psychiatry units and post-acute services. Communication throughout all these services ensures that patients are treated in the right setting.
"We know that a lot of access to behavioral health occurs in the emergency room," Dr. Horst said. "That's where we have an opportunity to shift the curve significantly. Creating the right placement for patients in the emergency room is a significant shift from the current treatment and outcome perspective."
This new model of care has improved the quality of patient care. Patient care and census are no longer impacted by a lack of physician availability. Coverage has been expanded in the emergency departments and medical floors, with dedicated consultation services provided for hospitals with high-volume behavioral health patients. TeamHealth's proactive approach to behavioral health medication management focuses on drug reduction, interactions and early identification of behavior changes.
"We want to transition patients from one place of service to another in a more seamless way," Dr. Horst said. "That means contacting providers in other service lines and providing patient history, as well as reconciling medications. If patients aren't restarted on medications or aren't given the right dosage, they often have significant problems and can result in people returning to the emergency room."
The partnership with TeamHealth has also improved the organization's operational and financial well-being. Through emergency department consults, TeamHealth clinicians help to reduce hold hours, which enables more efficient operations and patient throughput in the ED setting. The system has realized a revenue increase related to improvements in admission documentation processes. It has also eliminated expenses associated with locums providers and a previously budgeted telehealth back-up that cost each hospital between $10,000 and $15,000 per month.
Workforce changes and telehealth are key to solving the behavioral health crisis
As the behavioral health workforce ages, the landscape of behavioral health providers in the U.S. is shifting away from MD- and DO-credentialed psychiatrists to psychiatric mental health nurse practitioners.
"These specialized nurse practitioners have the ability to do the work of psychiatrists," Dr. Horst said. "We have created opportunity sets and leadership positions for these individuals at TeamHealth. Thanks to our behavioral health culture, we are becoming the employer of choice."
TeamHealth is also working diligently with health system partners to evaluate and update their bylaws so psychiatric mental health nurse practitioners can take on a much more visible care role on the front end. Since the COVID-19 pandemic, TeamHealth nurse practitioners deliver a considerable amount of mental health care and treatment.
Technology solutions like telehealth need to be the focal point in emergency rooms, inpatient floors and outpatient care settings. Health systems must create the right environment and connections with technology. This involves back-end technology and getting iPads in front of patients.
"We can use technology to influence care in a positive way," Dr. Horst said. "Historically, it was very difficult for mental health patients to get to behavioral health clinics. They had to get in their car or find other transportation to get to an appointment. Now it's much more seamless."
A culture of behavioral health + better outcomes for all requires commitment from the top
TeamHealth's CEO has created a culture of behavioral health. The same is true at TeamHealth's most successful partner health systems.
"If you look at where we are most successful, you find an engaged C-suite that knows what it needs to do and why," Dr. Horst said. "It's all about the culture at the top and cascading that throughout the organization. Once you get to the other side and create a holistic approach to behavioral health, the cost savings are significant. Organizations reduce boarding in the ED, improve patient throughput, decrease patient bounce-backs and experience fewer security issues."