One of the great challenges with behavioral health is that care can be uncoordinated. Patients with substance use disorders and mental health issues often seek care in multiple emergency rooms across a region, with no one getting a holistic view of the patient. In Southern New Jersey five health systems have come together to try to address the problem by sharing data and creating combined quality metrics.
Founded in 2014, the South Jersey Behavioral Health Innovation Collaborative is a partnership between five competing health systems in South Jersey. The Camden Coalition of Healthcare Providers supports their mission with a data-driven approach. Using claims data, the Camden Coalition team created a dashboard of agreed-upon metrics to help improve the quality, accessibility, capacity, and coordination of behavioral health services for all residents in the region.
Data from the collaborative’s Regional Behavioral Health Dashboard show that the number of visits to emergency departments with primary behavioral health diagnoses in the region increased about 40 percent from 2010 to 2016.
“We spent the entire first year of the collaborative reviewing claims data from across all five health systems,” said Emily Rosenberg Spector, senior program manager at Camden Coalition. They looked at how many patients with at least one behavioral health diagnosis were going to EDs in many or all of the five health systems. “We found that the more health systems a given patient had frequented in a five-year span, the higher the likelihood that they have at least one major behavioral health diagnosis,” she said. “Because patients are going to multiple health systems, it would benefit the patients and the health systems if they collaborated rather than treat them individually.”
The health systems in the South Jersey Behavioral Health Innovation Collaborative are Cooper University Healthcare, Inspira Health Network, Jefferson Health New Jersey, Lourdes Health System and Virtua. In 2017, four county behavioral health screening centers — Cumberland County Guidance Center, Legacy Treatment Services, NewPoint Behavioral Health, and Oaks Integrated Care — joined the steering committee of the collaborative to develop innovations for the region’s behavioral health system.
In the dashboard, the stakeholders are looking at the number of ED visits across the five health systems and identifying behavioral health visits through codes in claims data, explained Zach Martinez, data analytics manager. “In addition, we are looking at volume of in-patient admissions, ED 30-day re-visit rates, and what portion of ED visits are followed by another ED visit, regardless of facility.”
A health system looking only at its own data set would not be able to see that very easily, he noted. “They wouldn’t have the full picture by themselves. The dashboard also shows readmission rates on the inpatient side, and average length of stay for behavioral health inpatient visits. “We are looking at a measure of high utilization of behavioral health services,” Martinez explained. “We did by that looking at how many patients in a given year had 15 or more ED visits, which included at least one behavioral health diagnosis. We wanted to show what that population looks like over time.”
Although the dashboard is based on claims data, the Camden Coalition does operate a regional health information exchange with clinical data, and it is working to expand the amount of behavioral health data available with “break-the-glass” functionality.
“The expansion of the HIE functionality is an outgrowth of the trust and shared vision that started with the sharing of claims data,” said Stephen Singer, senior manager for information architecture and data analytics. “We are getting retrospective claims data every quarter and use it to track six metrics. As these five hospital systems further develop what kinds of programs they are collaborating on, that could change or be tweaked to give them the most appropriate feedback for the programs they develop.”
A Focus on Social Determinants
Spector said that a huge part of the effort is working more closely and sharing data with social service providers. “These health systems are ahead of the curve in understanding the part that social determinants play in effecting these individuals’ health and outcomes,” she said. “It is impossible to isolate behavioral health and make fixes to that system without seeing everything else impacting these individuals’ health and well-being, particularly for complex patients who have high utilization across the systems.”
Once you start broadening out the scope of social service agencies involve, you can really keep going, Singer said. "These individuals have a lot of unmet needs and come into contact with a lot of social service agencies. Each one generates data, and anyone not looking at all those encounters is not seeing the full picture and is missing opportunities to intervene,” he said.
In the case of Camden Coaliton’s Housing First program, it has connected to data from the jail and tries to connect people in the program who end up in jail with social workers. They also have a pilot program to reach out to people who are in jail and ease their transition back to the community.