Bringing Evidence Into Practice: Lessons From a Behavioral Health Care Model Redesign

Abstract

Purpose: The rapid change and instability omnipresent in the health care delivery and payment systems present a formidable challenge for clinicians and managers tasked with mental health and substance use disorder care delivery. Bringing evidence based practice into the clinical routine can be extremely challenging. The purpose of this project was to meet the needs of the changing health care landscape through a behavioral health care model redesign. Methods: This article reviews a case study of one organization’s experience in reforming mental health care delivery, and describes the implementation of a care model redesign in behavioral health. The case study emphasizes how the organizational structure and process were reshaped to address systems-level challenges, such as overburdened providers and lengthy patient wait times. Results: Since launching the behavioral health care (BH) model redesign in February 2016, the site-wide triage system evaluates roughly 1,600 patients each month. Average time to triage is 2.1 days, ranging by site from 1.4 to 4.1 days. The average wait time for therapist appointments dropped from over 60 days to approximately 10 days. Average therapist caseloads have decreased from 120 to 35 patients. The days between visits fell 40%, from an average of 24.9 days in 2015 to 15.9 days in 2017. Over 1,100 continuing education credits have been awarded as part of redesign process. Five care facilitators were hired and deployed to the sites with the highest perceived need. The care facilitator program is still in the pilot phase, but initial return on investment analyses have indicated savings of $112 per member per month. The department currently has signed letters of agreement with many community provider partners, who receive, on average, 260 referrals monthly. More than 60 therapy groups have been designed and initiated to augment medication and individual therapy interventions. These groups currently support over 350 patients’ treatment. Patient willingness to recommend the BH practice rose from 77.2% in January 2016 to 79.9% in December 2016. Additionally, psychopharmacology practices have been standardized across the BH sites, to ensure excellent care delivery to all patients. Conclusions: Significant hurdles, such as complexities associated with scale stakeholder engagement, were encountered in rolling out the care model redesign process. Despite these obstacles, the model redesign has been successful in the initial phase based on results documented to date. We hope this model may serve as a platform for other organizations to innovate through BH care redesign.