Since that change, there are a number of initiatives that have been put in place to better address their needs at WMHS. We created dedicated care coordinators and clinical coordinators in Behavioral Health; we are working in partnership with other providers to care for BH patients in settings other than as inpatients; better linking Psych services with inpatient care since close to 50% of our acute care patients also have a BH diagnosis; linking BH services with Primary Care to serve these patients more quickly and more thoroughly and most recently, evolving to using DNA testing to determine the efficacy of psychotropic drugs, just to name a few.
This population is especially vulnerable and can be challenging, but recognizing that you can certainly make a difference in their care while reducing unnecessary admissions, readmissions and ED visits can be extremely rewarding for all concerned.
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Posted: 09 Jul 2015 05:31 AM PDT
Norbert Goldfield is one of the more sophisticated and deep thinkers on the topic of integrating financial incentives with patient care improvement. He and Richard Fuller recently addressed the issue of the segmentation of different kinds of patients under such programs. Here's a teaser:
"It is evident that mental health issues drive increased utilization and, particularly within Medicaid programs, increase the likelihood of readmission. Poorly constructed penalties, apparent in many earlier health management efforts, look at the frequency of readmission at an institution, typically a hospital, and conclude that the hospital patient population as a whole has high rates and therefore the hospital performance merits a penalty. The result is a push to exclude and dilute the impact of patient populations that generate this loss, while the providers that treat them are seen as “loss centers.” The resulting mindset is a pervasive fear in which complex, high-needs patients that require more resources will uniformly experience higher rates of adverse outcomes, leading to them being identified as a problem.
"Exclusion from incentive programs may remove patient populations from the radar of cost-cutting administrators but will also ensure that attempts to improve their care will not be a top priority.
"But, with better crafted policies this need not be the case – in fact the reverse is true."
"It is evident that mental health issues drive increased utilization and, particularly within Medicaid programs, increase the likelihood of readmission. Poorly constructed penalties, apparent in many earlier health management efforts, look at the frequency of readmission at an institution, typically a hospital, and conclude that the hospital patient population as a whole has high rates and therefore the hospital performance merits a penalty. The result is a push to exclude and dilute the impact of patient populations that generate this loss, while the providers that treat them are seen as “loss centers.” The resulting mindset is a pervasive fear in which complex, high-needs patients that require more resources will uniformly experience higher rates of adverse outcomes, leading to them being identified as a problem.
"Exclusion from incentive programs may remove patient populations from the radar of cost-cutting administrators but will also ensure that attempts to improve their care will not be a top priority.
"But, with better crafted policies this need not be the case – in fact the reverse is true."
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