Payer Seeks to Lower Behavioral Health Hospital Readmissions

Blue Cross & Blue Shield of Rhode Island (BCBSRI) is partnering with Butler Hospital to address behavioral health hospital readmissions through methods such as care management and counseling.

“Transitioning from an inpatient setting to a home one can be difficult, particularly for people struggling with behavioral health conditions. Many do not have the adequate outpatient supports necessary to facilitate a successful transition. This can often result in readmissions,” explained Sarah Fleury, manager of behavioral health at BCBSRI.

“By collaborating with Butler Hospital, which is well-positioned and committed to positively impacting successful transitions for their patients, we are able to provide necessary supports for our members during what can be a critical time during their recovery journey.” 

Through the program, which is called the Butler Hospital Transitional Outpatient Program, BCBSRI members who are admitted to the hospital for behavioral healthcare needs will receive counseling, medication management support, and case management when they are discharged.

The program is designed to be a bridge from temporary care to long-term care for members with behavioral healthcare needs. Members receive this support for one to three months as they prepare to progress toward the next stage of their recovery.

Certain quality measures will define whether the program has been effective in achieving its goals. The partners are aiming for a five percent reduction in the number of 30-day readmissions. Additionally, they have set a goal of initiating member engagement within 48 hours of hospital discharge.

“We are excited to be able to provide this innovative new clinical service to patients to ensure they have the care they need following hospital discharge. The program follows a team-based approach and offers an increased level of support at a critical time to prevent relapse and help patients get back to their everyday lives,” said Brandon Gaudiano, clinical director of the Transitional Outpatient Program at Butler Hospital.

Payers have leveraged several approaches to prevent behavioral and mental healthcare conditions from needing hospitalization, primarily by making access to behavioral healthcare more ubiquitous.

Using the correct screening strategies can be crucial to preventing hospitalization in the first place. Failing to catch mental and behavioral healthcare conditions early can lead to a lack of treatment and more severe developments.

Warmlines are another strategy that payers have employed to prevent early-stage mental health conditions from developing into more serious mental or behavioral health crises. As opposed to hotlines that serve patients that are in the midst of an emergency, these call centers handle lower-risk situations and help connect patients with mental healthcare support.

During the pandemic, telehealth and virtual care became essential to supporting members with mental and behavioral healthcare needs.

However, these strategies may not necessarily take into account physical care factors.

The presence of comorbidities is a critical factor in whether or not a member is likely to be readmitted to the hospital after a serious behavioral healthcare event, according to a report from the Center for Health Information and Analysis.

The report found that patients with comorbid behavioral healthcare conditions stayed in the hospital over a full day longer than their counterparts and had a 95 percent higher rate of readmission than those without a comorbid behavioral health condition.

It is not unusual for certain conditions to go hand-in-hand with behavioral healthcare diagnoses. The rate of incidence of behavioral health conditions among multiple sclerosis patients, for example, is three times the national rate.

Given the tie between physical conditions and mental and behavioral healthcare, siloing behavioral and mental healthcare solutions via telehealth or other strategies is not the optimal, long-term strategy, payer executives have emphasized.

“Most things we think of as behavioral health aren’t actually seen by behavioral health providers. The biggest providers of behavioral health services are actually not behavioral health providers,” Paul Sherman, MD, chief medical officer of Community Health Plan of Washington, told HealthPayerIntelligence. “It’s actually our primary care clinics, providers, and staff.”

In order to keep members out of the hospital and provide the right support so that they can remain stable in their behavioral conditions, the payer industry and the healthcare community at large will have to strive for better integration of behavioral and physical healthcare.

As the country emerges from the coronavirus pandemic, maintaining a whole person care mindset towards behavioral healthcare—both when leveraging telehealth and in a clinical setting—will be crucial to ensuring that members receive the care they need and avoid poor outcomes, such as hospital readmissions.

Methods that provide long-term support, similar to the Transitional Outpatient Program, could be a step towards better integration of physical and behavioral healthcare.