Healing the Whole Person: First-of-Its-Kind Program Tests Mind-Body Care Model
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Program Aims to Improve Care, Lower Costs by Addressing Both Physical and Behavioral Health Issues and Social Needs
By Suzanne Kunis, Vice President, Behavioral Health
Tyler Neuman, a 24-year-old aspiring chef from Monmouth County, has been diagnosed with depression and a number of physical health conditions, but that hasn’t stopped him from pursuing a very New Jersey ambition.
“I would love to start my own food truck and spread the joy of New Jersey pork roll all across the country,” says Tyler.
Tyler is busy these days laying the groundwork for his dream. He’s attending the Monmouth County Culinary Education Center and training as a cook at an upscale restaurant in Red Bank. To deal with his depression and physical health issues, he’s participating in the Integrated System of Care (ISC), a first-of-its-kind program created by Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). As part of the ISC program, Horizon BCBSNJ has partnered with a local behavioral health agency, CPC Behavioral Healthcare (CPC), that is being paid to make sure Tyler gets all the care he needs – for both his mind and body – in an integrated fashion.
CPC provides the behavioral health services to address Tyler’s depression, while also serving as the program integrator – the care “quarterback” that oversees all aspects of Tyler’s care. They coordinate with health care providers from Hackensack Meridian Health, another partner in the program, to make sure Tyler’s physical health issues are treated. Horizon BCBSNJ supports the overall effort with data, analytics, reporting and operational and financial support. The program, which launched July 1 of last year, seeks to demonstrate that this approach in which a community-based behavioral health organization plays the lead role in coordinating services can deliver better health outcomes and drive down the total cost of a person’s care, all while improving the member’s overall quality of life.
Linking Mind and Body
“We know intuitively that mind and body are linked,” says Christine Barton, Clinical Design Liaison, Behavioral Health, at Horizon BCBSNJ. “It’s well known that physical health issues like cancer and heart disease contribute to depression and other mental health issues. The reverse is also true: people dealing with issues like depression, anxiety and substance use often have untreated medical conditions. Fear and stigma contribute to avoidance of physicians, and other concerns like housing and food insecurity, transportation, family and work concerns, may limit access to care.”
Nearly one in five U.S. adults – some 46.6 million in 2017 – live with a mental illness. And close to 20 million American adults (aged 12 and older) battled a substance use disorder in 2017.
“From a financial perspective, people with both physical and behavioral health issues make up a greater proportion of our annual health spend,” Ms. Barton says. “Directionally, we’re seeing that there is an impact on total medical expense when you treat behavioral and physical health conditions, as well as basic social needs, holistically – particularly in reducing visits to ERs and acute care hospitals.”
Despite the link between mental and physical health, treatment has often been fragmented and all too often fails to address social needs. Behavioral health care is also less well established than treatment for physical ailments due to a shortage of behavioral health care personnel and because of the age-old stigma associated with mental health and substance use issues.
Battling the Stigma of Behavioral Health
According to Ms. Barton: “When we talk with a client about speaking candidly with their primary care provider, there’s a moment of pause when they say, ‘Do I want my primary care provider to know that I have a mental health or substance use problem?’ Unfortunately, the stigma associated with behavioral health may prevent them from accessing care.”
Patients in the ISC program may be a Horizon BCBSNJ member already in a CPC program or they may be referred to CPC by a physician in the Hackensack Meridian Health network.
When a client enters the program, they come under the supervision of Ryan Cooperhouse, a licensed clinical social worker and program coordinator of the Horizon BCBSNJ ISC pilot. Ryan helps organize the patient’s behavioral health treatments at one of CPC’s five centers across Monmouth County. But he also asks whether the patient is seeing a primary care physician and inquires about any physical health and social needs they may have. If appropriate, he refers the patient to a doctor in the Hackensack Meridian Health network and then works with the patient to ensure they’re getting the care they need.
“Behavioral health issues sometimes prevent a client from even going to a primary care physician,” says Mr. Cooperhouse. “It’s just too overwhelming. So, we’ll walk them through the process. We’ll call the doctor’s office with them, schedule the first-time appointment and even bring them to the appointment, if necessary.”
This level of support was particularly helpful to Tyler, who in addition to seeing a new primary care physician also had referrals to a dermatologist and a gastroenterologist.
“Ryan and Julie helped me set up the appointments, figure out all the paperwork, deal with the lab tests and translate all of that into understandable terms,” says Tyler. “Having these resources in one place has allowed me to stay on top of everything.”
Extra Coordination Makes All the Difference
Horizon BCBSNJ provides extra money for this kind of coordination – something not normally done under traditional insurance plans.
“There are pieces of the integrated approach that have never been funded before by anyone,” says Vera Sansone, President and CEO of CPC Behavioral Healthcare. “But we’ve learned that having crisis staff who are available after hours and having enough staff so that we can send people to appointments makes a big difference.”
Ms. Sansone says the Horizon BCBSNJ program is more than halfway to its goal of 500 enrollees. The program will also be evaluated based on engagement rates, reduction in total medical expense and readmission rates.
While it’s too early to predict the outcomes, Horizon BCBSNJ has developed a staged plan to expand the program over the next five years, including an extension to Ocean County as a potential next step.
“I really believe this is the model for the future,” Ms. Sansone says. “It’s going to take time, but we’ve created a system that really can make a difference. I’m a believer.”
So is Tyler. “I’ve never had a bad experience with anyone at CPC,” he says. “The staff has been nothing but kind, friendly and helpful. Overall, it’s been a great experience.”