Integrating Behavioral Health Services into At-Home Care

Those living with a serious medical illness suffer from more than just the physical aspects of their condition. Often, they deal with a diverse range of mental health issues which in turn can exacerbate the negative effects a disease has on their bodies.   

It can be even more challenging to assist those with a diagnosed mental illness with the difficult realities of their chronic disease, especially near the end of life.

Research shows that “a considerable proportion of people entering a SIC (serious illness condition) will already carry a pre-existing BH (behavioral health) condition or will develop a new one.” Those could range from depression, anxiety, post-traumatic stress disorder, dementia, and many more.

Individuals with mild to severe mental conditions are being treated in hospice and palliative care settings nationwide, both of which are increasingly being administered in the home. Some experience issues like depression or anxiety because of their physical health issues. Others have a life-long mental illness that impacts their ability to function on a day-to-day basis.

For some, these stressors can lead to unhealthy behaviors, such as various forms of substance abuse.

Other patients may need additional support to understand, cope with, or make informed decisions about end-of-life care. Likewise, hospice and palliative care providers are attending to the physical needs of patients whose mental health needs may interfere with their ability to comply with treatment recommendations.

At least one in four older adults experience some form of a mental health disorder. Due to the rapidly aging population, the number of elderly folks who experience such conditions is forecast to double by 2030.

Although the need to integrate behavioral health with clinical care is gaining traction with in-home care providers for the value-based components of their integration, the two treatment types are still poorly tied together.

"When behavioral health is not addressed, individuals are overutilizing the hospital."

Brian Bertram is the CEO of Intrinsia Health, an Accountable Care Organization inside of ACO REACH, which works with seriously ill patients in Arizona, Nevada, Texas, South Carolina and Indiana, providing palliative, primary, and other forms of care. He sees a huge opportunity to increase mental health outcomes in home-based patients by weaving behavioral health services into care plans.

“When behavioral health is not addressed, individuals are overutilizing the hospital. It’s a failure on all fronts,” he said. “We need a more cost-effective option so people are not heading to the ER (for mental health services). This is where the real opportunity is -- to do that in the home.”

Bertram said that integrated behavioral health care could save as much as $25,000 a year on a per-patient basis by keeping them out of the hospital and a 14% reduction in overall hospital utilization in a demonstration program he helped run.

“We need a holistic approach to treating people with a serious chronic illness so they can age in place,” he said. “We can manage seriously ill people, but we can do more outside of just their medical care.”

So what can providers best do to integrate behavioral health services into their operations? Bertram has some answers.

“You need to ask yourself, ‘Do you see the whole person as you treat them? How are you addressing social determinants of health and health equity in your operations? How are you measuring outcomes?’” he said. “If you have answers to those, you can look into linking behavioral health into your care coordination efforts.”