CHA Behavioral Health Home Program Improves Care and Reduces Hospital Use Among Patients with Psychotic Disorders
SOMERVILLE, Mass. — Patients with serious mental illness who participated in a behavioral health home (BHH) program saw significant reductions in emergency department (ED) visits and psychiatric hospitalizations along with more preventive screenings for diabetes, according to a new study published by Psychiatric Services. The study was conducted by researchers at Cambridge Health Alliance, which launched its behavioral health home in 2015.
“The study extends existing literature by evaluating a clearly defined BHH program that was implemented in a safety-net institution for use by adults with schizophrenia spectrum disorders or bipolar disorder,” wrote lead author Miriam Tepper, MD, an attending psychiatrist at Cambridge Health Alliance and a faculty member at Harvard Medical School.
Cambridge Health Alliance’s BHH integrates medical services and care management with mental health care to offer more comprehensive, team-based care in an outpatient mental health clinic, offering a more comfortable environment for patients with serious mental illness than traditional primary care practices. The pilot included: (1) adding on-site medical care, health promotion activities (e.g. smoking cessation and healthy lifestyle groups), care coordination, and peer-to-peer engagement; (2) new electronic health record tools to track hospitalized patients; (3) addition of a medical nurse practitioner, care manager, and program manager to the interdisciplinary care team; and (4) a clinical paradigm shift toward integrated team-based care and chronic disease prevention and monitoring, and population health management.
For the study, statistical matching identified a comparison group (N=1,521) not enrolled in BHH, but similar to BHH patients (N=424). During the one-year study period, the total number of ED visits among BHH patients decreased from 1.45 to 1.19 visits while total ED visits in the control group rose from 0.99 to 1.16. Total psychiatric hospitalizations per capita declined for the BHH patients (from 0.22 to 0.10) while remaining stable in the control group (0.145 to 0.147). BHH patients also experienced greater metabolic monitoring than the comparison group. The groups did not significantly differ on measures of medical hospitalizations or cholesterol and blood pressure measures.
“Adults with serious mental illness have shockingly poor health outcomes compared with the general population,” said Dr. Tepper. “It is critical that the health care community address this health disparity in a way that accounts for the interplay of medical, psychiatric, and social factors. Our health care system is hard to navigate for the healthiest among us—creative approaches are essential to ensure that people with serious mental illnesses are able to access the care they deserve.”
“We are excited by these promising results, which support the theory that coordinated, person-centered, holistic care for people with psychotic disorders may lead to better care and lower costs and help our patients experience full lives in recovery,” said study co-author Alexander (Sandy) Cohen, MSW, MPH. “We hope our study will advance the science of integrated care for this population while also inspiring more mental health providers to adopt elements of a behavioral health home model or test their own innovations to improve how we prevent and treat mental health disorders in communities all across the US.”
Cambridge Health Alliance is an academic community health system committed to providing high quality care in Cambridge, Somerville and Boston’s metro-north communities. CHA has expertise in primary care, specialty care and mental health/substance use services, as well as caring for diverse and complex populations. It includes three hospital campuses, a network of primary care and specialty practices and the Cambridge Public Health Dept. CHA patients have seamless access to advanced care through the system’s affiliation with Beth Israel Deaconess Medical Center in Boston. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine and Tufts University School of Medicine. For more information, visit www.challiance.org.
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“Mind the Gap: Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness.” Miriam Tepper, Alexander (Sandy) Cohen, Ana Progovac, Andrea Ault-Brutus, H. Stephen Leff, Brian Mullin, Carrie Cunningham and Benjamin Lê Cook. Psychiatric Services. Published online first on August 1, 2017.