In caring for people with mental health and substance abuse disorders, a community hospital in California sought to help patients recover faster while minimizing inpatient re-admissions. Partnering with the Achievements in Clinical Excellence (ACE) team from Optum™ enabled the hospital to gain insights into how to manage costs and provide better care. Based on our analysis of unbiased, risk-adjusted data, the hospital:
- Started an outpatient group-therapy program for individuals with a psychiatric diagnosis or chemical dependence problem
- Opened a new outpatient clinic where patients can visit with a staff psychiatrist shortly after discharge to review medications, discuss their discharge plan and schedule additional appointments with a clinician
- Had some frank discussions, fostered by our data, with staff clinicians whose 30-day re-admit rates exceeded our benchmarks; as a result, the hospital has been seeking to discharge these patients to a more robust substance abuse program where appropriate
Another medical center significantly improved its post-hospitalization follow-up rates and readmission rates by adopting our “bridge-on-discharge” program. A discharge nurse or social worker briefly meets with patients after discharge, but before actually leaving the behavioral health unit, to make sure they understand their discharge plans.
Data is the foundation of ACE, which rates the quality and efficiency of behavioral health care facilities, based on several widely accepted industry standards. For facilities meeting quality and efficiency standards, the benefits include a waiver of concurrent inpatient case review with Optum clinical staff and marketing support.
Facilities respect — and rely upon — our ratings, because we use a case-mix methodology to adjust for severity of the patient population. Thus, the data used to evaluate and tier a facility reflect its actual type of cases. This lends statistical validity to the measurements and enables meaningful comparisons among facilities.
Unbiased, risk-adjusted data can help pinpoint and reduce unwarranted variations in practice patterns that drive increased costs and poor outcomes. That leads to better, more cost-efficient care.
- White paper: A new compact for behavioral health care
- Five minute brief: Achievements in Clinical Excellence: Using data-powered insight to improve behavioral health care
About the author:
Irvin “Pete” Brock III, MD, Senior Vice President, Affordability, Optum Behavioral Solutions
Dr. Brock is responsible for Optum initiatives to improve member experience, quality and affordability of behavioral health care for employers and commercial and government health plans, including Medicare Advantage and Medicaid plans. He is board certified in adult and geriatric psychiatry, and he has nearly 40 years of experience in health care, including 20 years while serving in the U.S. Air Force. He is a recipient of the Bronze Star and is a combat veteran of Operation Iraqi Freedom. Dr. Brock received his medical training at the Uniformed Services University of the Health Sciences, Bethesda, MD, with fellowship training in the dementias of aging at Johns Hopkins University. He joined Optum in 2008.