Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Behavioral Healthcare Providers

Name of Innovative Program: 
Diagnostic Evaluation Center (DEC®): On-Demand Behavioral Crisis Services. Real Solutions in Real Time
Sponsoring Organization
Behavioral Healthcare Providers
Name of Innovative Program Lead: 
Nicole Bauer
E-mail Address of Innovative Program Lead:
Project Description: 
Behavioral Healthcare Providers (BHP) has developed the Diagnostic Evaluation Center (DEC®) assessment tool that is used as part of an innovative care model for assessing and treating patients experiencing a behavioral crisis.  The DEC system provides on-demand access to a mental health clinician who uses two secure, web-based tools developed by BHP to support the DEC assessment and referral process.  First, the DEC application assists clinicians in identifying the appropriate level of care and treatment needed for patients, requires complete documentation, provides access to historical records across multiple care systems and integrates with the SchedulR®.  The SchedulR is a web-based scheduling tool that allows patients to be scheduled with BHP-network providers in real time, at any time. The goal of the DEC process is to ensure patients are treated in the appropriate setting and allows patients truly in need of inpatient care access to this service. BHP now provides the DEC services for patients in 10 locations, including 2 rural hospitals, with expansion to Hibbing, MN coming in early 2014.  Our telehealth expansion has allowed BHP to effectively replicate the DEC process in areas previously underserved by reducing the barriers of low demand and distance.
Creativity and Innovation: 
Emergency Department (ED) physicians struggle to determine the best level of care and are often unaware of appropriate referral options.  BHP is able to help by providing a thorough assessment and access to community providers.  BHP has established a behavioral network that includes over 4,500 licensed providers and programs within Minnesota.  The DEC clinicians have access to immediate appointment scheduling and provide comprehensive discharge planning.  A DEC audit team provides follow up the next business day and ensures that the resources provided were helpful. To reduce barriers such as low assessment need and lack of resources, BHP created access to the DEC process by utilizing telehealth technology.  Leveraging existing resources and community relationships already established by BHP, we enable patients to access to mental health clinicians located and increase access to follow up services based in the patient’s community in a realistic time frame.
In 2010 BHP was one of six alliance members recognized by Premier Insurance Management Services, Inc. (PIMS) of the Premier Healthcare Alliance, as a winner of the American Excess Insurance Exchange (AEIX) Risk Management Award.  This award recognized our DEC services, which reduced liability while providing high quality care and reducing cost.  BHP presented in Washington, DC upon receiving the AEIX award and encouraged attendees to replicate the same process in their communities.  Additionally, BHP has presented on the DEC process at local conferences, exhibits and schools with the goal of motivating attendees to reevaluate how they address behavioral crises and to find ways of improving coordination of care between healthcare systems.  While BHP is willing to partner with new care systems to provide the DEC services, we have also shared the strategies DEC employs to comprehensively and effectively meet patient’s behavioral crisis needs in various community settings.
The DEC services are sustainable through partnerships developed with insurance payers and healthcare systems that recognize the effectiveness of DEC services.  Most insurance companies agree to fund DEC assessments due to reduction in costs and the elimination of ambulance fees and additional caregiver costs ssociated with an ED visit.  BHP uses contractors and is able to increase access to licensed clinicians as assessment demands increase and when there is a high assessment demand, BHP provides on-site support.  Telehealth is available, however, when demand is low or transportation is too costly.  More and more services are being provided via telehealth and we have found that most new customers already possess the equipment needed to provide access to a DEC clinician.  Furthermore, BHP is able to nurture the relationships we have built with local network providers and programs to increase access that is necessary for quality patient care. 
The DEC process of assessment, collaboration and coordination is something that any care system can replicate.  The DEC services are currently functioning and thriving in emergency departments, schools, assisted living facilities and other emergent settings.  The telehealth component, in particular, has been successful in communities with diverse cultural and socio-economic populations. 
The DEC program admits approximately 50% of patients, saving the healthcare industry over $180 million. BHP immediately follows up with patients and, on average, 70% of patients attend their scheduled appointments.  Furthermore, while the DEC application prevents assessors from missing critical clinical content, ensures an audit team reviews the documentation the next business day on every assessment.  BHP tracks provider collaboration and can demonstrate that 100% of the time the appropriate information has been shared or an attempt to coordinate has been made.  Audit reports allow BHP to ensure that patients are being offered appointments within two business days over 80% of the time across all sites and BHP also sends out patient satisfaction surveys to ensure that patients are happy with their care.