Behavioral Healthcare Providers (BHP) developed the Diagnostic Evaluation Center (DEC) Telebehavioral Health Crisis Assessments Program in 2012 to expand access to licensed mental health professionals during emergency situations. Healthcare organizations who contract to use the DEC services triage their patients to determine if a behavioral health assessment is necessary. A request is then sent to BHP electronically, whereby a team of clinicians and coordinators help to assess the patient’s level of care needs, provide treatment recommendations and coordinate the appropriate care. Assessments are conducted using a secure, two-way audio/video application and care team communication is done via video or phone. The care team receives treatment consultation, assistance in bed finding, and is sent a copy of the completed crisis assessment. The patient receives an assessment by a licensed clinician, follow-up planning and discharge support from staff at BHP.
The DEC program provides on-demand telehealth access to a DEC clinician 24/7. Behavioral crises occur at all hours and days of the week, and patients need timely access to assessment and referral support regardless of location, day or time. Through the use of telehealth technology, BHP is able to provide access to more locations using the same clinician, which reduces the focus on volume requirements. Communication with the patient’s care team occurs within minutes of the assessment request, with average wait time from request to patient interview approximating 30 minutes across all sites. The DEC process also includes follow-up planning if the patient is not admitted for inpatient care. BHP has developed a network of over 55,000 provider and clinic combinations state-wide who partner to provide access to appointments for patients in need. Over 80% of discharged patients are offered an appointment within two business days.
Timeliness and safety are quality measures vital to emergency care. BHP feels it's important to have experienced licensed mental health professionals assessing patients who present with acute behavioral symptoms. These clinicians can quickly build rapport, determine a diagnosis and make timely care recommendations in a fast-paced setting. BHP also mointors wait time averages and has developed a coverage plan that provides backup options during high demand times. The DEC program focuses on thorough assessment documentation and care planning as key clinical compenents of the program. The goal is to assist care teams and ensure that patients are referred to the appropriate treatment levels so the right care begins sooner. DEC provides clear follow-up instructions and engages in safety planning with patients as needed. Several quality reports track both clinician and patient assessment metrics to ensure that care provided is effective. Coordinator support aims to improve efficiency.
The DEC program saves care teams time by assuming resposibility for behavioral assessment and referral activities, allowing staff to use their time more effectively. Through the use of web-based documentation and scheduilng tools, DEC is able to connect patients to timely follow-up care and prevent unnecessary admissions. This eliminates the need for 1-to-1 staffing while the patient awaits admission, and reduces the total cost of care for patients and the healthcare system. Follow-up coordinator support also prevents re-admissions by providing patients referral assistance and education about community resources. With permission, the DEC assessment is shared with the patient’s treating providers to save on further assessment time needed to continue care. These activities align well with current accountable care inititives. In schools, DEC often prevents the unnecessary cost of staff time, ambulance rides and emergency room fees when inpatient care is not indicated.
The DEC program creatively combines electronic medical record (EMR), telehealth and documentation technologies to advance the coordination of care. BHP designed the DEC application with flexible workflows for use in emergent settings at any time. The DEC application can be integrated with other EMR's, is web-based and provides electronic access to the DEC assessment for seamless provider collaboration. Care Coordinators are utilized throughout the DEC process to allow clinicians to focus on patient-centered activities and BHP network providers are encouraged to provide open times on the SchedulR to increase patient referral options. Predicting volumes and coverage needs is challenging, however DEC has cross-trained clinicians at multiple sites to provide backup support during busy times. BHP enhances behavioral health through innovation, provides education, and works tirelessly to utilize all available resources in support of patients at their highest time of need.
The DEC program has successfully treated behavioral crisis patients since 2002, and launched its telehealth services in 2012. DEC continues to invest resources in system enhancements, adapting to market demands. Recent assesment revisions include more screening tools and a focus on cognitive funtioning in older adults. These changes led to increased education for DEC assessors and staff at locations using DEC. DEC clinicians also educate school staff on inpatient admission criteria and BHP continues to present on telehealth and assessment technologies at a local and national level. In partnership with a rural hopital in Northern Minnesota, DEC assisted in staff education, behavioral health services expansion and participates in collaborative discussions about patient care practices and workflow efficiencies. The DEC program has been a leader in providing added support for patients experiencing acute behavioral symptoms, and continues to build strong partnerships along the way.
The DEC program is self-sustaining through contracts established with insurance payers througout Minnesota. DEC charges customers an assessment fee only when insurance cannot be billed, minimizing the cost to the facility. Payers continue to support DEC due to reduced cost over time. This allows DEC to cover the cost of both assessment and care coordiantion activities, and keeps the customers happy by providing comprehensive support with little time and resource commitment from them. DEC customers provide support for the program through continued use and by sharing success stories in joint-marketing ventures and by word-of-mouth. Overall, on a 5-point scale (5 is highest) DEC has scored 4.0 or higher on customer satisfaction surveys, with the highest support given to the recommendation for use of DEC in other facilities (4.9). DEC continues to expand, using telehealth to reach more people, reducing both geographic and volume contstraints that limited expansion in the past.
BHP recently began an initiative to replicate the DEC process in other care systems. Several integration options have been developed that would not involve BHP management or oversight. System access and consultation services can be purchased, allowing healthcare administrators to determine how DEC would best support their staff and patients, also providing the same framework to replicate the self-sustaining process that BHP has utilized with its current customers. BHP also continues to particpate in conference presentations to share knowledge gained by implementing a telehealth service and challenges healthcare systems to rethink how they treat behavioral crisis patients. The DEC program is currently utilized in multiple care settings, including emergency departments, schools and assisted living facilities. BHP’s vision is to replicate the DEC process at a national level, and provides support for the continued use of telehealth technology in the behavioral health field.
At a site in rural Minnesota, DEC reduced behavioral admissions from the emergency department by 20% from 2014 to 2015, and was able to connect patients to the recommended outpatient care over 80% of the time. Wait times continue to approimate 30 minutes or less, which aligns with customer expectations. DEC also began an intiative to increase collaboration with primary care physicians, and in 2015 met its initial goal, showing that 50% of identified primary care physicians received a copy of the DEC assessment. One physician shared “I appreciate what you guys have done for our community.” Hospital customer sites scored DEC at a 4.0 or higher on a 5-point scale (5 is highest) in all areas, agreeing on the recommendation to use DEC in other facilities (4.9). Metrics collected continue to provide positive feedback for the team, and identify areas for continued improvement.