Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Vinfen

Name of Innovative Program: 
Community Behavioral Health Homes and Telehealth
Sponsoring Organization
Vinfen
Name of Innovative Program Lead: 
Elizabeth Cella
E-mail Address of Innovative Program Lead: 
cellae@vinfen.org
Project Description: 
Vinfen is leading the way in implementing a novel technology solution to connect two critical life areas for people with severe and persistent mental illness: their physical and mental health needs.  Vinfen  has partnered with three other community based behavioral health organizations in the Metropolitan Boston area, one non-profit managed care entity, Dartmouth University and Robert Bosch Healthcare, a leader in telehealth system production, to build and evaluate a Community Behavioral Health Home (CBHH) model integrating primary and behavioral health care for adults with severe and persistent mental illness.  We have imbedded Nurse Practitioners (NPs) and Health Outreach Workers onto existing community based psychiatric rehabilitation and recovery teams to bring integrated care to individuals in their communities.  Our focus is to improve their health outcomes and quality of life, to increase their access to health care services, to improve care coordination and to reduce use of acute care services and their associated costs.  To this end, we are using an innovative telehealth system: the Health Buddy designed by Robert Bosch Healthcare. The Health Buddy is a simple, convenient device designed to help individuals manage their physical and mental health needs on a daily basis in the comfort of their homes.
Creativity and Innovation: 
The use of emerging technologies in health care is growing at an astounding rate, but these advances are not typically available for individuals with severe and persistent mental illness.  To address this inequity, our project provides individuals with access to more advanced technologies via the Health Buddy.  The system is designed to enable individuals with chronic medical and psychiatric conditions to connect with their health care teams daily while learning to manage their conditions effectively and independently.  Each day a new session is available for completion based upon an individual’s unique conditions and parameters.  During the session, an individual reports health status information and receives new information about causes, symptoms, and intervention recommendations. The data from each session is coded by algorithms based on level of urgency and sent to a NP for review and action to ensure proper disease management and overall improved health for the individuals we serve. 
Leadership: 
We believe that this model, in particular our use of emerging telehealth technologies, has the capacity to impact the entire service system.  Many PCPs are not equipped to address the complex needs of those with serious mental illness and significant medical conditions; if these conditions remain unmanaged, it can have a profoundly negative impact on health.  This can result in an increased use of acute care services at high costs to insurance providers.  It remains essential to continue to develop close relationships with local hospital and medical providers, research institutions and government agencies to better coordinate care among individuals’ provider teams.  Our CBHH model has paved the way in building such collaboration.  Vinfen selected our three behavioral health organization partners and Commonwealth Care Alliance (CCA), a non-profit managed care entity participating in the Massachusetts’ Duals Demonstration Project, to ensure expanded organizational involvement in this initiative throughout the Boston area.  
Sustainability: 
The Centers for Medicare and Medicaid Innovation (CMMI) has awarded funding to support our model to use telehealth technologies for this vulnerable and high risk population.  Evidenced by our project, we believe the success of the Health Buddy as a tool to help manage chronic diseases, improve health and reduce unnecessary utilization of acute healthcare services will influence insurance provider payment practices. Telehealth is gaining stature across the nation as a reimbursable Medicaid and Medicare service. This together with movement towards accountable managed care, global or episodic payments and a compelling need to integrate physical and mental health provides strong evidence that payors will recognize the cost/benefit value, and therefore sustainability of our telehealth model.
Replicability: 
Vinfen has managed the implementation of comprehensive data collection, data analyses and reporting processes to ensure we are able to evaluate and share our project results. We disseminate this information clearly and consistently to our partners and CMMI to enable replication by others.  We have received approval from the Department of Mental Health’s (DMH) Institutional Review Board to use relevant outcome measures for publication for those individuals from whom we have received consent.   As we are committed to replication of our model, we have presented our model design and use of the telehealth system with preliminary findings at several behavioral health field conferences thus far: 
  • Massachusetts Psychiatric Rehabilitation Association’s Annual Conference
  • National Provider Council’s Convention
  • Massachusetts DMH “Innovations in Health and Wellness for Individuals with Psychiatric Disabilities” Conference
  • Massachusetts DMH Health and Wellness Symposium
  • Connect 4 Mental Health Campaign Forum, Washington DC
 
Results/Outcomes: 
We have devoted significant resources to define data elements to collect and analyze, and to standardize processes for data collection amongst our partners.  As a result, we will compare acute care service use and relevant health metrics to Health Buddy session compliance to determine how the use of telehealth may influence our population’s health outcomes.  Users of the Health Buddy complete the SF-12 every six months, a scale designed to measure general health status from the individual’s perspective.  Preliminary findings suggest that roughly one-third of Vinfen’s participants use the Health Buddy 85% of the time, and 15% of participants use the system 90% or more of the time.  We have provided 183 interventions as a result of a Health Buddy monitoring alert, and estimate that we have averted 71 Emergency Department visits for a population that must often rely on emergency care in the absence of longer-term health management. 
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