The right care at the right time in the right place is a mantra at Lahey Health. Increasingly, it is the goal for behavioral health care — treatment for those with an addiction or mental illness. It is why Lahey Health Behavioral Services (LHBS), which started as a single detox program in Danvers almost 60 years ago and now has locations throughout Northeastern Massachusetts, is focused on creating a model of care that is easy to access, identifies problems early and connects individuals with effective treatment.
To that end, LHBS is actively collaborating with the Massachusetts Health Policy Commission (MHPC), the Blue Cross/Blue Shield Foundation (BCBSF) and Neighborhood Health Plan (NHP) on initiatives that share a common thread. “As we collaborate and gather as much data as possible, we’re starting to define the right interventions — the best ways to move individuals forward,” explained Kevin Norton, CEO of LHBS, which resulted when Northeast Behavioral Health joined Lahey Health in 2013. “For example, today we use physicians differently. We support them with social workers and community health workers who engage patients and perform outreach, literally visiting patients at home.”
Bringing psychiatry to primary care
Thanks to funding from BCBSF, 10 Lahey-affiliated primary care practices now have on-site social workers who screen patients for common conditions and offer early treatment. Bringing psychiatry to primary care offices is not new for Lahey. “Since the beginning of the Lahey group practice model, psychiatrists were integral to the health care team,” said Chief Medical Officer Mary Anna Sullivan, MD. “In the 1990s, we experimented with having psychiatrists available in primary care. We were able to treat patients early, and they appreciated the convenience.”
Today, primary care physicians value having social workers embedded in their practices. “They are there to spend time with the patient and determine what treatment is needed,” said Sullivan. “This is whole-person, patient-centered care, and it was inspired by Dr. Frank Lahey.”
It is precisely what Sam (not his real name) received when he came for an appointment with his primary care physician soon after the program was established. “He told his physician that he was depressed, so he was asked to complete a depression screening tool,” recalled Jonathan Metcalf, the practice’s social worker. When the result was 18 out of 27, his physician suggested that Sam meet with Mr. Metcalf.
“It works well when a trusted physician escorts a patient down the hall to see a behavioral health provider,” he noted. “Sam told me he had been thinking about suicide and hadn’t told his wife about his depression.”
Sam’s condition was serious enough to warrant medication and additional treatment in a partial hospitalization program. “In that setting, Sam benefited from group counseling and was followed closely to determine that his medication was effective,” Mr. Metcalf said, noting that he responded well to treatment.
When NHP invited Lahey to participate in a pilot program focused on its most complex members, the response was quick. “We saw it as an opportunity to learn how to provide accountable care to a challenging population,” said Mr. Norton, in reference to an approach that keeps the quality of care high and the cost low. “We are caring for the health plan’s 200 most expensive members — people with medical problems, as well as serious mental illness or substance use.”
The pilot program, called Here-for-You, employs dedicated LHBS community health workers who engage people, even going to their homes, when necessary, to offer the care and support that can avoid a health crisis and another hospital stay.
Diverting patients from the Emergency Department
With funding from the Massachusetts Health Policy Commission, patients at Lahey’s Addison Gilbert, Beverly and Winchester hospitals, in partnership with Lowell General Hospital, are diverted away from emergency departments. Trained community health workers assess the needs of individuals who frequently visit the ED, refer them to treatment in the appropriate setting and — importantly — stay in touch.
“We’re connecting the dots for our patients,” said Dr. Sullivan. “In some instances, the community health worker becomes the patient’s partner, and even friend.”
$1.3 million gift could prove transformational
The results of the two-year, state-funded initiative will be amplified thanks to a $1.3 million anonymous gift made in 2016. “The funding is being used to analyze and share our results,” said Dr. Sullivan, who noted that they plan to publish their findings and hold a symposium. It is hoped that the data assembled and analyzed by LHBS will document the effectiveness of the integrated treatment approach and bring about change in the care model to benefit patients everywhere.
“The symposium will involve people who have nothing to do with health care,” Mr. Norton added. “We need to think differently about behavioral health care and help overcome the stigma. With philanthropic support, we will do that.”