In New Jersey, redesign of mental health care services drives competitors to collaborate
By Betsy Ryan
Hospitals and health systems across southern New Jersey were faced with a challenge that has turned into an opportunity. They conducted a joint community health needs assessment which reinforced what each hospital was reporting anecdotally: Emergency department visits with primary or underlying mental health or substance use disorder diagnoses were increasing drastically.
Further analysis showed that from 2010 to 2014, these brain health emergency visits increased by almost 30% in South Jersey; statewide, these visits increased by 20% in a similar time frame.
The CEOs of five health systems realized that, while all deliver quality care to their patients, by working together they could better coordinate and provide follow-up care to patients in need of mental health and substance use disorder treatment. The executives of the five South Jersey hospital systems - Cooper University Health Care, Inspira Health Network, Lourdes Health System, Kennedy Health and Virtua – came together and formed the South Jersey Behavioral Health Innovation Collaborative (SJBHIC) in partnership with the New Jersey Hospital Association (NJHA) and the Camden Coalition of Healthcare Providers.
The goal: to improve the quality, accessibility, capacity and coordination of these important services to the patient. These five hospital systems are fiercely competitive, but they put those issues aside to share information and cooperate to determine how they fit into the necessary redesign of mental health and substance use disorder services in the region.
The first step was to understand the current landscape of care, so the group completed an assessment of opportunities and challenges. Through data analysis and stakeholder and community interviews, a first-of-its-kind report illustrated the chasm between the existing and desired systems of care.
Among the findings: More than 800 patients visited all five hospital systems in the region between 2010 and 2014, and of this patient population, the overwhelming majority had at least one mental health or substance use disorder diagnosis, and almost half had a dual diagnosis. Together, these patients accumulated more than 31,000 hospital visits over the five-year span with more than $260 million in charges to hospitals. Some stakeholders described the current system as "well-intentioned" but "disjointed," without enough access to appropriate services, leaving patients "unserved."
To address the siloed systems of care, seven short-, medium- and long-term recommendations were derived from the report. They include:
• Regional behavioral health complex case conferencing: For selected patients regularly visiting multiple hospitals, a care plan is developed and shared through joint conferencing;
• Shared protocols and education: Hospitals will share experiences to develop and implement proven, evidence-based protocols for mental health and substance use disorders across the region; and
• Integration of psychiatric specialists into emergency departments: New clinical staff with psychiatric specialization will be stationed in EDs to implement best practices.
These first-year findings and recommendations were announced in April at a well-attended event featuring former congressman Patrick J. Kennedy as the keynote speaker.
The Collaborative, building from the momentum of the April event, is assessing the best way to move forward in its second year. Some of the recommendations are already in the process of implementation, while other opportunities for research and collaboration are being explored.
Originally, the collaboration intended to find quick fixes to improve the more obvious flaws in the mental health and substance use disorder care delivery system. When confronted with the scope of the problem, though, these five health care systems did not abandon the work but pushed harder to find real solutions. The work continues, but we already are proud of the collaboration and leadership taken by these five New Jersey health care systems.
Ryan is NJHA’s president and CEO.