Podcast 02 – In Pursuit of the Quadruple Aim: Evaluating the Role of a Health Resilience Specialists in an Integrated Behavioral Healthcare Setting

Summary

Background: Health systems are in constant pursuit of the quadruple aim, which embraces patient-centered, high quality, low cost healthcare: patient-centered, high quality, low cost healthcare, and fulfilled staff. This is particularly challenging, yet critical, in a population of patients with serious and persistent mental illness (SPMI). Cascadia Behavioral Healthcare partnered with CareOregon (Medicaid payer) to embed a Health Resilience Specialist (HRS) into an integrated health center with the objective of improvements in the quadruple aim. HRSs engage in extensive outreach, and are particularly skilled in working with complex patients with co-occurring physical and mental health concerns. Only one study has evaluated the use of a HRS to improve care, reduce emergency department (ED) visits, and decrease costs. Embedding a HRS in a behavioral healthcare setting has not been evaluated. We will evaluate the process of embedding a HRS into an outpatient integrated behavioral health center, to determine its effectiveness for the highest risk patients. Methods: Cascadia serves individuals with mental health and addictions. Many clients have SPMI and co-occurring physical health and addictions concerns. Cascadia is piloting the use of a HRS in an outpatient health center, selected based on staff culture and readiness for change, and high rates of emergency care utilization among clients. Clients who engage with the HRS will complete baseline and follow-up assessments. Outcomes will assess the quadruple aim: satisfaction with and quality of care; ED visits and hospitalizations; healthcare costs; and physical and mental health. Analyses will include a pre- post-intervention comparison, as well as changes over time. Results: In the past 12 months, 332 adults in the health center visited the ED at least once, and on average, clients had 9 ED visits in the past year. Of this sub-population, 13% visited the ED 5 or more times. Clients with a SPMI represent 58% of those using the ED at high rates. Cascadia will engage in population health management to target HRS services to clients identified as higher risk for using the ED, and outcomes in this cohort will be evaluated. Conclusions and Implications: This research will provide evidence to support the effectiveness of embedding a HRS in an integrated behavioral health setting. Results will highlight whether this role can contribute to realization of the quadruple aim and benefit Cascadia and similar organizations.