How Health Systems Can Develop a Financially Sustainable Behavioral Health Program

How Health Systems Can Develop a Financially Sustainable Behavioral Health Program

In the U.S., 14.1 million people have a serious mental illness, making behavioral health treatment critical. However, significant barriers keep people from the care they need, including the provider shortage and lack of specialty care, leading people to seek treatment in the ED.

Building a financially sustainable behavioral health program at scale can help these patients get quality care and reduce the total spend on their medical conditions (for both the patients and the health systems providing treatment). Partnering with an organization that can facilitate efficient care models can help your organization scale services and meet quality measures that enable your health system to thrive.

In this blog, we’ll share the keys to building a financially sustainable behavioral health program and insights from our Chief Marketing & Strategy Officer, Dan Ferris, on the benefits and impact on total cost of care.

The benefits of achieving a financially sustainable behavioral health program

Every health system faces a hierarchy of needs regarding patient care – from those who need immediate care in the ED to those stuck in referral queues to those who need proactive outreach in the community.

Let’s take a look at the six ways achieving financial sustainability can benefit your patients and overall organization:

  • Increased revenue: In outpatient settings, many health systems are foregoing revenue by not having timely access available – driving unnecessarily high leakage and no-show rates. By having scalable care models that provide high-quality care, you can see and retain more patients.
  • Sustainable margins: To drive sustainable margins in outpatient behavioral healthcare, health systems must leverage a multidisciplinary care team that works top-of-license and deliberately ensures patients are navigated to the right resource at the right time in the right way.
  • Increased ED throughput: By augmenting your on-site care with a multidisciplinary team of behavioral health providers available 24/7/365, you can ensure every patient receives timely access to quality care and is not taking up valuable space in the ED longer than is clinically appropriate.
  • Reduced admissions: By having access to a variety of virtual providers, like licensed counselors, PMHNPs, and MDs, on your team, patients are more likely to get to the right level of care and help ensure only the most critical are admitted, and those who might be more effectively treated in a lower level of care get the help they need. Ultimately, this approach can help decrease long-term costs.
  • Limited revisit rates: By providing the most effective care possible, and ensuring every patient has an optimal discharge plan to manage their mental health, patients are less likely to come back to your hospital. At the same time, it can also better position your organization to retain patients within your network.
  • Improved total cost of care: By treating behavioral health, you get the benefits of integrated behavioral health care. That’s because alongside physical conditions, you’re helping total cost of care over time, and increasing key metrics like pharmacy cost, reducing length of stay, and improving patient outcomes.

All six of these benefits combined help create a behavioral health program that’s both efficient and successful. Next, we’ll review the quality care models that help make financial sustainability in behavioral health care possible.

Dan Ferris, Chief Marketing & Strategy Officer

By integrating behavioral health, you are providing the care patients need and want, creating market differentiation while driving better economics. It’s a win-win.

Care models that build a financially sustainable future

At Iris, we design programs that seamlessly integrate into a health system and connect organizations with the highest quality behavioral health specialists. These services have helped organizations reduce their referral backlog by 83%, divert 36% of psych referrals to a lower level of care, and improve depression symptoms by 38% over eight weeks of care. You can read the full story here.

Dan Ferris, Chief Marketing & Strategy Officer

Our programs are designed for both clinical quality and financial sustainability. We bring expertise on driving top of license care, navigating patients to the right level of care, and billing appropriately to get paid for the care that’s provided. We’re not just providing access – we’re delivering a program with the know-how to drive clinical and financial success.

Here’s a look inside how our services work

Bridge Care Services: A Behavioral Health Integration model backed by clinical and operational expertise to solve ambulatory care at scale and deliver long-term clinical and financial outcomes for hospitals and health systems. We ensure the patients who need care first get care first – while being efficiently directed to an appropriate care plan. Our cross-functional care team of psychiatrists, therapists, and psychiatric mental health nurse practitioners will fully integrate into your health system. When clinically appropriate, our team will facilitate collaborative transitions to additional ambulatory services, primary care, and community partners as needed.

Key takeaway: Bridge Care Services hits target metrics such as expanding and accelerating access to care and achieving critical financial results like increasing revenue, driving sustainable margins, and improving total cost of care.

On-Demand Services: These services leverage a team of providers to help support ED and MedSurg units with on-demand consults 24/7 – ensuring your health system is never without a behavioral health specialist. On-Demand Services provides access to providers who are experts in assessing and managing risk to help patients get triaged and evaluated as quickly as possible.

Key takeaway: On-Demand Services leads to increased ED throughput, decreased inpatient admissions, and reduced revisit rates.

Scheduled Services: This approach provides a predictable coverage model for organizations, meaning your virtual providers are available on a regular schedule each week. Most importantly, it means your providers are never without a behavioral health provider to lean on for their expertise.

Key takeaway: Scheduled Services expands patient access to behavioral health care, increases revenue, and improves total cost of care.

Laying the foundation for whole-person care

Physical and behavioral health are intrinsically linked. For example, research from the National Library of Medicine shows that 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24.

If you’re managing total cost of care and population health, behavioral health integration is essential.

Dan Ferris, Chief Marketing & Strategy Officer

There’s an opportunity to use behavioral health as a weapon to drive competitive differentiation for health systems. We believe providing quality behavioral health is a strategic advantage and can be financially sustainable. If an organization can offer integrated behavioral health at-scale, they can attract more patients, reduce leakage and the total cost of care.

According to a behavioral health analysis by Evernorth Health Services, treating behavioral health conditions in outpatient care is directly tied with a reduction in medical and pharmacy costs. In their analysis, they highlight savings up to $2,565 per person over the 15 months following a diagnosis and up to $3,321 per person over the 27 months following a diagnosis.

Where Iris Telehealth fits in

Iris Telehealth delivers high-quality behavioral health services via telehealth all across the country. From our rigorous provider vetting process to our in-depth knowledge and expertise, we help ensure your organization has a thriving, financially stable behavioral health program.

Contact us today to learn more about our care models and how we can help your organization increase ED throughput and provide short-term care to your patient population.

We want to hear from you. Seriously.

Whether you are a health organization looking to expand your telepsychiatry services or a prospective clinician who wants to join the team, we’d love to talk!