Every year, about $8.3 billion is wasted on unnecessary emergency department (ED) visits. The majority of that — $4.6 billion — is attributable to ED use for behavioral health conditions.
On top of being expensive, EDs can’t always treat mental illnesses and substance use disorders (SUD) properly. However, patients are often forced to seek care there anyway due to the national shortage of behavioral health providers.
To troubleshoot that problem, SSM Health — a multi-state health system based in St. Louis — has opened a unique new behavioral health urgent care center. While similar on-demand mental health care facilities are slowly beginning to pop up across the country, SSM touts itself as one of the first to partner with behavioral providers to help funnel patients into comprehensive behavioral health treatment post-visit.
The hope is that the new Behavioral Health Urgent Care, also based in St. Louis, will eventually serve as a replicable model for health care providers nationwide, according to Michelle Shafer, regional vice president of behavioral health for SSM.
“Our ultimate goal is to truly change … the way we approach behavioral health and SUD care in our communities … and to work together in collaboration instead of competition,” Shafer told Behavioral Health Business. “[We want] to raise the health of the community substantially.”
In addition to the new behavioral urgent care, SSM Health has more than 23 hospitals, 290 physician offices, 10 post-acute care facilities, a pharmacy benefit company, an insurer and an accountable care organization, among other offerings. The health system serves patients in Missouri, Wisconsin, Oklahoma and Illinois.
In 2019, its total annual operating revenues were north of $7.9 billion.
Developing the model
While SSM’s Behavioral Health Urgent Care only opened its doors late last month, the project has been in the works for more than two years.
The idea came together after the regional health commission enlisted local health care leaders and other stakeholders to troubleshoot Saint Louis county’s shortage of behavioral health care services. Originally, they were tasked with determining the viability of an assessment-and-triage-center model. But, ultimately, it wasn’t the right fit for the community.
The process inspired Shafer to find a different solution to the problem. After exploring a variety of options, she settled on an urgent care model different than any she’d seen.
The key to the model — and its main differentiator — lies in collaboration with community behavioral health providers and other partners. Nationwide, there are only a handful of centers operating this way, according to SSM.
“I wanted to do it in a way that I thought it would be the most efficient, which was by approaching other community providers and making it a joint effort,” Shafer said. “I was really interested in looking at not only providing the urgent care access, which was really appropriate, but then more significantly providing a wellness path after folks came to the urgent care.”
As such, SSM teamed up with seven community mental health centers for the project. Those partners — some of which include BJC Behavioral Health, Hopewell Center and Preferred Family Healthcare, among others — provide follow up services to patients who visit the center.
Employees from both SSM and its behavioral partners staff the new $2 million center, which is 3,400-square-feet with six exam rooms and two telemedicine rooms. At any given time, there are two master’s-prepared clinicians, a nurse, a nurse practitioner and an administrative worker on the clock.
The center will serve patients from seven counties around the St. Louis area. Anyone suffering with a mental illness or SUD-related issue can walk into the clinic for an appointment. After registering, they’re triaged by a nurse, who makes sure the patient is medically stable.
“We aren’t providing any medical services in this urgent care,” Shafer said. “It is truly for substance use disorder (SUD) and mental health issues.”
From there, patients are taken into an exam room and seen by a clinician, who determines what kind of care the patient needs. That might be outpatient services, medication-assisted treatment (MAT) or hospital-based care, just to name a few examples. If the clinician determines the patient needs medication, the nurse practitioner on staff can get them set up with a prescription day-of.
Meanwhile, patients are also immediately connected with SSM’s community behavioral health partners for follow up outpatient care. Those appointments occur within two to three days of the initial urgent care visit.
Still in its first few weeks of providing care, the center is already serving eight to 12 patients a day, which is more than they anticipated to start, according to Shafer. The goal is to eventually serve about 16 to 20 patients per day, though SSM can leverage telehealth to accommodate more patients if need be.
The health system is also working with local stakeholders to set up police and ambulance drop off services at the urgent care.
Finessing financing
SSM’s Behavioral Health Urgent Care will serve patients regardless of their ability to pay, which means the health system and its community partners have had to get creative when it comes to financing the project.
“We have a lot of people in our corner that are looking at how they can help provide the funding and do things differently and creatively for long term sustainability,” Shafer said. “But when we started this, everybody put a stake in the ground without a single guarantee of another dollar.”
So far, the center has yielded significant interest from payers and the Missouri Department Of Mental Health, as well as the state Medicaid program, all of whom are excited about the model’s collaborative element, Shafaer said.
They’ve also been engaged in helping SSM and its partners redeploy funds for the center.
Here’s one example: Community mental health centers receive state and federal funds, which come with certain requirements.
“The Department of Mental Health in the state is helping us look at those requirements and whether those can be fulfilled with visits at the urgent care that allows [our mental health partners] to draw down on a fund and count it as an admission into their center, even though it took place at the urgent care,” Shafaer explained. “That’s a new way of looking at it, but it also helps those centers then sustain their ability to have people dedicated to the urgent care and see patients [there].”
SSM is also working with managed Medicaid companies, who are interested in getting the center approved as a dedicated care delivery site.
In the end, the new urgent care is very much a joint effort, no matter how you slice it.
“We all know that there are limited resources and there’s limited funding, so [this center] serves as a model to show folks that coming together and using those dollars differently and better will allow us to help more people,” Shafaer said.
Behavioral health urgent care trend
Despite SSM’s unique model, it isn’t the only health system to debut a mental health urgent care center recently.
Hackensack Meridian Health — a network of healthcare providers in New Jersey — opened a behavioral health urgent care of its own last fall. The center provides each patient with a “check up from the neck up,” according to a September 2019 press release announcing the news.
“So many people with mental illnesses end up in crowded and complex emergency departments,” Hackensack Meridian Health CEO Robert Garrett said earlier this year during a podcast interview with Bloomberg Businessweek explaining the impetus for the new center. “They have to compete with people who have had heart attacks, strokes [or who have] been in motor vehicle accidents.”
While these types of centers are becoming more common, there are still just a few examples of on-demand mental health care offerings nationwide. However, Shafaer predicts specialty behavioral urgent care facilities — especially those with collaborative models — have a huge role to play in the future of behavioral health care delivery.
“It’s a different and appropriate access point, and it’s also a much less expensive access point than emergency rooms,” she said. “You’re getting patients to the right place with the right level of professionals for the right level of health at the right time.”
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