This article is sponsored by VNS Health. In this Voices article, Behavioral Health Business sits down with Jessica Fear, SVP of Behavioral Health, to talk about how VNS Health is applying industry-leading care management models to behavioral health today. She shares best practices for alleviating recidivism and rehospitalizations while reducing the overall cost of care. And she explains what differentiates VNS Health’s SUD care management program from others in the space. She also discusses how the organization uses data to introduce new behavioral health programs to other health plans.
Behavioral Health Business: What career experiences do you most draw from in your role today?
Jessica Fear: It’s a culmination of 25-plus years of experience working at the ground level, trying to help underserved communities and individuals receive the care they need.
I have a marriage and family therapy license, and a master’s degree in counseling psychology. I spent the first part of my career providing direct service with an emphasis on children and adolescents. Then at some point, I worked my way into overseeing programs and learning how to manage teams that were doing the work.
I’ve worked in both the provider realm and the managed care side of the business, which is where I learned how the money flows to provide access to services for underserved populations. Both sides of that coin — the provider and the payer side — have given me a 360-view of how to impact populations. At this point, I’m really focused on moving the needle for whole populations as opposed to individuals.
VNS Health appears to be an early adopter of the Payvider model that many providers are moving toward. How is your organization applying industry-leading care management models to behavioral health today?
We have over 130 years of experience as one of the nation’s largest nonprofit home and community-based organizations. On the provider side, we help other health care organizations manage their most vulnerable and medically complex members, who are also some of the costliest to care for. In this new integrated landscape, leveraging our health plan is a perfect fit.
As we develop new behavioral health programs for our external partners, it has allowed us to pilot, validate and improve on care model innovations in real-time, using real clinical indicators and claims data as benchmarks for the work that we’re doing. We think of it as our sandbox for program development and expansion.
The health plans that we partner with are confident in our expertise to provide the guidance and support that their teams need to improve how they deliver care to the members. It’s really a symbiotic relationship. We are already providers, and because we are connected to a health plan, we can do that push-pull in-house to validate and launch those new care management programs with external partners..
How is VNS Health able to alleviate recidivism and re-hospitalizations while reducing the overall cost of care?
VNS Health is boots-on-the-ground with a team that is embedded within the community and can clear barriers to care in a way that is unique. If you’re a provider working out of a facility, hospital, office or remotely, VNS Health can help meet a patient where they’re at. Face-to-face, we can see what they need and help them break down barriers to the care that they need to get healthy.
That could look like physical care, it could look like behavioral health care, it could look like specialty care — everything we do is home and community-based. In the grand tradition of what this organization has done for over 130 years, we are a community-based behavioral health organization. I think the ability to follow somebody — both physically and metaphorically — through their care journey, encourages and empowers them to get on top of their own health goals and helps keep them out of the hospital.
Many health plans are focused on trying to improve their capabilities around analytics and insights in today’s environment. How does VNS Health use data to introduce new behavioral health programs to other plans?
We are lucky in that we have a business information and analytics department at our fingertips, as well as a data team to extract and analyze data. We’ve developed a state-of-the-art risk modeling and analytics engine. It allows us to take huge amounts of clinical indicators, as well as claims data that we can get from external plans or internally, and analyze that data to design and deliver population health solutions that plans will find valuable.
When we partner with health plans, we start by working closely with their data teams to exchange whatever the metrics might be. That allows us to map the members to the right programs based on their diagnostic profiles, then leverage all of that real-time data once they’re in the program, in order to manage their entire health journey and care experience. Developing these capabilities in analytics has been a major advantage for us because our technical prowess allows us to identify and react quickly to trends or changes in indicators, so we can deliver the right care at, the right level, in the right setting, for the members that are enrolled.
How does VNS health approach post-acute discharge, and what actions make the greatest impact on member engagement in your behavioral health programs?
Post-acute discharge is everything. It’s about capturing somebody and making sure that there’s a soft landing in the community. We’ve been doing this for a really long time. We have amazing longstanding, collaborative relationships with hospitals and standalone behavioral health and SUD facilities, and a whole team dedicated to nurturing these relationships. We learned early on, that cultivating strong relationships with the discharge teams at hospitals is critical to ensuring a smooth transition of care for our patients. Whenever possible, we embed our onsite behavioral health staff members into the facility. If we can’t embed them, then we work with each discharge team to let us onto the unit when we know somebody has been admitted, so that we can at least go visit them before they’re discharged.
We meet them as early as possible in their hospital stay. This is a critical step, because that’s where engagement is first established. That’s where you’re going to build the foundation of ongoing connection. Once an individual is discharged from the hospital, we make sure that they’re going to stay connected to outpatient care. We find that without an early touchpoint, the likelihood that someone will be lost to care or not follow up on their appointment skyrockets. This is where people fall through the cracks. We start very early, and we do so in coordination with their existing care team if they have one.
Talk about VNS Health’s SUD Care Management Program and what differentiates it from other programs in the behavioral health space.
Our SUD care management program is designed to interrupt the cycle of the revolving door of admissions and readmissions for substance use care. We know for a fact, that this is a significant challenge for most health plans. Re-admission rates for individuals with substance use disorders hover in the 50% range — roughly half of all people admitted are coming back within 30 days.
We also know that many times, individuals will wind up in an inpatient setting for a substance use disorder, when they don’t necessarily need to be there. They will go to the ED because they need a place to stay for the night, or they need a meal. They wind up getting discharged very quickly. Unfortunately, this does not truly address any of their real problems. It doesn’t address the social determinant needs, and it doesn’t address any ongoing substance use problems.
Our program is designed as a unique, three-way partnership between the health plan, VNS Health and the SUD facility, whether it’s a hospital or a standalone facility. When someone’s admitted, the facility is going to make the referral to us, the health plan is going to sign off on it, and we are going to go meet that person before they’re discharged. With that engagement securely in place when the patient is discharged, we are their discharge plan. We are the ones who will meet their needs in the community, connecting them to outpatient treatment and making sure that they go to those appointments — physically escorting them if needed.
We provide comprehensive care management, including initiating medication assistance treatment, as well as addressing social determinant barriers such as housing, personal safety or transportation.
It is quite common for us to follow that person for up to nine months or longer, to ensure consistent engagement in their outpatient care and to make sure that it’s stable. It hits a lot of points from an outcome perspective, and it hits a lot of quality metrics for plans. The most important objective is helping an individual on their road to recovery. It also winds up being a huge cost-saver for the plan and for the facilities.
The facilities are also highly-engaged, because they know that they have the most appropriate members in their care, and that they’re keeping people for the appropriate amount of time, at the right level of care. It helps free up the beds for the people who need them at the time that they need them.
Finish this sentence: “In the behavioral health industry, 2023 will be the year of…”
…workforce development and integrated care.
Editor’s Note: This article has been edited for length and clarity.
CTA: VNS Health offers customized care management and managed service solutions to help health plans, ACOs, IPAs, and other large health care organizations improve outcomes and lower costs. Visit the Professional Solutions section of our website to learn more, and email [email protected] to discuss options for partnering with VNS Health.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].