The emergency department is often the first point of care for patients experiencing a behavioral health crisis. However, a trip to the ED is expensive for patients and payers and often isn’t the most appropriate place for patients.
New models of behavioral health urgent care have begun to emerge. These models don’t replace EDs but offer an alternative way to stabilize patients and prevent avoidable inpatient behavioral health stays.
“You would never have an idea that you say, ‘Oh, we just opened up a medical urgent care next door to the Walgreens. Therefore, we can close the trauma center,'” Dr. Scott Zeller, VP of acute psychiatry at Vituity, said at Behavioral Health Business’ INVEST. “There are different acuity levels, and it’s the same thing in behavioral mental health. Sometimes, people have situations where we can intervene and help them with counseling or supportive environments or what have you. But then sometimes people are hearing auditory hallucinations telling them to do bad things, and they need a much higher level of care.”
Vituity is a physician-owned and led health care delivery organization. Its services include emergency medicine, outpatient care, hospital medicine, psychiatry, neurology and telehealth.
Besides the traditional ED, there are a few new types of urgent care. For example, PE-backed Connections Health Solutions offers a 23-hour observation unit, crisis stabilization, outpatient mental health services and discharge planning. It has community partnerships to help patients connect to appropriate resources.
“The goal should be to create a model that never has to say no. We call it the no wrong door model,” Colin LeClair, CEO of Connections Health Solutions, said at INVEST. “So whether they’re insured or uninsured, regardless of their specific diagnosis, we can see them stabilize them and then find the right path. We think that’s the right alternative. We also think that’s really the only economically viable way to do this.”
Other models, such as EMPATH units, are often embedded within a health system and specifically cater to patients with behavioral health conditions.
Both options can often save time and money for providers and patients alike. For example, behavioral health crisis care embedded in hospitals could save on expensive boarding costs that come to about $3,000 a day. In the long run, that can save a lot of money.
“There’s an EMPATH unit in Sacramento, California, that recently showed in their first two and a half years of operation they save Medicaid close to $40 million by getting people better care and at the same time making sure every different part of the system got a reimbursement that made sure they made ends meet,” Zeller said.
Meanwhile, community-based urgent care models could omit an expensive hospital stay altogether.
“We’re taking that patient out of the hospital together and bringing them to a community-based solution facility providing very similar care, but we’re helping them avoid that ER visit and hospitalization altogether,” LeClair said. “Instead of working with the hospital to save dollars on the ER visit or the boarding, we’re working with the health plan. Just think about a ten-day hospital stay that cost them $1,000 And an ER visit before that cost $2,000. We’re erasing that and replacing it with a single day of observation for about $1,200. So a massive arbitrage opportunity for a health plan controls a broader patient care spectrum.”
As a result, private equity investors, health systems and payers have taken note. Urgent care and alternative crisis models can help cost and potentially increase access to care.
LeClair noted that there is a lot of room between an eight-week wait for outpatient care and an emergency room visit. Connection’s investors are certainly interested in filling in this space.
“So there’s a big opportunity to save a lot of dollars there,” LeClair said. “In terms of our private equity backers, its Heritage and Townhall ventures and, and their limited partners are the big nonprofit health systems and health plans across the country that are trying to solve this problem and recognize that they can’t innovate themselves and need help.”