This is an exclusive BHB+ story
During the COVID-19 pandemic, the rates of emergency department (ED) visits for behavioral health conditions spiked. News stories of excessive boarding times for pediatric and adult patients needing behavioral health services dotted national news sites.
While the national health emergency has ended, the needs of patients in behavioral health crises remain. Still, many industry insiders have questioned if an emergency department is the right place for a person in an acute behavioral health crisis.
Over the last few decades, we’ve seen the rise of alternatives to traditional emergency department visits for behavioral health patients. This includes a spectrum of alternative services ranging from EmPATH units, which function like specialized EDs for behavioral health, to mobile crisis clinics and community-based offerings where patients can enjoy a meal surrounded by a support team.
These types of alternative care models have caught investor attention. For example, urgent behavioral health care provider Connections Health Solution has raised nearly $60 million in funding.
The topic of emergency behavioral health has also sparked some recent changes in the medical community. Late last month, the American Board of Emergency Medicine recognized emergency behavioral health as a focused practice designation for interested emergency physicians and psychiatrists.
This is important because it could lead to more physicians with expertise in treating patients experiencing a behavioral health crisis, and could help make the case for specialized units.
Many industry insiders argue traditional EDs are often not the right place for a person presenting with a behavioral health condition and can often lead to long wait times, unnecessary inpatient stays and high costs.
I think we’ll continue to see the rise of alternative behavioral health crisis care models and more clinicians with an expertise in treating this patient population.
In this week’s edition of your exclusive BHB+ Update, I’ll explore:
– The history of behavioral health emergency and crisis care
– The emergence of new models of crisis care
– Why it could be a savvy choice for investors and providers to explore
Alternative crisis care models
Alternative emergency behavioral health care models have been around for some time. In fact, the first de novo EmPATH was created in 2016 by Dr. Scott Zeller, vice president of acute psychiatry at Vituity, in response to long wait times.
“Over the last decade, the number of behavioral emergency patients in [emergency rooms] has increased over 400%. And now one in every seven patients in the ER is there for behavioral emergencies,” Zeller previously told me. “What ends up happening is that these poor folks who are having maybe the worst day of their lives are getting stuck in the ER for a very long time – hours, days and in some cases, even weeks, waiting for an elusive inpatient bed to open up.”
An EmPATH unit is an ED alternative to a patient presenting with a psychiatric condition. It can care for and observe behavioral health patients for up to 24 hours. The units are often located in the same building as a traditional ED. They are designed to specifically cater to behavioral health patients’ needs, including rooms for patients to destress in and more mental health clinicians on staff.
But it’s not the only emergency department alternative. There has also been a rise in behavioral health urgent care models. For example, Connections Health Solutions offers a 23-hour observation unit, crisis stabilization and discharge planning.
Connections works with community partners to help ensure that patients can access appropriate care and resources.
Connections Health Solutions CEO Colin LeClair said that this business model makes sense for investors and payers.
“Instead of working with the hospital to save dollars on the ER visit or the boarding, we’re working with the health plan,” LeClair told me at a previous INVEST conference. “Just think about a 10-day hospital stay that costs them $1,000 [a day], 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.”
While Connections Health Solutions has garnered tens of millions in funding to support its growing business, new models of crisis care are just beginning to emerge from stealth with fresh capital.
For example, new startup TownHome has recently landed $500,000 to build out its crisis care model.
The provider pitches itself as an alternative to a hospital alternative. But its services are more “homey,” if you will. It offers peer counseling and support led by social workers, as well as an in-person facility where patients can access a private room and have dinner with others in a supportive environment. It works with hospitals and payers, including the Mayo Clinic and UnitedHealthcare.
It’s an interesting model that appears to prioritize community – a key component of behavioral health care, according to many experts.
Yet behavioral health crisis care doesn’t always need to take place in a facility. In 2022, the Centers for Medicare & Medicaid Services (CMS) rolled out its first mobile Medicaid behavioral health crisis program in Oregon.
As part of the program, mobile crisis teams made up of behavioral health care professionals and paraprofessionals, can be dispatched to a person in need 24/7. The teams are able to provide screenings, assessments, stabilization, and de-escalation.
When it was launched, the program was pitched as an alternative to not just emergency department visits but potentially as a way for people in a mental health or substance use disorder (SUD) crisis to avoid interaction with law enforcement.
What’s next?
Outpatient mental health services have been the investor darling for the last few years. While I think that’s unlikely to change anytime soon, I do think there is a growing business case for behavioral health crisis care.
Emergency department visits are expensive for payers and for patients. Having a second or even third option that doesn’t include boarding for a long period, is generally better for the patient and could save all stakeholders money.
Instead of having patients spend multiple days boarding in the ED, offering clinical services during a community dinner for those who aren’t a danger to themselves could be a nuanced approach.
On the provider side, having a new practice designation for behavioral health emergency services is a great step in the right direction. This could give more providers the toolkit to specifically address the needs of patients in crisis and avoid COVID-era boarding issues in the future.
Companies featured in this article:
