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Intermountain saves big by marrying behavioral health with primary care

Leaders at Intermountain Healthcare believe that health systems can't manage population health without addressing lifestyle issues.

Kim Henrichsen - Intermountain

Kim Henrichsen

Leaders at Intermountain Healthcare believe that health systems can’t manage population health without addressing lifestyle issues. So, that’s exactly what the Salt Lake City-based organization is doing by integrating behavioral health into primary care.

Intermountain now pays attention to the entire continuum of care, particularly for those with multiple chronic conditions. “Our clinical programs are focused on what we call health pathways,” said Intermountain Chief Nursing Officer and Vice President for Clinical Operations Kim Henrichsen.

The results speak for themselves, as Henrichsen pointed out Tuesday at the World Health Care Congress in Washington.

It costs Intermountain’s SelectHealth insurance subsidiary $22 per member per year to embed mental health workers in primary care clinics and processes, and SelectHealth gets an annual return on investment of $115 per member, according to Henrichsen. “When you multiply that by hundreds of thousands of members, that’s pretty significant,” she said.

Intermountain sees about 150,000 patients in any given year that “have some level of need for mental health integration,” Henrichsen said.

By paying attention to patient mental and behavioral health — often symptomatic of lifestyle issues — Intermountain has been able to cut visits to the emergency room, hospital admissions, avoidable hospital visits and radiology tests, Henrichsen said. Meanwhile, visits to primary care and urgent care increased, suggesting that patients are getting more preventive care and choosing urgent care as a less-costly alternative to the ER.

Intermountain also has seen a whopping 559 percent increase in the number of patients who had self-care plans. “We must not have been doing very well there [prior to emphasizing on care management and behavioral health],” Henrichsen said.

On the outcomes side, the focus on behavioral health has produced a 91 percent increase in patients taking PHQ-9, the depression module of the Patient Health Questionnaire, Henrichsen reported. Adherence to disease management program “bundles” went up by 26 percent, while nearly 9 percent more patients had annual visits with primary care physicians.

The first seven Intermountain facilities to get mental health workers and care managers saw higher patient and provider satisfaction, according to Henrichsen. The organization has since rolled out the program — as well as the patient-centered medical home model — to all 130 primary care clinics. The patient’s family is a key component.

There are mental health liaisons in some Intermountain ERs as well. Many who come in are “desperate” for behavioral health services, and they usually can get into outpatient treatment within 72 hours, Henrichsen said.

It’s a holistic approach to patient and family health, and patients get more than the standard 15 minutes if they need it. Clinical team members “work to the top of their licenses,” Henrichsen said. “We’re also going to be relying on our patients and our members to take some responsibility for their own health and their own healthcare,” Henrichsen added.

There have been a couple of negative results, though. Intermountain has seen a 13 percent decline in hypertension control and a 3 percent drop in the number of patients with advanced directives on file, Henrichsen said.

In 2014, Intermountain recently changed mission statement for first time in at least 20 years. It went from “Excellence in the provision of healthcare services to communities in the Intermountain West,” to “Helping people live the healthiest lives possible.” That reflects a shift to patient-centeredness.

In general, when setting best practices, Intermountain asks three questions: “Does it improve the clinical care of our patients? Does it improve the performance of our clinicians? And does it lower the cost of providing care?”

According to Henrichsen, best practices have different connotations to different people. It could mean new methods, or it could mean finding new ways to apply old methods, she said. Consistent application means doing the right thing for the right patient every time. That’s what Intermountain strives for by taking a holistic approach to primary care.

Click here to listen to a World Congress podcast with Henrichsen.

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