Behavioral Health: Moving to a Chronic Care Model Helps Payers, Providers, and Patients

February 6, 2017   Jacob Levenson

Nurse working on a tabletFor several years the healthcare industry has focused on providing immediate, time sensitive care by optimizing delivery times for individuals. This simply doesn’t work anymore.

Patients, especially those with a chronic disease, diseases lasting three months or more that can’t be treated with medications and vaccines, are expecting that healthcare providers be involved with and invested in that patient throughout the entire continuum of care. That’s at the heart of the chronic care model. It’s what patients want, it’s the more effective model, and it saves time, money, and resources for all involved individuals from consumer, to provider, and payer alike.

This isn’t just true for chronic physical conditions, it’s also true for behavioral health disorders and arguably more important. Take a look at a chronic brain disease like addiction or substance use disorder (SUD). We know that patients who go in for treatment for substance use and are in recovery for SUD are incredibly vulnerable for 12 to 18 months after they leave an acute care facility. They need individualized support through that entire post-treatment process, because they’re increasingly vulnerable to relapse and regression.

Understanding the Chronic Care Model

Ultimately, that’s what the chronic care model is all about: treating people long term and recognizing that care extends beyond health care facilities. The NHS Institute for Innovation and Improvement at the University of Birmingham identifies the six key aspects of the chronic care model(1):

  • Community resources
  • The healthcare system
  • Patient self-management
  • Decision support
  • Delivery system redesign
  • Clinical information systems

These aspects of the chronic care model can be implemented in a number of ways including utilizing the community, developing safe healthcare culture inside the treatment facilities, patient education and empowerment, self-management support for patients when they leave treatment, gauging patient preferences and needs, and probably the most important is the last aspect on the list, improving clinical information systems. It’s been proven that adopting even one aspect of a chronic care model can begin to improve outcomes across the entire spectrum.

Another way the chronic care model excels is in how it improves patient engagement. Patient engagement involves prevention and detection, management from the provider, and self-management from the patient. It's been proven that when patients are engaged in their healthcare they're more likely to make early detections(2). This allows providers to intervene earlier which is a primary driver of improved clinical and financial outcomes. This is especially true in high risk, high cost populations like behavioral health and substance use disorders. Engagement after treatment helps patients track their health in the long term which improves outcomes across the entire field. Active participation from the patient will allow payers and providers to better understand a patient's risk of relapse and recidivism.

Chronic Care Models Improve Data Collection and Implementation

Nurse writing on a patient report

MAP has already shown that the collection of data is vital in improving outcomes in the treatment of opioid addiction. The gathering, organizing, and synthesizing of patient data through new and innovative technologies like Electronic Medical Health Records (EHR) and Health Information Exchanges (HIE) saves time, money, and lives. The chronic care model’s focus on long-term care is dependent on the adoption of new and effective technologies and the collection of patient data. However, it’s not just about getting the data, it’s about how providers turn that data around and use it to improve existing treatment modalities and identify the modalities that drive the best outcomes.

Payers and providers can collect this data, analyze it, and use it to improve patient outcomes across entire populations. By identifying what works and what doesn’t through the careful analysis of real patient data, providers demonstrate their expertise. This rewards them in the long run by proving to future patients and payers that they’re effective and reliable. For payers, this focus on utilizing more accurate analysis of patient data demonstrates the efficacy of the chronic care model and demonstrably justifies the costs of these treatment modalities.

Everyone Benefits in a Chronic Care Model

The involved parties in the chronic care model can be broken down to include three important figures: the healthcare team, the patients and their families, and the community as a whole. Healthcare teams benefit incredibly from the chronic care model:

  • Employee resources are optimized, which saves time;
  • Patients lower their costs from the reduced use of healthcare resources;
  • The quality of care for patients is exponentially higher for long-term treatment;
  • Communities improve as a whole through education, the development of supportive environments, and empowerment from the adoption of chronic care models that focus on self-management and community resources.

It’s no doubt that quality is the focus in a chronic care model, but cost is an important factor as well. The chronic care model is already proving to be a reliable way of saving costs for payers. Simply put: it saves money. We know this because we already have data from programs that have effectively adopted chronic care models. Missouri’s Chronic Care Improvement Program saved $8.3 million in its first year and reduced costs by 8.1% for individuals with severe and persistent mental illness(3).

Transitioning from an acute care model to a chronic care model doesn’t happen overnight, and many providers struggle with the model. Things like patient education, hiring personnel with expertise in chronic care, regulatory compliance and technology adoption take time and money. For several payers and providers it’s easier to look to outsourcing chronic care management, and this is proving to be a viable solution to the shift from acute to chronic care.



2. How Patient Engagement Supports Chronic Disease Management,

3. Many Providers Eye Outsourcing Chronic Care Management,

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