Sharing best practices to improve care and outcomes for individuals with mental health and substance use disorders

Optum, part of UnitedHealth Group, is an information and technology-enabled health services business. As the nation’s largest managed behavioral health care organization, Optum is going beyond its traditional functions—utilization review and claims processing and payment—and turning health care data into powerful insights to help providers offer cost-effective care through its Achievements in Clinical Excellence (ACE) program, which promotes high-quality, efficient care by rating behavioral health facilities based on their clinical outcomes and costs of treatment.

Brigham and Women’s Faulkner Hospital is among the Mass General Brigham facilities that participate in the ACE program. Recently, Jessica Rosado, LMHC, MaCCS, Utilization Manager for the Department of Psychiatry, was invited to share BWFH’s approach to one of the key metrics on which facilities are rated—seven-day follow-up attendance after hospitalization—at a first of its kind virtual Clinical Excellence Collaborative Learning Session.

“I was honored to be asked to participate,” says Rosado. “It’s nice to have an insurance provider recognize the power of facilities learning from each other rather than from decrees from on high.”

Rosado explains, “The ACE program is really nice in the way that they monitor us. They spent a year establishing our baseline, and now we are being looked at against our self and similar hospitals. We have consistently met our metric for seven-day follow-up attendance.”

In her presentation, Rosado outlined some of BWFH’s successes and challenges when it comes to encouraging patients discharged from 2 South, the hospital’s inpatient psychiatric unit, to continue their care in the outpatient setting. “I talked a lot about our multidisciplinary approach to our work. I highlighted the fact that we have established roles with identified responsibilities and how we initiate discharge planning from day-one,” she says. “We also utilize the array of services we offer within our own department. That makes continuity of care and transitions much smoother. We also have appointment reminders built into Epic (our electronic medical record), which help patients maintain their scheduled appointments.”

Continuity of care is of particular importance with this unique patient population. Studies show patients are most at risk for suicide when they are first discharged from inpatient psychiatric care. BWFH offers a partial hospitalization program as well as traditional outpatient therapy, which are both options for follow-up within seven days of discharge from 2 South. While access can be an issue, the biggest barrier to follow-up care is the patient themself. “Many of these patients are not ready to discuss aftercare when they first come to 2 South. And sometimes, even when they are ready to leave 2 South, they are still not ready,” says Rosado. “A lot depends on the patient’s willingness to engage.”

During her presentation at Optum’s Clinical Excellence Collaborative Learning Session, participants were very impressed with BWFH’s process for communicating appointment reminders via Epic. They asked many questions and shared new ideas. “I personally have found it beneficial to participate in meetings with other facilities in the past. Even if I walk away with just one new idea. I hope that the participants in my presentation were able to take something with them,” says Rosado.