Like many health systems, University of Utah Health has been focused on the best ways to treat patients with multiple risks that include physical, psychiatric and substance-use disorders.
Taking an intensive integrated approach to primary and behavioral health care has enabled the system to improve outcomes and reduce costs. Through its intensive outpatient care program (IOCP), UofU Health is taking a deeper look at patients with multiple, complex medical and behavioral health issues, notes Peter Weir, M.D., executive medical director of population health.
UofU’s Intensive Outpatient Clinic Model
UofU’s IOCP is a primary care clinic for high-risk, high-need Medicaid patients. The clinic was designed to demonstrate financial sustainability while providing comprehensive care to patients with multiple needs. It features a team of multidisciplinary clinicians including both primary care, behavioral health and substance-use treatment providers as well as social workers with experience in providing trauma-informed care. These clinicians all work together to treat both the physical, mental and social needs of a defined patient population.
The Benefits of an Intensive Approach to Outpatient Care
UofU Health established the IOCP in response to a need for innovative care models for the highest-risk and highest-cost patients. Weir, a pioneer in integrated health care, and his colleagues based their approach on other integrated clinical models that were successful in reducing hospitalizations while improving patient adherence to treatment protocols — a key factor in improving patient outcomes.
Weir was an author of a study that was published in Translational Behavioral Medicine. The study examined the effectiveness of IOCPs in achieving overarching goals of reducing emergency department visits and hospitalizations, and improving care continuity and patient outcomes.
The study found that IOCPs improve patient outcomes by:
- Significantly lowering hospital admissions — with a 54% reduction of admissions at six months and a 46% reduction in admissions at 12 months.
- Lowering emergency department visits — with a 25% reduction at six months.
- Reducing length of hospital stays.
How Establishing an Integrated Approach Impacts Costs
The cost of developing a multidisciplinary care team is a perceived obstacle to creating an integrated model. However, just the opposite is true. “Our hypothesis was that we could reduce unnecessary costs by more than what we would internally cost to function. That’s what ended up working out,” Weir said in a recent interview.
A 2019 Journal of the American Medical Association (JAMA) study reported that large health systems can save millions annually by providing comprehensive integrated health services. A separate JAMA study reported on a 10-year study of Intermountain Healthcare’s integrated team-based care practices. The study, one of the largest of its kind, found that payments to providers in team-based practices resulted in a savings of 3.3% over traditional practices. The provider payments amounted to less than the investment costs Intermountain incurred in creating a team-based model.
Some health systems find external funding sources to support behavioral health integration. New Jersey-based Hackensack Meridian Health secured more than $5 million annually in federal and state primary care funding to develop specialized programs with integrated behavioral health services.
An AHA Trendwatch report offers additional examples of the cost benefits of integrating behavioral and physical care.
In a normal fee-for-service environment, hospitals don’t have the resources to adequately address the social factors influencing health, Weir notes. “It’s a mismatch between the payment model and the care model,” he said. “We flipped the equation. We changed it so that success is improving health and reducing costs — not generating revenue.”
LEARN MORE: Visit the AHA’s Physical and Behavioral Health Integration Resources webpage for information on how hospitals and health systems successfully integrate behavioral health into their existing care, as well as research and thought leadership resources on the impacts of that integration. And listen to an AHA podcast on the importance of integrating behavioral and physical care.