Behavioral Health Crisis Stabilization
Value-Stream Mapping Process: Groundbreaking Work in Orange County
This October week-long session sponsored by the Orange County Department of Mental Health, along with MHVC and others, was facilitated by Dr. Corey Waller, MD, MS, FACEP, DFASAM, Senior Medical Director for Education and Policy, Camden Coalition of Healthcare Providers.
During the week the objective was to value-stream process-map each service to help understand the current state as well as define the associated barriers and gaps. The process and results are summarized in the MHVC November 2017 Newsletter coming soon.
We encourage you to watch the proceedings and hear what participants had to say:
Above: Video highlighting the recent Value-Stream Mapping event featuring Dr. Corey Waller.
Above: Dr. Waller's summation of the week-long event.
Above: Summation with introductions and Q&A session.
Behavioral Health Community Crisis Stabilization Services
WHY WE CHOSE THIS PROJECT
Data from our Community Needs Assessment (CNA) on behavioral health (BH) care as related to inpatient(IP)/Emergency Department (ED) utilization show that the MHVC region has a significant opportunity to decrease IP/ED utilization and increase needed urgent care and outpatient crisis stabilization services. Over one-third of the total number of IP admissions were for BH, and half of the total ED visits were unique visits for BH issues. Patients with BH diagnoses lack sufficient resources for treatment and support in the Hudson Valley; further, there are only 21 crisis intervention programs throughout the region and many areas do not have same day appointments for urgent BH issues. These gaps in care likely drive IP/ED utilization for BH.
MHVC intends to bridge these service gaps with improved triage capabilities for crises, growth of mobile crises units, development of alternatives to IP hospitalization, use of comprehensive community-based services, and development of additional outpatient capacity (as part of our medical village) in order to decrease ED utilization and inpatient admission for BH needs. Also, given that four hospitals were responsible for billing 36% of ED visits for behavioral health primary diagnoses, MHVC will actively work with them and their counties -- Westchester and Orange -- to develop targeted services and networks to serve their at-risk populations.
The overarching goal is to get patients in treatment and drive outcomes around follow-up treatment after hospitalization for mental illness and avoidable ED and hospitalizations. MHVC will utilize “an intelligent design” for a BH crisis service system that can be adapted based on local needs, conditions and preferences to offer both early identification of BH urgent needs and timely effective interventions to reduce avoidable use of ED and BH inpatient services.
To achieve this, MHVC is part of a cross-PPS effort with Refuah Community Health Collaborative (Refuah) and WMCHealth PPS (WMC) to develop protocols for the Hudson Valley region (link here to the January 2017 report), and to support planning and implementation for the development of comprehensive crisis services in conjunction with local governments, providers, and consumers. The three PPSs have supported county “mapping” of BH crisis systems, and the development of two key protocols for (1) care transitions from BH inpatient to community care to improve community stability and reduce readmissions, and (2) community-based BH crisis and urgent care for people experiencing BH crises as an alternative to hospital emergency services.