Creating a Better System of Care for Patients with Complex Needs

DASH Project Spotlight: Using a Connected Information System to Enable Spontaneous, Shared Community Treatment of Adults with Severe Mental Illness

Man speaking with behavioral health clinician

Lead agency: Center for Health Care Services

Partners/collaborators: Healthcare Access San Antonio (HASA), Community Medical Directors Roundtable

The challenge

For people with co-occurring physical and behavioral health disorders, America’s fragmented health care system can be tough to navigate. Behavioral health issues can make it difficult for people to convey their complex needs and histories when seeking help or when in a crisis. As a result, people with severe mental illness are more likely to be denied community resources, treated inappropriately in health care settings, and even incarcerated, because of system failures to give them the help they need. Many feel caught in a perpetual cycle between emergency departments, homeless shelters, and the criminal justice system, making it challenging to live a stable and productive life.

San Antonio, TX is just one community working to improve the system of care for this high-need population. Police officers, first responders, health care providers, and agencies serving the homeless all recognize that the status quo is inefficient, costly, and fails to meet people’s needs. Yet, these sectors have disparate data systems, contributing to the problem by making it difficult to coordinate treatment and social support services.

The opportunity

The Center for Health Care Services (CHCS), a local mental health authority in San Antonio, TX, envisions a health care delivery system where all relevant sectors are working collaboratively to share data that will help streamline services for patients with complex needs. Through a Data Across Sectors for Health (DASH) project, CHCS is leading a multi-sector effort to create a connected information system that integrates physical and behavioral health care data into Healthcare Access San Antonio (HASA), a regional health information exchange. The system will enable critical sectors—including law enforcement, hospitals, and homeless services providers—to rapidly identify people in crisis and notify CHCS staff through real-time HASA alerts. This will allow behavioral health providers to intervene earlier and prevent inappropriate hospitalization or incarceration.

When a patient ends up in an emergency department exhibiting psychiatric symptoms, the staff will able to access a Community Treatment Plan with that person’s medication lists, medical history, and CHCS behavioral health contacts. Project Director Bren Manaugh explained:

“[The Community Treatment Plan] is a high-level overview of an individual’s clinical concerns and needs so that each time he or she presents to ED or inpatient intake staff, they aren’t going into the interaction blind. The plan gives them the advantage of having historical clinical information and knowing what’s going to be most effective at that point in time.”

CHCS is also working to develop a tool that can provide law enforcement with partitioned access to Community Treatment Plans. Through handheld devices, they will be able to identify enrolled clients in the field and refer them to appropriate interventions and services.

Engaging sectors to work together

The Community Medical Director’s Roundtable is a 10-year-old collaboration in San Antonio that brings together hospital systems, law enforcement, government, and other sectors interested in providing more efficient and effective care for this vulnerable population. The objectives and priorities of the roundtable are naturally aligned with the DASH project, providing an ideal forum for problem-solving and working towards common goals.

Although these relationships were already in place at the outset of the project, Manaugh emphasizes the importance of continuing to make the value case to all sectors involved to ensure their continued buy-in as they undertake the complicated implementation process. Manaugh commented:

“Members of the Community Medical Director’s Roundtable are already invested in trying to figure out how to do better by this population, so that helps since we are not starting from baseline with community collaboration. But that doesn’t mean that they’re then poised to invest the time, the money, the energy, or the data to help us with the solution. So what we’ve had to do is try to show the actual cost impact of this program so that they can see that, to the degree to which care is not individualized and coordinated, it’s impacting the bottom line.”

Every month, the roundtable meetings are an opportunity for the project team to outline the clinical, financial, legal, and technical advantages of sharing data. They have been able to make the business case by showing a 40% reduction in emergency department and inpatient utilization among an evaluated subset of those who were actively engaged in the program. In addition, with the robust treatment data that is being gathered through HASA, the team can offer compelling information to participating hospitals about how many of their clinicians accessed Community Treatment Plans, sent alerts, and made successful referrals to appropriate interventions. Amanda Ternan, Program Manager, noted:

“The hospital systems, emergency departments, and other agencies that are participating in the health information exchange will be able to see their impact because they’ll have access to their data.”

Looking to the future

Integrating data from multiple sectors in HASA will help create a continuum of care in San Antonio that rapidly identifies clients with mental health needs and provides appropriate services in times of crisis. Streamlining the process will save costs by directing the course of care and providing appropriate treatment, while reducing incarceration and emergency department visits. The Community Medical Director’s Roundtable also plans to use the aggregated data to identify resource gaps, plan new services, and evaluate the project’s impact on their clients, their organizations, and the general community.

As more organizations start to see the benefits of sharing data through HASA, rather than interfacing with multiple hospitals and agencies, the project team hopes they can break down silos that have been holding the community back from providing more effective care.

Learn more

Watch this video to learn more about CHCS’ Integrated Care Program.