Category: Partnerships

CommonSpirit Health Closes Care Gaps

CommonSpirit Health Closes Care Gaps with Personalized, Community-Based Care Navigation in Partnership with Docent Health.

CommonSpirit Health, a nonprofit health system serving patients in 137 hospitals and 1000+ care sites across 21 states, and Docent Health are expanding their virtual care navigator program to build on the program’s success in improving health outcomes for maternity and orthopedic patients. Docent Health is a leader in consumer engagement and patient navigation technology and services. Partners since 2016, the virtual care navigtion program has paired patients with care navigators who are in and of CommonSpirit’s communities and provide individualized guidance to patients.

The Centers for Medicare and Medicaid Services (CMS) has stated that achieving health equity and driving improvements for all patients requires further investment in tools that address social determinants and close care gaps. CMS notes that social determinants of health – including housing, transportation, education, social isolation, and more – affect minorities in particular, and negatively impact access to care and health outcomes. However, even with the recent attention on racial injustice and the correlation to poor health, CMS finds efforts to lessen these inequities often reach a fraction of the population, perhaps as few as two percent of all patients. Both payers and providers cite outdated tools, resource complexity, and bandwidth constraints as factors limiting their ability to elevate support for social determinants.

Docent Health’s engagement model captures and aligns numerous unique patient attributes and maps CommonSpirit’s resources to those of local, community-based organizations. The program will expand not only geographically to include more of CommonSpirit’s care sites across the country, but the virtual care navigators will also improve continuity of care among the health system’s hospitals and extend to primary care practices, behavioral health specialists, and community-based organizations.

“We simply cannot place enough value on the improvements we’ve seen in our patients’ health as a result of the individualized, community-based navigator partners who augment the work of our clinical teams,” said Alisahah Cole, MD, system vice president of population health innovation and policy at CommonSpirit Health. “The real-time capabilities from Docent Health’s platform take away much of the burden of care coordination, allowing us to scale services, which is particularly important for vulnerable or underserved patients in CommonSpirit’s communities. We are excited to bring Docent Health’s human-centric model to more of our patients with complex care needs.”

Using artificial intelligence to analyze care data, Docent Health’s platform can quickly coordinate personalized care by predicting and generating the right referrals into CommonSpirit’s workflows. Together, the technology and care navigator partners individualize support and proactively guide patients to local resources, educational programs, and care preparation. The multi-language cloud-based navigation platform interprets unique patient attributes in real-time to streamline interactions with the patient such as reminders, phone calls or text notifications, resource recommendations, and surveys, in addition to sending tasks out to care navigators and clinical care teams.

CommonSpirit and Docent Health are expanding their partnership based in part on the results of a multi-year study that quantified how Docent Health’s innovative technology and human care navigator program has successfully improved patient outcomes. The model also lowered the cost of care across all patient types, including among vulnerable populations and specifically for Medicaid patients. The study included more than 10,000 of CommonSpirit’s patients and found:

Maternity Patients:

New mothers had a 10 percent shorter average length of stay (2.29 vs. 2.46 days)

Medicaid neonates with complications had a 1.8-day shorter length of stay (4.3 vs. 6.13 days)

There was a 37 percent reduction in pre-term births for mothers on Medicaid (7.5 percent vs. 11.9 percent)

Orthopedic Patients:

Orthopedic patients had a 45 percent shorter average length of stay (1.93 vs. 3.5 days)

30-day readmission rates for orthopedic patients were 71 percent lower (1 percent vs. 3.5 percent)

“As an industry, we’ve known that community-based culturally responsive programs work but we’ve lacked the technology to deliver them cost-effectively, at scale. Our tech-enabled approach is driving better outcomes for physicians and helping to build trust and engagement, and improve health in the communities that need the support the most,” said Royal Tuthill, co-founder and president of Docent Health. “We are honored to continue our work with CommonSpirit to address health inequities in more of their communties, which is especially needed during this challenging time.”

The virtual care navigator model has led to more comprehensive support for patients with complex health care needs, and ensures a greater degree of care continuity. An internal reseach study analyzed data related to 10,220 of CommonSpirit’s patients between the years 2016 and 2018. Over sixty percent of patients in the research study were either Medicaid or Medicare patients, and were from a mix of urban, suburban, and rural communities. CommonSpirit’s study controlled for numerous variables, including age, race and ethnicity, and physician.

The collaboration is expected to extend Docent Health’s care navigation technology and services across 11 states and more than 60 of CommonSpirit’s care sites.

About CommonSpirit Health

CommonSpirit Health is a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. With its national office in Chicago and a team of approximately 125,000 employees and 25,000 physicians and advanced practice clinicians, CommonSpirit Health operates 137 hospitals and more than 1000 care sites across 21 states. In FY 2020, Catholic Health Initiatives and Dignity Health had combined revenues of nearly $29.6 billion and provided $4.6 billion in charity care, community benefit, and unreimbursed government programs. Learn more at www.commonspirit.org.

About Docent Health

Docent Health is a venture-backed healthcare experience technology and services company focused on helping healthcare organizations transform and truly embrace a consumer-centric approach to healthcare. The company’s mission-driven platform and services combine digital and human interactions to guide customers on journeys tailored to their specific needs and preferences. By utilizing Docent Health’s platform, health systems and payors can provide personalized, empathetic experiences at scale and support a multitude of complex care pathways. For more information, visit www.docenthealth.com or follow us on Twitter and LinkedIn

CommonSpirit Health Expands Behavioral Health Support

CommonSpirit Health Expands Behavioral Health Support through Primary Care Collaboration in Partnership with Concert Health.

CommonSpirit Health, a national nonprofit health system serving communities at more than 1,000 care sites and 137 hospitals across 21 states, today announced it is offering new access to support for depression and anxiety within the primary care setting through a partnership with Concert Health, a leading behavioral health medical group. This model will place CommonSpirit’s primary care physicians at the center of all physical and behavioral aspects of care by connecting patients with Concert Health’s remotely located behavioral health care managers who provide therapy and develop a behavioral health care plan for each patient.

Access to behavioral health services in the U.S. is challenging at the best of times, and for patients, the lack of care can have far-reaching consequences. More than 115 million Americans live in an area where there is no access to a mental health professional. As a result, many seek care from their primary care provider, with whom they often have a long-term, trusted relationship. In fact, a study found that primary care providers prescribed 79 percent of antidepressant medications. That strong relationship and lack of access to specialty mental health services often leaves primary care providers managing depression and anxiety, without the professional support they need to address their patients’ conditions. Given the proven connection between physical and mental health, it is essential that patients receive the appropriate care and treatment for all of their health needs — physical and mental — in one place, which is most convenient in primary care.

An integrated approach is particularly critical for patients with multiple health conditions. One recent report found that high-risk patients require up to 6.2 times more spending on medical care when they have an active behavioral health diagnosis.
The partnership between CommonSpirit and Concert Health is based on Collaborative Care Management, an evidenced-based model proven to improve behavioral health conditions such as depression and anxiety within the primary care setting.

CommonSpirit’s primary care physicians will now manage all aspects of patient care by diagnosing depression and anxiety in patients and making warm handoffs to a dedicated group of Concert Health’s behavioral health care managers. The Concert Health care managers develop the behavioral health care plan and serve as a liaison between Concert Health’s psychiatric provider and the primary care physician who both review the patient’s progress and make needed adjustments in care. The primary care physician also prescribes medication recommended by the behavioral health care team. Patients meet regularly with their care manager via phone, video visit, or in-person at their primary care location.

Collaborative Care is already a covered benefit for Medicare, most commercial insurance, and under Medicaid in 18 states. CommonSpirit is already working with Medicaid partners in California to ensure it can offer this care to all patients who need it.

“To bridge long-standing gaps between mental and physical health care, we need to turn to evidence-based models that integrate these areas of care and provide real outcomes. Especially for the vulnerable or underserved, seeking behavioral health care in the community can be challenging due to stigma, lack of access, and prohibitive costs,” said Christine Brocato, vice president of strategic innovation at CommonSpirit Health. “By offering coordinated behavioral health services from Concert Health to CommonSpirit’s patients utilizing the Collaborative Care model, we have one team working together to meet all of the patient’s medical and behavioral health care needs in a matter of hours, rather than fragmenting care through referrals that take weeks. Care simply must be inclusive of mind and body.”

“Concert Health is proud to support CommonSpirit’s commitment to comprehensive, outcome-based care for people with behavioral health conditions,” said Virna Little, LCSW, PsyD, co-founder and chief operating officer of Concert Health. “We are excited to partner with CommonSpirit’s outstanding physicians to make these services available to improve health outcomes for their patients.”

Patients are screened for depression and anxiety using evidence-based tools: Without screening, over half of people struggling with behavioral health concerns never get the care they need – either because they lack a diagnosis or don’t realize what it is that they are experiencing.

Instead of external referrals, primary care providers can make warm handoffs to behavioral health providers: CommonSpirit’s primary care providers will work closely with a dedicated team of Concert Health’s behavioral health care managers to provide support in less than 48 hours.

Patients can receive evidence-based psychotherapy interventions at their preferred location: Behavioral health care managers provide a mix of medication management, goal setting, and evidence-based approaches. Patients are given the choice of engaging via video visit, telephone, or in-person care.

The care team is aligned around measurement-based care: A core part of the Collaborative Care model includes regularly assessing behavioral health symptoms, much like is done for diabetes (A1Cs) or hypertension (blood pressure). Concert Health’s team regularly assesses patients’ symptom severity using evidenced-based tools like the Personal Health Questionnaire 9 (PHQ9), General Anxiety Disorder 7 (GAD7), and Columbia Suicide Severity Rating Scale (C-SSRS) and alters patients’ treatment plans.

Psychiatric consultations support the primary care provider: For those patients who need more support, Concert Health’s consulting psychiatrists and psychiatric nurse practitioners speak weekly with the behavioral health team to review information and make written recommendations to the primary care provider to support their decision-making around diagnosis, medications, and dosage.

The organizations have initially launched these integrated services in Bakersfield, California to help address the area’s high unmet need for behavioral and mental health care. The program is expected to scale to additional CommonSpirit care sites across the central California region during the remainder of the year as well as to additional markets in 2021.

More information about the Collaborative Care Model can be found from the American Psychiatric Association (here) and the University of Washington’s AIMs center (here).

About CommonSpirit Health

CommonSpirit Health is a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. With a team of approximately 125,000 employees and 25,000 physicians and advanced practice clinicians, CommonSpirit Health operates 137 hospitals and more than 1000 care sites across 21 states. In FY 2020, Catholic Health Initiatives and Dignity Health had combined revenues of nearly $29.6 billion and provided $4.6 billion in charity care, community benefit, and unreimbursed government programs. Learn more at www.commonspirit.org.

About Concert Health

Founded in 2016, Concert Health is a leading behavioral health medical group integrating Collaborative Care Management, an evidence based model for treating depression and anxiety, into primary care settings. Concert Health’s clinicians work arm in arm with hundreds of primary care and women’s health medical providers to identify and address the behavioral health needs of all patients.

Headquartered in San Diego, Concert Health, Inc is the management services organization for a group of affiliated professional corporations that deliver medical services. Together, they deliver exceptional care in California, Arizona, New York and Connecticut. Concert Health, Inc and its affiliated medical entities do business under the “Concert Health” brand. To learn more about Concert Health’s approach, visit concerthealth.io.

CommonSpirit partners with Concert Health to create a new primary care model that better addresses depression and anxiety