Maryland s Behavioral Health Crisis The Hospital Perspective
Topics to Cover The National Experience Maryland s Experience Hospital Data 2
The National Experience 3
Behavioral and Physical Health are Linked Risk Factors Childhood adversity Loss Abuse and neglect Household dysfunction Adverse life events Chronic stressors Poverty Neighborhood Social support Isolation Adverse Health Behaviors & Outcomes Obesity Sedentary lifestyle Smoking Self care Symptom burden Disability Quality of life Behavioral Health Disorders Chronic Medical Conditions Source: Mental Disorders and Medical Comorbidity Adapted from Robert Wood Johnson Foundation, 2011 4
Comorbidities: Mental and Medical Conditions 25% of the adult population has a mental disorder 58% of the adult population has a medical condition 68% of adults with mental disorders also have a medical condition 29% of adults with medical conditions also have a mental disorder Source: Mental Disorders and Medical Comorbidity Robert Wood Johnson Foundation 2011 5
Significant Unmet Needs 11% 25% 22.7M 43.8M Adolescents & adults needed substance abuse treatment Received treatment at specialty facility Adults with a mental illness Reported an unmet need Source: SAMSHA Report to Congress on the Nation s Substance Abuse and Mental Health Workforce Issues Substance Abuse and Mental Health Services Administration, 2013 6
Maryland s Experience 7
A Crisis in Maryland Based on conversations with Maryland Hospital Leaders: Lack of behavioral health capacity causing rise in ED and inpatient utilization Insufficient inpatient capacity for children patients often transferred long distances Lack of funding for community behavioral health providers Long waits for community services Unclear what resources are available and if tools currently available are accurate and/or updated Lack of behavioral health screening Source: Council on Clinical and Quality Issues. December 2014 meeting 8
Gaps in Finding Warm Hand Offs No comprehensive directory of community behavioral health providers exists Problems with existing information Incomplete recognition of all providers Self-reported provider information Incomplete insurance coverage information Gaps in information Hours of operation not reported Wait time information not available 9
Hospital Data 10
Behavioral Health Readmissions Patients hospitalized for a behavioral health condition are more likely to be readmitted than other types of patients In 2015, there were 7,144 readmissions for patients who were previously hospitalized with a behavioral health primary diagnosis The readmission rate for these patients was 16.3 compared to a readmission rate of 12.8 for nonbehavioral health patients 11
Top Readmission Diagnoses in Maryland Diagnosis Heart Failure Septicemia & Disseminated Infections Chronic Obstructive Pulmonary Disease Bipolar Disorders Other Pneumonia Renal Failure Schizophrenia Kidney & Urinary Tract Infections Major Depressive Disorders & Other/Unspecified Psychoses Cardiac Arrhythmia & Conduction Disorders Source: MHA analysis of Health Services Cost Review Commission CY2014 data 12
Behavioral Health Emergency Department Visits By Age Group By Payer 3% 15% 17% < 19yrs 20-39 3% 13% 16% Medicare Medicaid 25% 40% 40-54 55-74 28% 41% Commercial Self-pay/Charity 75+ Other While behavioral health illness affects all age groups, it is clear that volume is associated with a significant portion of government payers -- both Medicare and Medicaid cover 57 percent of all emergency department visits 13
Percent of Behavioral Health ED Visits Mood disorders 26.3% Alcohol-related disorders 23.8% Anxiety disorders Substance-related disorders 12.3% 14.7% Schizophrenia & other psychotic disorders 7.8% Delirium, dementia & other cognitive disorders Other MHSU disorders Adjustment disorders Attention-deficit, conduct, & disruptive behavior Miscellaneous mental disorders Suicide & intentional self-inflicted injury 3.0% 2.7% 2.3% 2.4% 1.8% 3.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Using the Agency for Healthcare Research and Quality s Clinical Classification Software, the conditions above represent the type of behavioral health ED visits, by primary diagnosis 14
Emergency Department Use by Patient Residence This population-based map depicts where patients with behavioral health needs who use emergency department services reside; the legend identifies ratios of emergency department visits per 1,000 population 15
Behavioral Health ED Visits by County and Primary Diagnosis In your packet 16
For More Information 17
Regional Breakout Groups Region Anne Arundel & Howard Counties Baltimore & Carroll Counties East Baltimore City West Baltimore City Montgomery County North East/Eastern Shore Prince George's County Southern MD Western MD Your Breakout Room is: Delaware Salon H Salon A Salon B-C Washington Pennsylvania Virginia Executive Board Room Maryland 18
Breakout Session Objectives Understand the type of patient profiles that create challenges for hospitals to discharge and challenges for community providers to accept Identify opportunities to improve transitions of care and discuss what information is needed from both hospitals and community providers Learn how you work with Local Addiction Authorities and Core Service Agencies in your community and how these relationships can be optimized 19