Behavioral Health Care@100%: Innovation 1
Tracking Supply and Demand
The projects presented in the ten innovations areas are all designed to address barriers to vital services. Action teams should review all projects and prioritize those that have the best chance of addressing the barriers identified in the 100% New Mexico countywide survey. Your collaborative and result-focused local work is nothing less than heroic.
Project: Behavioral Health Care.1.1
Project 1: The “all-important behavioral care analysis” project
Most of the time somebody uses a behavioral health care provider and that visit is paid for by insurance, data on that visit is collected. The Health Insurance Portability, Access and Accountability Act (HIPAA) means that health visits are reported in the aggregate. You can’t see whether a particular person received care, but you can know how many women aged 30–39 received care, for example. Gaining access to behavioral health information is harder than other data, because laws and policies see this information as sensitive due to the enduring stigma about mental illness. It is also cumbersome for many kinds of behavioral health providers to manage billing insurance companies for care, so they make the patient file the claim.
No one number will provide a complete picture of a community’s health. By gathering multiple data sources and tracking them over time, you should be able to get an idea of how much behavioral health care insecurity exists in your community. Here’s your list:
- Available data: Your state Behavioral Health or Mental Health Department should have aggregate data for the whole state and maybe some by county.
- Sources of care: Locate the sources of behavioral health care, both private and public. Include the following: emergency rooms, urgent care centers, doctor’s offices, hospitals, community health centers, free clinics, school clinics, pastoral counseling centers, social workers, licensed mental health counselors and psychologists.
- Access limitations: Determine the operating hours and eligibility requirements for every source. Do they take Medicaid, Medicare, self-pay patients? Do you have to be a US citizen to get care?
- ER data: How many behavioral health patients does the hospital Emergency Department serve each year? How many of these cases are transported by ambulance? How many of those patients were there due to violence, injury or threat to harm self or others? Were these patients identified and tracked for behavioral health issues?
- Community mental health center: Does your community have one? Does a federally-qualified health center or tribal health center have a behavioral health staff?
- Free clinic data: Does your community have a free clinic? How many patients can it handle on average? Is care restricted to certain age groups or other populations?
- Clergy: Many clergy provide initial behavioral health support to their members. You may have to call pastors/faith-based organization leaders. Note how many sessions they offer on average, and whether they have a credential in pastoral care or behavioral health.
- Elder service agencies: How many have social workers or other behavioral health care providers on staff? Who is eligible for care?
- School districts: Is there a school-based health center in your community? What services are provided, what age group(s) do they serve? How many visits occur in an average month? Do your schools have volunteer or paid school nurses on staff?
- Homeless shelters: Many serve substance using or mentally ill clients routinely. Who do they call when they can’t manage a client with behavioral health or addiction issues?
- Domestic violence shelters: They may track visits to shelter program supports. Maybe take a snapshot once per month and track over time.
- Child welfare data: While not easy to acquire, there may be a way to assess data on adult and child clients needing behavioral health care.
- American Community Survey: The ACS is an ongoing survey that provides vital information on a yearly basis about the United States and its people. Information from the survey generates data that help determine how more than $675 billion in federal and state funds are distributed each year.
As mentioned, this won’t be as simple an assessment as those for other sectors, but if you get these numbers, you should be able to tell if the situation in your community is going in a good or bad direction. In this project, you will be gathering as much data as you can to paint a picture of local behavioral health care, the first step in identifying challenges.
Project: Behavioral Health Care.1.2
Project 2: The “behavioral care accessibility analysis” project
Your mission is to figure out where people of limited means can access behavioral health care. Make a list of all sliding scale clinics, health department operations, public hospitals designated for charity care, school-based health centers and the like, then see what you can learn about how accessible they are. Ask patients, or maybe even the administration, how many days or weeks it would take to get seen by a behavioral health care provider, or how many hours the average wait time for care is. As a bonus, you could call up a few psychologists, psychiatrists and health centers to see if they take Medicaid.
Project: Behavioral Health Care.1.3
Project 3: The “what’s ailing you?” project
This is an advanced project, and may not be possible in your state, but here’s the background: as part of the ongoing effort to identify ways to reduce health care costs, many states have developed something called an all-payer claims database, and your state may be one of them. The idea is that instead of hoarding all this useful information for proprietary reasons, all payers (translation: insurance companies) would be forced to turn over data on what behavioral health services they are buying to a central state authority for further analysis. These data would, of course, be anonymized but should provide a helpful level of detail regarding the number of people receiving various treatments and the cost. We can also infer from this data the types of medical problems people have.
So if your state has one of these programs, and if the data are actually accessible to lay members of the public, then you may have an interesting data analysis project on your hands. Because this varies everywhere, our best advice is to find an expert at the local university to help see what you can find. Look for leading causes of death, the most expensive procedures, the most common ailments, ways in which your local area deviates from other parts of the state and other interesting trends.
All-payer claims databases: https://aae.how/118
Project: Behavioral Health Care.1.4
Project 4: The “does our behavioral health care exist, and if so, where should it be?” project
Your behavioral health care system (notice the term “system,” as it should be one seamless system serving the entire county) should serve all residents, but especially your community’s most critical areas: communities with high rates of child welfare involvement, low income areas, areas with high unemployment, high schools with low achievement and high dropout rates. Find or make a map of the county, then make a map of all “high risk” areas and all behavioral programs. Next, see how well those two maps overlap. Also take a look at service frequency: is care, in its many forms, being offered when the need is the highest? Whether care “serves” the most critical areas depends on more than what the map looks like. This may become a strengths-based process, as you can identify where excellent assets exist and how they can be strengthened.
Project: Behavioral Health Care.1.5
Project 5: The “can you get cared for from here?” project
This might best be done in conjunction with the transportation task force/action team, but here’s the mission: Map out all your county’s behavioral health facilities, then figure out how accessible they are using only public transit. Look at service frequency, hours of operation, etc. Try to figure out if an average patient with a doctor’s appointment could make it work without a car. If you feel really creative, create a map in Google Maps showing where services are and where transit goes. If you are feeling adventurous, your action team could attempt to walk to services.