THE CHALLENGE for a behavioral health provider is that they do not always know when a consumer in their care is being seen or was seen in an acute care facility. Without knowledge of a transition of care, the need for intervention may easily be missed, resulting in a more expensive course of care. In order to minimize hospital readmissions and reduce the cost of care, a behavioral health provider must be made aware of changes in a consumer’s status in real-time. In particular, admission, discharge, and transfer information from facilities the consumer may visit must get back to the behavioral health provider who may then invoke the care team.
THE BHPI SOLUTION is an easy to use process that provides a daily summary of consumer activity within an acute care facility, for participating partner care coordinating or support coordinating agencies. This daily summary, collectively called Admission/Discharge/Transfer (ADT) Daily Notification Report provides a daily list of consumer activity, providing full transparency to a behavioral health provider, enabling them to notify appropriate care team members to respond to a potential, immediate situation.*
Integration entails both improving the screening and treatment for behavioral health care needs within primary, acute and community-based care settings, as well as improving the medical care of consumers receiving services in behavioral healthcare settings.
- Reduced chance of a hospital readmission
- Reduced Emergency Department (ED) utilization
- Improved quality of care and patient satisfaction
- Reduced healthcare costs
BENEFITS of ADT messages are numerous. Organizations can experience many benefits from successful ADT implementation. ADT messages are beneficial to organizations because they allow care team members and providers to be better informed about their consumers’ hospital activities.
An ADT notification can be used to trigger an action to be taken by a behavioral health provider to reach out and engage with a consumer that is transitioning from inpatient care to community-based care. This intervention can enable the provider to engage with the consumer and assist with the care and services needed that could help divert readmission, prevent care disengagement, and reduce symptom exacerbation.
Enhanced Access to Care
ADT messages allow for enhanced access to care. The messages deliver the care teams more information about their consumers’ health. ADTs, give care team members and providers documentation of their consumers’ health status in near real-time (within 24 hours). This will allow the consumer, care team members, and providers to build a stronger relationship by providing the consumer with access to high-quality care. Over time, the consumer may feel more connected to their behavioral and healthcare providers. This may result in the consumer visiting their PCP instead of the ED for healthcare services.
- ADT messages allow the care team to call and set up an appointment with the consumer at the time of discharge. This allows the care team to monitor the consumer’s condition instead of waiting for the consumer to call in and schedule an appointment themselves.
- ADTs may show patterns of consumers who are frequent users of hospitals. This information allows the care team to be more proactive and take initiatives to reducing unnecessary hospital admissions and ED visits.
ADT messages may include diagnostic information about the admitted consumer. This diagnostic information will help the care team better prepare for and conduct follow-up visits. This will allow caregivers to have a better idea of a consumer’s condition before seeing the consumer or referring a consumer to their primary care physician (PCP).
Using ADT Messages at a Behavioral Health Agency: A CASE STUDY
A behavioral health agency agreed to assess the process of receiving and distributing ADT messages. The overall goal of the ADT pilot was to create a process to monitor acute care facility admits and transfers specific to inpatient, as well as discharges, specifically from an inpatient status.
Either a designated team member or individual behavioral health providers identified admission of one of their consumers, and would “red flag” the consumer and thus, contact the consumer’s PCP for follow-up at transition. When discharged, the practice team contacted the consumer directly or the consumers’ PCP to follow-up and schedule an appointment within a designated time period (typically within 5-7 days).
The behavioral health agency received and used information provided by the ADT feeds. The agency saw a decrease in hospital readmissions and ED visits since using the ADT messages. Additionally, the agency was able to identify frequent ED and hospital users. The practice team then worked on keeping those consumers out of the hospital. They were also able to know where their consumers were within a facility, in real time. This helped the practice team improve follow-up care by scheduling timely visits and care services for that consumer.
Overall, the use of ADT messages became a part of the agency’s daily workflow and the information became beneficial for the age caregivers, and the consumer. Care coordination significantly improved.
*Since the source of these notifications are acute care facilities, BHPI does not control whether we receive these notifications, however, we are successfully receiving and distributing them from participating acute care facilities.