Oregon Integrated Care Organization Uses Data to Drive Targeted, Innovative Services

Data about physical health, mental health, and substance use disorders as well as social determinants of health can drive improvements in care for behavioral health patients.

Mark Moran

That’s the principle behind a research project at Cascadia Behavioral Healthcare in Portland, Ore., a community-based provider of integrated care as well as social services including supportive housing.

This year, Cascadia partnered with Health Share of Oregon (HSO), the largest accountable care organization in the state, and CareOregon (CO), the largest Medicaid payer in the state, to build a “warehouse” of data on a wide range of variables affecting Cascadia’s patient population—general medical conditions, mental health and substance use disorders, emergency department (ED) and hospital utilization, housing and employment status, and other social determinants of health.

Analysis of those data has revealed important facts about the patient population—for instance, who the highest utilizers of expensive services are and the relationship of certain physical and mental health conditions to ED use.

“It’s a project that has allowed us to understand the needs of our population better than we ever did before, in a way that can really drive changes in how we deliver care,” said Jeffrey Eisen, M.D., M.B.A., chief medical officer at Cascadia and an assistant clinical professor of psychiatry at Oregon Health Sciences University. Eisen described the project during presentations at IPS: The Mental Health Services Conference in Chicago in October.

It’s a high-tech, data-driven version of “health care hotspotting”—a term coined by Jeffrey Brenner, M.D., of the Camden Coalition of Healthcare Providers. Hotspotting is based on the principle that a small minority of patients in a given population are the highest utilizers of expensive health services. Brenner sought out the highest utilizers of health care in Camden, N.J., for the purpose of targeting them for primary care and preventive interventions.

At Cascadia, Eisen said that the data collaboration revealed a startling fact: just 7 percent of Cascadia’s patients accounted for 55 percent of ED visits.

“The ED is not a place to receive quality, continuing care,” Eisen said. “These data provide us with insight into individuals for whom we can design better programs.”

Eisen explained that Cascadia’s population health project was paid for by federal funding Cascadia received as a Certified Community Behavioral Health Center (CCBHC), a designation created by the 2014 Excellence in Mental Health Act. Oregon was selected as one of eight demonstration states, and three of Cascadia’s clinics were chosen as demonstration sites to provide integrated health and mental health care to patients in the community.

Among the core activities of a CCBHC, as defined by the Excellence in Mental Health Act, is “collecting, recording, and analyzing” data to drive population health research and innovation. Working with Health Share, Eisen and colleagues formulated three research questions:

• How are psychiatric and other medical diagnoses linked in a shared client population?

• How do Cascadia psychiatric diagnoses predict nonpsychiatric ED visits, nonpsychiatric inpatient admissions, and overall costs in a shared client population?

• How do HSO/CO medical diagnoses predict nonpsychiatric ED visits, nonpsychiatric inpatient admissions, and overall costs in a shared client population?

“Among our findings, one of the most revealing is that individuals with trauma-related disorders were significantly more likely to be diagnosed with a number of general medical conditions and to utilize expensive health services, including emergency department visits,” Eisen said.

Even when controlling for age, gender, and psychiatric risk factors, patients with a diagnosis of a trauma-related disorder were:

• 53 percent more likely to be diagnosed with hypertension;

• 62 percent more likely to be diagnosed with asthma;

• 49 percent more likely to be diagnosed with low back pain; and

• 76 percent more likely to be diagnosed with COPD.

A second crucial finding is that chronic pain—especially low back pain—was associated with increased ED visits, inpatient admissions, and overall costs of care. PTSD, major depressive disorder, and generalized anxiety disorder were all highly correlated with chronic pain.

“Chronic pain can be viewed as an indicator of the intersection of mental and physical health,” Eisen said.

Based on these findings, Cascadia initiated a pilot project targeting 100 individuals with chronic pain that includes group and individual psychotherapy, gentle exercise and yoga, massage, care coordination, and medication reviews based on best practices for pain management.

“Assessments will be tracked rigorously to demonstrate efficacy,” Eisen said. “We hope to achieve a significant reduction in the cost of care, emergency department utilization, and inpatient admissions across the course of the program.”

Eisen says a rich source of data such as Cascadia’s collaboration with Health Share gives psychiatrists and community mental health centers leverage with potential partners and payers.

“Some of what we are finding has been intuitively understood for a long time, but having data to back it up is very powerful,” he said. “We are able to take these data to Medicaid payers and to affiliated collaborative care organizations, and it really helps us in talking to legislators at the statehouse in Salem. Most importantly, this kind of data allows us to design targtoeted programs to help our patient live healthier lives.”  ■