Podcast Episode 3: Caring & Advocating for Provider Mental Health
Providers across the country face mental health challenges, including burnout and suicidal ideation. Learn more about these unique challenges from the nation’s leaders in provider health research and advocacy.
Join Dr. Enrique Enguidanos, CEO and Founder of Community Based Coordination Solutions and Kat McDavitt, Chief of External Affairs at Collective Medical as they interview Bernard Chang, MD, PhD, FACEP, Vice-Chair of Research and Associate Professor of Emergency Medicine at Columbia University Irving Medical Center and Lisa Wolf, Ph.D., RN, CEN, FAEN, Director of Emergency Nursing Research at the Emergency Nurses Association.
- Data on healthcare workers
- The impact of COVID-19
- How to support each other as healthcare professionals
About the Speakers
Bernard Chang, MD, PhD, FACEP and Vice Chair of Research and Associate Professor of Emergency Medicine at Columbia University Irving Medical Center
Bernard Chang is Vice Chair of Research and Associate Professor in the Department of Emergency Medicine at Columbia University. He has research interests in clinician psychological and physiological health. He has received grant funding at the institutional, state, and federal level for his work on burnout and is currently one of the leading NIH-funded Emergency Medicine Principal Investigators in the United States with 2 active large (R01) federal grants looking at long term cardiovascular and psychological development of burnout in emergency physicians and nurses.
Chang received his Ph.D. from Harvard in psychology, his MD from Stanford and completed his Emergency Medicine residency training at the Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women’s Hospital. Prior to going to medical school, he served as a professional sailboat captain doing yacht deliveries internationally.
Lisa Wolf, PhD, RN, CEN, FAEN, and Director, Emergency Nursing Research at the Emergency Nurses Association.
Dr. Lisa Adams Wolf is the director for Emergency Nursing Research at the Emergency Nurses Association. Her work has focused on the intersection of workplace environment, moral agency, and clinical decision-making in the healthcare setting, as well as workplace violence, mental health and suicide in care teams.
Wolf is an adjunct professor of nursing at several area colleges and Universities, and maintains a clinical practice in a local ED. She holds a bachelor’s degree in anthropology from Amherst College, master’s degrees in fine arts (Emerson College) and nursing (Molloy College), and a PhD in nursing from Boston College.
About the Podcast
The Collective Conscious is a monthly podcast aimed at addressing gaps in healthcare for some of our nation’s most vulnerable patients. Each month, we’ll meet with healthcare leaders to discuss what care teams, communities, and government agencies are doing to better support individuals with unique care needs—this includes mental and behavioral diagnoses, substance use disorder, homelessness and social determinants of health, and other complexities of care.
About the Hosts
Enrique Enguidanos, MD, MBA has over 20 years of clinical experience in emergency medicine—much of which has been spent also serving in organizational and systems management roles. As CEO and founder of Community Based Coordination Solutions and a practicing ED physician, he has spent over a decade developing and fine-tuning systems of care and community management systems that have proven very effective for frequent utilizers. He has organized these systems in a manner that allows CBCS to continuously reproduce care results across varying communities and healthcare systems.
Kat McDavitt is Chief of External Affairs at Collective Medical. With over ten years of experience in healthcare marketing, communications, corporate, and government strategy, she has positioned healthcare companies from small angel-funded start-ups to multi-vertical public corporations. Her knowledge of the healthcare industry spans both clinical and administrative innovations—as well as professional services—in the patient, physician, institutional, and payer markets.
Podcast Episode 1: COVID-19 and Healthcare Post-Pandemic
CBCS and Collective Medical are collaborating on a monthly podcast series addressing a variety of social determinant health issues. The inaugural podcast focuses on a post-pandemic world.
As healthcare organizations reach COVID-19 peaks and leaders begin to look at post-pandemic healthcare protocol, it becomes clear that the healthcare scene post-COVID will be very different than it was before the pandemic.
Join Collective Medical’s Head of External Affairs, Kat McDavitt, and our CEO and Founder, Dr. Enrique Enguidanos, in this inaugural podcast as they interview Dr. Joanne Roberts, Senior Vice President and Chief Value Officer at Providence St. Joseph Health System, and Deborah Kozick, Associate Director of Delivery System Reform at the Center for Health Care Strategies to see what changes we can expect to see moving forward, and how this will impact our nation’s most vulnerable patients.
- Challenges faced with an influx of inpatient care
- Employee retention during recession and pandemic
- Positive “lessons learned” as a result of COVID-19
- Forward-moving initiatives to address patients with behavioral health, social determinants of health, and other vulnerable populations
The social impact: What we’re forgetting in today’s age of interoperability
*This article is written by CBCS Founder, Enrique Enguidanos, and is a re-post from Becker’s Hospital Review that ran on April 29, 2020.
Earlier this year, communities around the world engaged in a collective movement called “social distancing”. Schools and offices shut down as the world went virtual and individuals and families committed to isolation in hopes of limiting the spread of the COVID-19 virus.
But this idea of using social circumstances to affect physical health is not a new concept. The impact social interactions and situations have on the medical world goes beyond preventing infectious disease and can actually significantly improve a patient’s well-being when the right resources are in place.
Understanding Social Determinants of Health
Social determinants of health affect 80-90 percent1 of a person’s health outcomes and one-fifth2 of all Americans are living in environments that compromise their health. (And no… I don’t mean the busy coffee shop where someone is likely to pick up a pandemic-causing virus).
These Americans are living in situations where they lack access to housing, education, public safety, proper healthcare services, transportation, or job opportunities. There are neighborhoods where crime rates and residential segregation are so prevalent, zip codes have become a stronger predictor of overall health than both race and genetics3. And if we’re ever going to truly help these patients, we have to address the things that affect them outside hospital doors.
CMS Interoperability—A Step, Not a Solution
As an ED physician, I hear the word “interoperability” now almost daily as this month’s most trendy buzzword. The recent CMS rules on interoperability are breaking down traditional silos between hospitals, post-acute facilities, primary care physicians, and others—so that when patients leave my care in the hospital, the next provider to care for them will have exactly the insights needed to ensure a smooth recovery.
Grateful as I am for this progress, I’d like to argue that these rules are a step—and not a solution—in providing better care for our vulnerable patient populations.
Interoperability is only as effective as the people it connects. Traditional healthcare teams alone represent a small percentage of what impacts a patient’s wellbeing. For interoperability to be effective, it has to facilitate communication beyond the boundaries of traditional healthcare into the communities that these patients call home.
Stepping Outside Traditional Medical Community
When I founded Community Based Care Solutions, I wanted to close the gaps I saw in traditional healthcare models. I recognized that while hospitals, health systems, and health plans work to care for the unique needs of each patient, without the insight and support of a community care team their effectiveness is limited and may come at a high financial cost.
Our social workers have been able to see the power interoperability facilitates using a real-time, ADT-based care collaboration platform—Collective Medical. The platform’s notification system sends messages directly to our case managers, letting them know where their patient is, so they can meet the patient at the point-of-care and proactively work with that patient to connect him or her to the right resources for optimal care—despite any challenges posed by existing social determinants.
For example, half4 of state and federal US prisoners have a reported chronic condition—including cancer, heart-related problems, diabetes, kidney problems, arthritis, asthma, and others. When these individuals leave the prison system and return to civilian life, their transition from correctional healthcare to traditional healthcare systems is often difficult and results in their condition worsening, leading the individual to seek otherwise preventable emergency care.
When case managers are notified and able to work with a patient—in the prison and before release—to complete appropriate Medicaid paperwork, set up and arrange transportation for needed follow-up visits with a traditional PCP or specialist, and ensure housing has been squared away, the patient’s outcomes improve significantly.
Meeting the Homelessness Crisis
Over the past two years, homelessness has been rising, reaching over an estimated 560,000 last year.5 Of these individuals, roughly 40 percent visit the ED at least once a year, with 8 percent accounting for 54 percent of all visits.6 This is due largely to their unstable living situation and the health conditions those conditions cause or exacerbate.
Including housing resources as part of the interoperable care management system can significantly reduce ED utilization for patients experiencing homelessness and lead to better long-term outcomes. With interoperable homelessness support systems, our case managers know where patients are going, confirm that they have a living situation suitable to any existing chronic conditions, and maintain appropriate follow-up contact for continued health.
While finding long-term housing arrangements can be challenging, even small changes can be a great start. For one of our clients, simply negotiating four guaranteed respite beds within a local shelter saved $3 million in unnecessary ED care within one year.
The Right Direction
While we have a long way to go in obtaining true interoperability between all needed parties, the CMS rules allow us to make a step in the right direction. Starting small, and growing the programs as we learn, will get us where we need to go more quickly and effectively than waiting for the day when we magically have a solution for all the complexities of patient care.
As we do what we can, recognize shortcomings, and strive to address social determinants—we will be able to not only improve the medical care given, but the lasting outcomes thereof. And the progress we see in our patients, our hospitals, and our communities will improve exponentially.
Dr. Enrique Enguidanos has over 20 years of clinical experience in Emergency Medicine—much of which has been spent also serving in organizational and systems management roles. As CEO of Community Based Care Solutions and a practicing ED physician, he has spent over a decade developing and fine-tuning systems of care and community management systems that have proven very effective for frequent utilizers. He has organized these systems in a manner that allows CBCS to continuously reproduce care results across varying communities and health care systems.
Case Study from Collective Medical Highlights CBC Solutions’ Work
Coordinating Care for Vulnerable and Complex Patient Populations
Community Based Coordination Solutions (CBCS) works with at-risk entities—such as insurers, health systems, accountable care organizations, managed care organizations, and health foundations—to coordinate the care of patients with complex care needs. Many of their patients have comorbid conditions, including substance use disorder and mental illness and social determinants of health that require special care.
The Challenge: Controlling Costs for Patients with Unique Care Needs
For complex care patients, the care needed often exceeds what can be reasonably provided within the emergency department and/or hospital walls. Approximately 30% of these patients struggle with homelessness, 40% struggle with substance use disorder (SUD), and 50% have some behavioral health diagnoses. Many of these patients face more than one social determinant of health issue simultaneously, and some struggle all three of the above.
Without appropriate care, these conditions will go untreated, leading to a costly and unending cycle of ED utilization. CBCS works with at-risk entities to create better community care coordination patients within the top 2-3% of utilization, with a goal of reducing and preventing utilization by connecting these patients with the care they really need. As patients are connected to strong resources outside the ED, patient outcomes improve, leading to fewer unnecessary ED visits and readmissions and the associated reduction in cost. Dr. Enrique Enguidanos, CEO and Founder of CBCS and practicing Emergency Physician in Washington, explains:
“Vulnerable patients often turn to the ED when psychosocial crisis occur and they feel they have nowhere else to go; in such instances, they would be better served by a community-based team and care plan that’s designed to meet their individual needs. Hospitals, health systems, health plans, and other entities that are trying to care for the unique needs of these complex patients— but without the insight and support of a community care team their efforts are limited, and come at a high financial cost. This is when providers and payers need additional help to control costs and strengthen care for their patients.”
The Solution: Working Proactively with Patients in Real-Time to Direct Care
Working as an ED physician, Enguidanos understood the urgency required when caring for these patients. When a patient presented at the ED with an opioid overdose, suicidal following a psychotic episode, or hungry and ready to be off the streets, the patient needed access to appropriate care connections in that moment—not days or weeks later.
CBCS implemented Collective Medical, a care collaboration platform designed to connect care teams across medical neighborhoods through real-time patient notifications and care guidelines. With the platform, CBCS case managers receive real-time notifications when one of their patients present to the ED, allowing the case manager to meet the patient in the hospital and work with appropriate care team members to determine the next steps of care.
Along with meeting patients at the point of care, coordinating with others has been crucial in helping these vulnerable patients. Creating cohorts within the platform, case managers are able to bring ED physicians, primary care and specialty physicians, social workers, pharmacists, and key community members together to collaborate on patient guidelines and determine what can be done to best help each patient. Enguidanos explains:
“As we bring both those who will provide the care and the entities that will pay for it to a table together, we’re able to create plans for these patients that not only reduce unnecessary spending but genuinely improve the care each patient is being given. As we focus on these individuals, rather than increasing cost and complexity, it actually simplifies care by ensuring each patient goes to the best resource for his or her needs the first time and receives a continuity of care across care teams.”
Outcomes and Patient Stories
By bringing the care community together to coordinate care for these patients, outcomes improve—both for individual patients and for groups as a whole.
Patient Story: “Ken”
When Vietnam War veteran, “Ken” was referred to CBCS for case management, he had over 200 visits within two years across hospitals. The case manager began receiving notifications whenever Jim was in the hospital and made a point to meet him at the ED or follow-up shortly thereafter. The increased follow-up led to a 50 percent reduction of readmissions within one year.
With each visit, the case manager noticed a trend—Ken was struggling with post-traumatic stress disorder (PTSD). When his PTSD became unmanageable, he would turn to the hospital, often presenting ten or more days in a row wanting to talk with someone. When the symptoms subsided, he could go up to two months without a hospital visit.
The case manager met with hospital care teams and local resources to determine a plan for Ken. It was decided that someone from a community support resource for veterans would call Ken twice a week to check-in and talk with him. During these calls, a member of Ken’s care team could gauge how he was feeling and watch for triggers or patterns that might suggest his PTSD was becoming unmanageable. If things started to get bad, the care team member would have the appropriate resource reach out to follow-up with Ken at home.
With a care guideline in place to address his behavioral health needs, Ken’s ED utilization decreased by 50%.
Organizational Outcomes: The Mat-Su Health Foundation
The Mat-Su Health Foundation—a non-profit organization set up to support the health of the people of Mat-Su, Alaska—was looking for a way to support its “High Utilizers of Mat-Su” (HUMS) program. Partnering with CBCS, it relied on improved communication through real-time notifications and collaborative care to track and help these patients, achieving a 61 percent reduction in ED visits and a 20 percent reduction in opioid use.
This ultimately saved Mat-Su several million in unnecessary care costs, and improved community satisfaction.
Overall Outcomes: Breaking the Cycle of Addiction and Utilization
Depending on the area, CBCS will partner with a number of different resources—including those outside the traditional care continuum. Law enforcement and correctional facilities, EMS services, housing authorities and food banks, chemical dependency services and more all come together with one platform, bringing unique insights that lead to a custom-tailored care plan for each patient.
CBCS patients with these collaborative care plans see, on average, a 50-60 percent reduction of ED visits—while breaking the addiction cycle in the process.
The organization continues to expand its collaborative efforts to improve care for these vulnerable patients, including addressing social determinants of health, behavioral health, and complex chronic medical diagnoses.
Advocates for Change: “Beth’s Story”
When “Beth” was referred to CBCS for case management, she was sleeping in her car. A wife, mother, and successful business owner, she lost everything—including her business—after her divorce. She turned to alcohol, and that turned into a substance use disorder.
A CBCS case manager met Beth in the hospital every time she presented, often with dangerous blood-alcohol levels, but Beth wanted nothing to do with any of the programs offered. Finally, on the tenth visit, she accepted help.
The case manager was able to put Beth up in a hotel for two days while they waited for an opening in the detox facility, then helped Beth get the clearances she needed to complete the nine-day detox and move to a rehabilitation facility. Upon successful completion of both, Beth was released and continued to attend regular community meetings. Her case manager worked to get her into temporary, and eventually permanent, housing and employment, and Beth became proactively involved in her community meetings as a mentor for those patients currently struggling with SUD.
Beth eventually graduated from the program and went to work with CBCS as a powerful advocate for change—approaching her patients with empathy and hope.
*This Case Study was written by our exclusive IT partner, Collective Medical.