Putting Clinical Evidence to Work: IT Solutions Enhanced by Evidence-Based Medicine Will Improve Behavioral Healthcare

Article excerpt

In recent years, clinical information technology (IT) and evidence-based medicine (EBM) have played major roles in general medicine, ensuring that care processes are informed by the best, most up-to-date medical evidence and that costs are predictable and appropriate.

Not so in the world of behavioral health. Mental health lags behind general medicine in both IT and EBM for complex reasons, beginning with simple economics: Behavioral health budgets are typically tight and, as a result, clinical IT solutions tailored to this market have been slow to emerge. Additionally, while general medicine has had a sizable body of research upon which to draw for clinical decisions, behavioral health only recently has begun to enjoy the same bounty of EBM resources.

Behavioral healthcare organizations can deliver higher-quality care at lower costs by building EBM into their processes through the use of IT. In general medicine, this combination forms a tool for identifying and stratifying patients, as well as informing case and utilization management decision making. It is time for behavioral health to follow suit.

Identifying the Risk

Let's look at a few of the most important ways that technology can put clinical evidence to work in behavioral healthcare, beginning with analytics: identifying patients who need behavioral health services and stratifying them into severity levels for appropriate treatment. The goal is to prevent symptoms from worsening and requiring more intense levels of treatment.

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Early identification could occur when organizations feed medical, behavioral, and pharmacy claims into analytic software that uses built-in algorithms based on EBM. For example, the software could find a patient who is being treated with medication for both diabetes and depression but is not receiving behavioral health services.

Those identified to be at risk in some way can be assessed for the severity of their risk, then stratified according to the level of service they need. Stratification helps guide determination of the most appropriate next steps--for example, whether to enroll a patient in a diabetes disease management program with a strong focus on depression, or perhaps follow up with a more in-depth evaluation by a psychiatrist.

Treating behavioral health issues is simply good medicine, as any endocrinologist who struggles with keeping people with depression and diabetes compliant with their medication and diet regimens will attest. And the return on investment for treatment can be impressive. Just as the presence of general medical conditions can cause behavioral health issues to arise, treatment of behavioral health conditions can have a favorable impact on recovery from general medical conditions, as well as the prevention of further complications. This leads to overall healthcare cost savings.

Empowering Care Management

Case management and utilization management are two more areas in behavioral health in which the combination of EBM and IT can be extremely valuable.

Traditionally, behavioral health has had a "mother may I" dynamic, in which case managers have been cast primarily in the role of permission granters (cost focused) rather than care coordinators (care focused). With EBM tools empowered by IT at their disposal, case managers can resume their seat at the care management table, ensuring that the entire team has access to the best and most current scientific thinking, and that all decisions are made from a common platform. …