Transforming Behavioral Healthcare

1. Transforming Behavioral Healthcare

2. the most disablingdisorder before age 50 • 11.4 M Americans • 35% did not receive mental health services in past 12 months • Medicaid FY17 spent $576B with $282B spent in State managed care • 20% of Medicaid beneficiaries have a BH diagnosis and 50% of the expense

3. poor outcomes drivenby lack of measurement RELAPSE RATE • Lack of outpatient care and follow-up places burden of care on patient leading to over utilization of urgent care and hospitalization (Olfson et al, Arch Gen Psych,2012) • Lack of objective diagnostic measurement leads to inadequate treatment of mental illness and increases cost of managing medical condition (Hogan, Psych Serv2003) COMORBIDITY COST FAILURETODIAGNOSE • Lack of detection in high-risk groups leads to failure to treat with long-term disability (Addington et al, Psych Serv2016)

4. digital phenotypinga new kind of biomarker DIGITAL BIOMARKERS RAW FEATURES Machine Learning Pattern Identification Feature Extraction DIGITAL PHENOTYPE Passive, objective, continuous assessment of mood and cognition Signatures for prediction and preemption

5. tracking brain health in a 48 year old womanunder care for bipolar disorder with psychosis

6. detecting deteriorationto prevent crisis I'm doing a lot better. I was experiencing a lot of auditory hallucinations. They made it difficult to sleep which made things progressively worse. I checked myself into the hospital. They adjusted my medications, gave group therapy, and monitored me. I believe I slept for 12 hours each night 3 days in a row. What a relief! The hallucinations finally subsided.

7. crisis servicescontinuum Outpatient Provider Family & Community Support Crisis Telephone Line Peer Support Mobile Crisis Team Walk-In Clinic Hospital Emergency Dept. • Crisis care is an expensive way to deliver care • It does not support recovery goals and community tenure • The long-term outcomes tend to be poor Crisis Services Continuum Crisis Planning Detox Intensive Outpatient Prog Hospitalization Crisis care is focused on respond-and-stabilize

8. crisis prevention serviceswhat if we could detect deterioration before it became a crisis? IMPROVEMENT DETERIORATION ESCALATION & INTERVENTION DETECTION CRISIS RESPONSE BH VISIT OR TELEPSYCHIATRY FURTHER DETERIORATION

9. why itworks • Integrated care delivery is essential in reducing crises in SMI and SED • Today’s models coordinate provider workflows that are health-system centric and an obstacle to accessing care • Early access to integrated services can reduce symptom burden, avert crises and to safely navigate patients to appropriate county services Coordinated Care Co-Located Care Integrated Care We bring integrated care to the patients, in their journey, where and when they need it

10. Mindstrong continuumof care integration Care Transitions Between Visits Care Collaboration Bring medical/behavioral care to the patient, in their journey, when and where they need it Bridge care between clinic visits, move integrated care to where patients live • Care transitions are vulnerable times for patients and anxious times for providers • “CARE IN PLACE” • CLOSE GAPS IN CARE • CARE PLAN ALIGNMENT WITH PCP • CARE PLAN ALIGNMENT WITH BH • (where there is established care) • SAFELY NAVIGATE TRANSITION • MEET HEDIS MEASURES • ACCESS AND MONITORING • EARLY DETECTION • CARE PLAN ADHERENCE • 24x7 CARE TEAM ACCESS • PROMOTIONG RECOVERY GOALS

11. passive detection of clinical severityshow results comparable to clinical assessment A psychiatrist in your pocketWill digital phenotyping lead to better health outcomes?