Dwelling well being nurses consider they are often the “quarterback” for behavioral well being wants

As home care providers look for a more integrated approach to care, for some it is vital that mental health and behavior are a part of the equation.

Despite the additional costs associated with offering these services, the need to care for patients with these conditions is undeniable.

“Typically these people are 10 to 15 times more expensive than a patient with no behavioral health experience,” said Joe Cramer, president of hospice and behavioral health at Elara Caring, during Aging Media Network’s Continuum event in December. “We are looking at how we can work with primary care or psychiatric providers to determine the total cost of care from either an episodic perspective or from an overall total cost of care perspective, where we are essentially the quarterback of their care.”

Elara Caring is a Texas-based home health, hospice, personal care, palliative care and behavioral health service provider. It has a presence in 16 states and conducts approximately 100,000 home visits annually for patients suffering from serious mental illness or addiction.

Before the pandemic, Elara Caring provided behavioral health services in two states. It now does this in nine states and has been able to do this by training its psychiatric nurses on how to properly care for patients with special needs.

Recently, Elara Caring has developed a program called Embrace that aims to help its members who have experienced a loss. That loss could be a loved one, their independence, or their home, Cramer explained.

Patients can access the program from their home, which may be a skilled nursing facility (SNF), a senior living facility, or a private residence.

“Approximately 50% of people who go into a senior living facility or SNF have increased anxiety or depression,” Cramer said. “Our nurses are really trained to support their behavioral health diagnosis.”

Joe Cramer, president of hospice and behavioral health at Elara Caring, speaks at the Aging Media Network’s Continuum event in December.

Elderly caregivers sometimes focus on the medical and consider behavioral treatment secondary. However, Elara Caring’s approach is symbolic of a larger movement in elderly care where the two types of care can be treated under one roof.

“At Elara, we focus on behavior with the diseases there,” said Cramer. “We look at what’s causing the anxiety or depression, if they have it, and what kind of loss they’re dealing with to really support them.”

Embrace, Cramer said, has reported a 78% reduction or stabilization in a patient’s anxiety or depression and a 33% reduction in patients being admitted to facilities rather than the places they call home.

Payers and insurers are also heavily involved in this movement.

“ACOs, Medicare Advantage, Medicaid organizations come to the table knowing they have to pay for these services,” Cramer said. “Right now we’re trying to find a balance of what we can do to support these services. For us, we also try not to step over our skis and go too far down without having the full staff there. But looking at how we get reimbursed is the first step.”

Chicago-based Oak Street Health (NYSE: OSH) is a good example of how targeted behavioral health services work. It has a network of value-based primary care facilities that serve adults on Medicare. At the end of 2022, the company had 161 centers in 21 states, treating over 145,000 at-risk patients.

Katherine Suberlak, Vice President of Clinical Health Services at Oak Street Health, speaks at Continuum.

“We often find ourselves in several underserved communities where they don’t have access to other services or where those services have not been available,” Katherine Suberlak, vice president of clinical health services at Oak Street Health, said at Continuum. “For us, behavioral health ticks all the boxes. Clinically, it is right for the patient. It is very helpful for our nursing teams to have the additional specialty there. Finally we see the results. There is an impact on our overall cost of care when we include behavioral health as a service to our patients.”

By incorporating behavioral health into their care programs, 73% of Oak Street Health report sustained reductions in depression 6 months after treatment, according to Suberlak.

Going forward, Elara Caring and Oak Street Health both believe partnerships will be key to staying on this issue.

“As a full-risk provider, partnerships are critical to us, especially when we are serving a patient across a continuum,” said Suberlak. “We can’t do it alone.”

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