By Rhae Gamber, Sg2 Senior Consulting Director, Intelligence
Dionne Dela Cruz, Sg2 Consultant, Intelligence
As children's hospitals and providers of complex pediatric care emerge from the pandemic, we have seen familiar challenges and priorities tenaciously reemerge. Chronic inadequacies in pediatric behavioral health service delivery, combined with pandemic-induced disruption and stress, have worsened today's acute pediatric mental health crisis.
The rising prevalence and severity of pediatric behavioral health conditions increase the need for interventions across the pediatric behavioral health System of CARE, which is a clinical alignment and resource effectiveness concept for healthcare systems to apply for assessing and optimizing patient volumes, as defined by Sg2®, a Vizient company. Inpatient demand, specifically in the emergency department (ED), is fueled by inadequate outpatient access and is manifested via the rising risk of suicide, eating disorders and substance use among teenagers.
Insights and forecasts on pediatric sites of care and delivery models
There is work underway that will begin to mitigate inpatient demand for pediatric behavioral health services later in the decade and drive steady outpatient growth across multiple sites. This includes the continued integration of behavioral health services in primary and subspecialty care, increased upstream programming, and the rise of intensive outpatient and partial hospitalization program alternatives as preferred treatment sites for anxiety, chemical dependency, autism and eating disorders.
As systems expand outpatient treatment options that broaden access and capacity of providers, strategic use of virtual offerings (like teletherapy and digital therapeutics) and community partners such as schools will be pivotal. Investments across the pediatric behavioral health System of CARE remain essential to addressing dire community need.
While inpatient discharges and ED visits rise in the first half of the decade, the shift to enhanced alternatives — such as walk-in and virtual crisis care, partial hospitalization and intensive outpatient programs — redirects patients from the hospital to patient-preferred outpatient settings at the end of the decade. As providers across specialties recognize their individual roles in addressing the pediatric behavioral health crisis, care models focused on physical and mental health integration will grow and mitigate inpatient and ED growth.
Guidance for sustainable behavioral health programs
It's important to be strategic when considering how to best integrate behavioral health services across all care settings. Some key considerations include:
- Reassessing ED strategy to meet the clinical and facility needs of children with severe behavioral health diagnoses
- Proactively screening for behavioral health conditions across healthcare practices to improve access to early treatment for low- and middle-acuity patients
- Evaluating how expanded access and securing of payment impact the ability to adopt and implement telehealth and digital therapeutics for behavioral healthcare
- Leveraging social workers and nurse practitioners to provide behavioral health services for patients and employ peer recovery specialists to work with patients with substance use disorders
- Examining partnerships with local community allies and augment with national firms, to expand services without needing to house all services under the hospital umbrella
It's also crucial to evaluate if various care models and community opportunities can function as key aspects of an organization's behavioral health strategy. If developed properly, behavioral health programs can drive departmental revenue and secure timely patient access. Integrated behavioral health models emerge as behavioral health needs exceed available services. A closer look at efforts to integrate behavioral health across the pediatric System of CARE highlights the impact of upstream investments in settings such as primary care and schools on reducing emergency department visits and inpatient admissions.
Additionally, the Collaborative Care Model (CoCM) allows reimbursement to primary care providers for integrating physical and behavioral health via a triad team-based approach, with a primary care provider, care manager and psychiatric consultant. Today, 24 state Medicaid programs reimburse CoCM codes, as do select commercial plans. Mastering the team-based approach and reporting registry for time-based payment are critical to successful implementation.
The rising prevalence and severity of pediatric behavioral health conditions necessitate interventions across the pediatric behavioral healthcare continuum. As your organization evaluates the surrounding behavioral health landscape, keep in mind the pediatric behavioral health System of CARE curve as a roadmap to develop sustainable programs.
About the authors
Rhae Gamber contributes to the delivery of content and thought leadership for women’s health and pediatrics. At Sg2, a Vizient subsidiary company, she works closely with members to provide comprehensive research and analytics-driven strategic insights, leveraging her clinical experience in maternal-fetal medicine and pediatrics to inform decision making. In her current role, Gamber leads the development of the annual women’s health and pediatric Impact of Change® forecast and numerous service line publications. She contributes to consulting engagements as a subject matter expert and regularly presents national trends and market-specific data to members. She also works closely with Sg2’s children’s hospital members, sharing her special interest and expertise in the unique strategies deployed by this cohort.
As a consultant on Sg2’s intelligence team, Dionne Dela Cruz provides support to the complex care practice. Her topic areas of focus include pediatrics and women’s health. In her current role, Dela Cruz contributes to the development and delivery of Sg2's pediatrics and women's health service line strategy, for which she researches and analyzes leading trends and practices. She helps develop publications and contributes to the annual women's health and pediatrics Impact of Change forecast. Prior to joining Sg2, she completed an administrative fellowship at Children’s Hospital of Orange County, working on projects for hospital operations, performance excellence, regulatory and strategy. During graduate school, she completed an administrative residency at OptumCare, where she supported regional strategy and special projects for six locations in Southern California. She earned a Master of Health Administration from University of Southern California, and she earned a Bachelor of Science in health care administration from San Jose State University.