Dr. Lauren Durant on Integrated Care and Evidence-Based Models
December 26, 2017
Lauren Durant, PhD, is the CEO of B&D Integrated Health Services in North Carolina, and she is on a relentless pursuit of efficacious and culturally relevant evidence-based care models. The population that B&D serves depends largely on Medicaid and Medicare for support, thereby demanding Dr. Durant to demonstrate that her services bring value to her patients and the surrounding community.
This year, B&D expanded their services to include primary care, creating a one-stop-shop for integrated healthcare needs. Our team sat with Dr. Durant to talk about how B&D’s models adapted to the expansion into integrated care, what the future is for B&D, and how technology fits into their long-term goals.
Before we get started, a few facts on B&D:
- Founded in: 2005
- Added Primary Care: 2016
- Annual revenue: $8,200,000
- Consumers served annually: 1,000
- Staff of 190 including Psychiatrists, Family Care MDs, PNPs, PAs, Psychologists, Licensed Clinical Social Workers, Licensed Addiction Specialists, Certified Addiction Professionals, RNs, LPNs, Case Managers and Peer Support Specialists
A Data-Driven Model
VALANT: How does your focus on evidence-based healthcare practices drive your mission and your strategy?
Dr. Lauren Durant: We implement evidence-based practices so what we do can be data driven. The evidence-based practices we select are based on the fact that either the model directly applies to our population, or it’s a close approximation. The expectation is given that we use these models that are relevant and applicable to the population. We should be able to count on the fact that certain outcomes, which are driving our practice, will be met.
For example, one of our goals is to keep people out of the emergency room, whether for physical health or mental health reasons. People who embark on treatment with us should have better outcomes in terms of their overall health. In our system, which is a state-run public system because most of the benefits that we accept are like Medicaid or Medicare, it is a huge detriment to the system if folks who are in treatment are using additional resources by landing in emergency rooms. That’s something we have to be able to report on.
VALANT: How do you measure success in integrated care?
LD: There are a couple of things. On a state level, we integrate outcomes that are specific to physical health. Part of that is basic measures; for example, we’re giving measures that will get people’s level of anxiety, people’s level of depression, or people’s level of what they determine as self-efficacy or ability to do for yourself and affect your outcomes. We’re using baseline measures to identify and stratify people in terms of risk. What we know in practice is that patients with higher risk levels or risk scores tend to be…let’s say “sicker” in terms of how often they’re becoming symptomatic or how well they are able to manage chronic illness.
VALANT: How do you measure a patient’s level of mental illness?
LD: It would be ideal if we could give patients a tablet and have them answer questions. One of the struggles that we have with our population is there tends to be lower literacy so it’s more difficult to just hand people measures. Quite often we’re doing paper-pencil measures that we’re reading to our patients, then the administrator will then enter it electronically so that we can capture the data.
The Future of Integrated Care
VALANT: Where do you see the future of integrated care within B&D?
LD: Our integrated care has been up and running for a year and we have about 420 enrolled patients. Our goal was to have close to 500 by year-end. We tend to get 10-15 new patients enrolled per week, so we should have about doubled our enrollment by the end of 2018. As we’re getting a higher volume, the clinic is becoming self-sustaining, which was our goal since the initial dollars were an investment from our reserve.
Integrated care is hard because most mental health patients do not prioritize their physical health. Quite often, a mental ailment gets in the way of a patient’s understanding of the magnitude of certain chronic illnesses and how not managing those symptoms impacts their ability to have positive outcomes by the time they get to the doctor.
VALANT: You said you’ve been adding 10-15 new patients every week in primary care. How do you accomplish that steady flow of new patients?
LD: We see about 25-30 new behavioral health patients per week, so our 10-15 new primary care patients comes out of behavioral health patients who are already entering the system. The population we serve has a very low percentage of patients who have primary care providers, so when they come in, we say if we’ve noticed in their file that they haven’t seen a primary care provider in a year or more, and ask if they’d like to see someone. Most of the time they say they’ve had needs they never attended to or test results they didn’t know how to follow up with. It’s a huge need.
VALANT: Is it more likely for patients to open up about physical ailments if they’re already talking about mental or emotional ailments?
LD: Absolutely, and that is what our model is. It’s much more difficult to go from saying, “My toe hurts” to “Oh, by the way, I’m severely depressed. I’ve thought about suicide.” Now, if you came in and you said, “Hey, I thought about suicide and I’m not emotionally well and, by the way, my toe hurts,” that’s an easier disclosure. So you’re coming from the hardest to a more simplified disclosure versus from pretty simple to very complex.
Strategy and Technology
VALANT: What are B&D’s strategic goals in the coming years?
LD: In this system, a lot of our goals are related to census. When you’re treating the Medicare and Medicaid population to sustain yourself, there’s an economy of scale that has to happen.
We have to identify evidence-based models that can treat specialized populations of people and keep them well, as well as create a system that can monitor and manage them over time.
In my business we talk about having a clinical home. Based on that perception, we don’t expect people to leave us. Our goal is to present levels of care so patients can access their needed level of care depending on their needs or start again if necessary. Our strategy doesn’t count the sheer number of patients as much as the number of services each patient takes advantage of within the same system. We perceive ourselves as a one-stop shop for all of your needs, whether it’s physical or mental health. Based on that, we’re able to meet monetary benchmarks because the people who are engaged in the system are usually willing to engage in multiple services. We also find that when we use this model, there’s higher consumer satisfaction as well as a sense of greater connection to the system.
VALANT: How does technology fit into your needs and your strategy?
LD: One of our main concerns is the timeliness of information dissemination, which in some cases can be the difference between hospitalizing a patient versus having them remain in their home and be served on an outpatient basis. It can make the difference between life and death. If there’s a crisis situation which leads to hospitalization, there may be information needed to, what we call, involuntarily commit the patient. The doctor won’t have that unless it’s documented, and if you were the last contact, then it could become a stalemate because without certain observations, one cannot really submit to a magistrate the necessary information to make a convincing argument for inpatient admission.
VALANT: What team on your staff suffers the most when dealing with an older EHR?
LD: Definitely the compliance team. I’ve spent a number of years developing an infrastructure of clinical and administrative teams who just deal with compliance. We have standards that we’re following based on our accreditation, and each of those standards has specific mandates around what needs to be done or what shouldn’t be done in terms of delivering services, documentation, the type of tracking we need, the usage of data, etc. So when our EHR fails us, it is always in terms of a monitoring, report-driven deficit. That’s why we’re very concerned about what types of reports can be generated when we’re vetting a vendor for an electronic medical record, because there’s so much data that has to be digested.
We’re into a system and a state of affairs where Medicaid and Medicare are requiring that all these data points are collected and utilized in terms of driving the system towards the outcomes that we need.
VALANT: So, what was it about Valant that you appreciated?
LD: The flexibility and configurability of the Valant Platform is such that it can handle physical health where all of the other EMRs that we were looking at were purely behavioral health. Given that our charge is to deliver integrated care, you can’t have separate databases that don’t speak to each other. Our challenge is to select an EHR that will be functional for both our physical and mental health providers and can interact in a meaningful way for both disciplines. That’s the entire point of providing integrated care; to create a data-driven pathway for others to follow and to use these evidence-based models that are proven.
I’m always trying to break down the component parts which lead to an increase in census. We cannot get an economy of scale without an increase in census. We can’t get an increase in census without breaking down what the things are that lead to that. We need to monitor all this data so we know how many people came in this week and how many of those people went to primary care. I’d really like to have reports that are looking at that specifically, so my meetings can be data driven, which lead to the outcomes we’re looking for. We need reports that are actionable.
Why Behavioral Health?
LD: What really sets behavioral health apart from other industries is our product. Our “commodity,” is the person, so it’s not like a can of soup, where a negative outcome could be the taste is bad or not selling many. When the commodity is a person, the worst outcome is death. The best outcome, however, could be that person enhancing their quality of life and going from being addicted into recovery. This is a big deal. Someone who otherwise may not have gotten prenatal care is now getting it, which also impacts their child’s life. Or if a person is able to get therapy for a mental illness, it positively affects their family, friends, co-workers, and the community they live in.
Everything has so much meaning it can be overwhelming to think about the type of effect you can have or the potential harm that you could cause if things are not monitored, if they’re not regulated, or if things aren’t done in a systematic way. Those are the pressures of the business that I’m in. We take it very seriously, which is why being data-driven is the only approach that we espouse.
We are incredibly grateful for the opportunity to chat with and learn from Dr. Durant, and we hope you enjoyed the conversation as well! If you’d like to speak to us about what Valant can do for your comprehensive reporting needs, schedule a demo today.