What do we mean when we talk about clinical transformation?

May 9, 2018

It’s no secret that our nation is facing a mental health crisis. More than 40 million adults have a mental health condition, and more than half go untreated. Only one in 10 individuals struggling with substance misuse or addiction actually receive necessary care. And, as we shared in our Pain in the Nation report last November, more than one million lives were lost to drugs, alcohol, or suicide over the past 10 years, a number that will double over the next 10 years, if we continue on the same path.

Well Being Trust was founded to address these very issues.

From its founding, Well Being Trust has been committed to addressing mental health and well-being from multiple angles. As I wrote last month, we believe in pulling multiple “levers” at the same time: clinical transformation, community transformation, policy & advocacy; social engagement; and measurement & data systems. Over the coming months, I plan to highlight some of these levers and raise up some of the work we are doing in each, as well as how that work is interconnected to create our “all in for impact” approach to issues of mental health and well-being. I will also ask other Well Being Trust staff and partners to weigh in with their perspectives on how we are addressing these issues.

This month, we are starting with clinical transformation, with input from Dr. Arpan Waghray, Well Being Trust’s Chief Medical Officer.

Clinical care challenges

Born out of a health system, we at Well Being Trust understand all too well the challenges with clinical delivery when it comes to mental health. Care is fragmented and siloed. More often than not, mental health is treated as completely distinct from physical health. Prevention – everything from practices that build mental and emotional resilience to screenings for mental illness and addiction – is not adequately addressed. In other words, we don’t do enough of the things that keep people mentally healthy. For people that are already sick, those that need mental health care or addiction services, it can be extremely difficult and frustrating to find the care they need – and pay for it.

Whole-person health

Focusing on clinical transformation is our way of addressing these issues by starting where we are. We believe that our nation’s health care providers need to integrate behavioral and physical care. Caring for the whole person means caring for spirit, mind, and body. And we must bring mental health and substance use services to the places that people need them most.

Case in point: Providence St. Joseph Health and the Clinical Performance Group

We’ve started our clinical transformation work inside our initial investor-partner, Providence St. Joseph Health. Providence St. Joseph Health realized that behavioral health was a key strategic priority for them. It was named a top-three issue in community needs assessments in all 51 of their hospital regions.

Starting in 2017, we worked with system leaders inside Providence St. Joseph Health to establish a Mental Health & Substance Use Clinical Performance Group. This multiyear learning collaborative addresses three of the most pressing and costly challenges within the health system:

  1. Integrating behavioral health into primary care
  2. Finding better ways to care for people with mental health issues in the emergency department
  3. Transforming substance use treatment and services

To tackle these challenges, the Clinical Performance Group brings together a full spectrum of behavioral health & related clinical services across the entire health system – everything from acute to ambulatory to specialty and primary care behavioral health services. By bringing together leaders in each of these services periodically, the Clinical Performance Group enables expert-to-expert collaboration, the development of clinical standardization, and the ability to scale innovation across the entire organization.

One example of the Clinical Performance Group’s work is with the “ED & Upstream” project. Through Well Being Trust, Providence St. Joseph Health joined a partnership with the Institute for Healthcare Improvement (IHI) to address whole-person health in the emergency department.

In the United States, the emergency department remains the first point of entry for many individuals who have mental health needs. The goal of the “ED & Upstream” project is to support people’s health and well-being in the places they most often seek care for mental health needs and then go “upstream” and find ways we can prevent those individuals from showing up in the emergency department in the first place. This work will result in field-tested comprehensive change packages that provide road maps to scale and spread solutions.

What’s next?

Besides Providence St. Joseph Health, Well Being Trust is continuing to work on clinical transformation with eight other leading health systems on the ED & Upstream partnership with IHI: Adventist Health, Allina Health, Ascension, Kaiser Permanente, Maine Health, Memorial Hermann, Northwell Health, and Orlando Health. We are also emphasizing that although changing how mental health is addressed in the health care setting is vitally important, it is not enough. As I like to say, clinical transformation is “table stakes” – the minimum we need to do to truly make a difference in the human lives discussed at the beginning of this blog. It’s a natural starting point, to be sure, but these efforts need to be combined with other elements, like more attention to addressing the community conditions that create well-being (community transformation), the policy changes needed to sustain and pay for better care (policy & advocacy) and using data to identify and reach the areas of most need (data & measurement systems).

Clinical transformation is so necessary, but it is not sufficient to create the change we seek. Well Being Trust is uniquely positioned to catalyze clinical change while also amplifying that change beyond the walls of a clinic or hospital. It’s a special place to be, and we look forward to co-creating a ripple effect with our partners in the years to come.

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