Page 17 - Silver Linings Issue3

Silver Hill Hospital offers three levels of service: Inpatient, our most intensive form of care; Transitional Living, designed for stabilized patients proceeding with recovery; and Intensive Outpatient, for patients living at home while continuing treatment here. Insurance typically covers Inpatient and Outpatient treatment, but not
Transitional Living, which can be cost prohibitive for many patients.
To improve treatment accessibility for as many people
as possible, Silver Hill Hospital has engaged Joel Bernanke,
MD, MSc, to research the potential benefits of having residential psychiatric care
covered by insurance. Joel reasons that insurance
companies can save money by covering residential
stays because many patients who do not receive that level of
care end up back in an inpatient unit.
Your support allows us to explore important
issues like this as part of our effort to make
mental health care more accessible to those who need it. Here’s a look at
what Joel is researching and why.
What is goal of your work at SHH?
Treatments between acute inpatient
and low-intensity outpatient, broadly
referred to as “intermediate levels of
care,” and which would include the Transitional Living Program at Silver Hill, have become hard to find and even harder to have covered by commercial or government insurance programs.
Our short-term goal is to conduct
a pilot study using insurance claims data to establish both the popularity and potential utility of intermediate levels of care. This will fill a gap in the literature and be helpful for explaining to payers that these services are important and work. They might even be a sound investment in addition to reducing suffering and improving outcomes for patients.
A longer-term goal is to add a layer of academic inquiry into intermediate levels of care because there is currently a dearth of research on this topic, and this has clear implications for national healthcare policy. We will also continue to work with payers to appropriately reimburse providers such as Silver Hill for high-quality care that improves outcomes for patients and lowers long-term costs.
Why is this research important?
Intermediate levels of care could be used as an alternative to inpatient care, which is much more expensive because it requires more staff. With intermediate levels of care, some patients can have longer stays at the same cost.
Understandably, many patients struggle to transition from inpatient to outpatient care. In fact, 1 in 5 patients discharged from inpatient care for behavioral health issues are readmitted within 30 days. Almost by definition, a readmission implies
a failed transition. Readmissions are disruptive to patients and costly to payers, since emergency room visits, and inpatient stays are expensive.
We are also interested in stabilizing complex patients who have a significant mix of problems, disorders or circumstances. These patients have unique barriers to engaging in successful outpatient services. We can bridge a lot of those gaps and help patients overcome those barriers to re-engaging in their personal lives.
Joel Bernanke, MD, MSc
Why are many intermediate levels of care not covered by insurance?
A few reasons. A lot of providers are not in network. The service is not widely accessible. And mostly a bad culture among insurance companies to cut costs by depriving people of meaningful care.
What I worry about is that our culture
allows insurance companies, even in
the face of mental health parity laws, 17 to save money by not covering
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SILVER LININGS MAGAZINE | ISSUE THREE | FALL 2021