How Connected Data Can Help Patients Navigate Healthcare
Host: Today is Wednesday, September 16, and you’re listening to Podnosis, the pulse of the healthcare industry. I’m your host, Eyla Ellison.
Finding mental health care can be difficult enough.
Then there’s the challenge of navigating a healthcare system where providers, health plans, and other organizations often have different pieces of the patient’s story.
Bamboo Health is trying to connect some of those pieces using real-time data to help patients get to the right care and make sure they don’t fall through the cracks after a referral or hospital visit.
This week on Podnosis, Fierce Healthcare senior writer Anastassia Gliadkovskaya talks with Vatsala Kapur, Bamboo Health’s Senior Vice President of Market Access, Policy, and Partnerships. They discuss who should be responsible for care navigation, what Bamboo is seeing from its behavioral health programs, and why better data, along with AI, could play a bigger role in the future of value-based care. Let’s get into it.
Anastassia Gliadkovskaya: Well, Vatsala, welcome. Thank you so much for coming on.
Vatsala Kapur: It’s a pleasure. Thank you so much.
Anastassia Gliadkovskaya: So, we’re here to talk about behavioral health navigation. And just to set the context, I think we can all agree that it’s obviously very poor in the US. Like it’s very difficult to find mental healthcare. It’s difficult to find an appointment that works with your schedule. It can be expensive even if you have insurance.
And I don’t think anybody is happy with the system. So, Bamboo Health is all about filling these gaps and supporting care, navigation and behavioral health. From your point of view, what are the main barriers to finding mental healthcare in the U.S. right now?
Vatsala Kapur: I think that there are a number of barriers that play into it. One of them is the fact that we have an access issue.
This is particularly exacerbated for individuals that live in health professional shortage areas, which account for 40% of the US population. So, there are geographic barriers.
I think that there are also ways in which the services that are available aren’t tied or connected in a way that works for the individuals. So, this could be that the right level of care isn’t accessible. It could be the type of provider that isn’t available.
And then there’s a lack of connectivity between primary care providers in the community and their wherewithal to connect patients to adequate treatments. So, the system is failing on multiple levels, and that is leading to a significant spend and suffering on the part of individuals that aren’t getting the care that they need. We know that individuals with behavioral healthcare are conditions are three times, three and a half times more costly. And even though they are only just under 6% of the population, they account for 44% of the spend. So, they’re costing a lot of money.
And more importantly, there’s a moral imperative. We’ve got to fix this because individuals aren’t getting the care they need, and it affects them. It affects their families, and it affects their communities.
Anastassia Gliadkovskaya: So, from shortages to referrals to ongoing care, like you said, there are a lot of different things at play here. How do you think about who should be offering care navigation support? I mean, who is the responsible party? Should it be the insurance plan of the patient?
Vatsala Kapur: To a large extent, insurance plans are already trying to address this problem. They have historically and traditionally done that through care management infrastructure that they either build internally or outsource to vendors on their behalf.
What we know is that care management alone is insufficient and that particularly for behavioral health conditions where individuals are often in crisis, there’s a need for timely interventions. The time sensitivity for individuals with behavioral health conditions is particularly acute. Behavioral health conditions, we don’t think of them as chronic conditions, but they really are chronic conditions.
And so, in terms of answering your question more directly, I would say that, yes, health plans are responsible, but providers also feel that responsibility and see the ramifications of a system that isn’t working in their offices on a daily basis. So, providers also are bearing the brunt of it, as well as community entities that are caring for individuals that are inadequately treated or untreated.
It’s a shared it’s a shared responsibility.
Anastassia Gliadkovskaya: Right. Can you explain where Bamboo comes into this and the types of stakeholders you guys work with in this ecosystem?
Vatsala Kapur: So, we know that there’s sort of a set of ingredients that are generally accepted principles for care navigation, including assessment, matching, scheduling, and follow-up. Those are kind of the general ingredients that are used by care navigation services, whether they live in within a health plan or elsewhere.
What sets us apart is that we are doing those things in a high-touch manner and with real-time data. And that has been one of the missing ingredients in a lot of care navigation initiatives that have been stood up heretofore. So we conduct the outreach, we assess the patient, we match them to a curated network.
And that curated network is comprised of in person providers, as well as telehealth and virtual providers.
So, that is a really important ingredient, especially for behavioral health patients who sometimes are reticent to seek care in person and prefer a virtual modality.
And we’re doing this with real-time data. We’re doing it with admit discharge transfer feeds, as well as other data sources that we have access to that give us visibility into individuals when they are leaving a care setting or a community setting, where that transition may make them more vulnerable to exacerbation of their condition.
Anastassia Gliadkovskaya: And who are the partners in this scenario giving you access to this data?
Vatsala Kapur: So, to a large extent, we have that data ourselves. We have a national network of admit discharge and transfer feeds. We work with thousands of hospitals, all the major health plans in providing that data to help support better transitions of care. We are also able to access with permission from states’ prescription drug monitoring data, which tracks controlled substance dispensations, and where states are able to give us permission to access that data, we’re also able to leverage that to inform the the care navigators.
And, lastly, we also have access to to jail data, and that is really important and essential for what is an extremely vulnerable population.
We know the data shows that when individuals are discharged from jail, they are at much higher risk of an acute event related especially to overdose.
And so we we’re able to leverage all that data as well as data that’s available through our customers, including claims data.
Anastassia Gliadkovskaya: Great.
Can you give an example of what a patient journey might look like for someone that you have this real-time visibility into?
So it sounds like you guys are helping with the triage as well as care and then follow-up. But what are how would it look like if someone is just starting to enter the treatment system?
Vatsala Kapur: Yeah, well, we actually heard a patient story recently that was really inspiring. A member of our team, a care navigator, was talking to us about a patient who had been discharged from the emergency department for anxiety and depression.
And our team was able to leverage that data and really make sure that this person got into care quickly. And within a couple of weeks of that being in place, the caregiver reported that the individual was thriving again. So that was a very real personal story where we were able to change someone’s personal trajectory.
And, you know, in addition, we’ve seen, you know, results at scale with our DTRN360 initiative in Delaware, where we know that, for instance, there was a story about an individual who showed up at an emergency room, went across town to another emergency room. This individual was unhoused, and we were able to, the care navigators were able to get that data in real time and get that person stabilized and get him the services that he needed.
Anastassia Gliadkovskaya: So, and just for folks who might not be familiar with the Delaware initiative specifically, I covered this last year. And when we spoke at the time with your team, over 180 organizations in the state were participating. What’s the latest on that? Can you just explain what the platform is and who it’s working with there?
Vatsala Kapur: At the moment, we have over 180 organizations that are participating, 600 registered users across the state, 14,000 client care journeys, and we’ve been able to see over 280,000 referrals to appropriate care sites. And of those 280,000 referrals, 70% of those were tracked from initiation to outcome, which is really phenomenal.
Anastassia Gliadkovskaya: And what does that mean? Does that mean that 70% of appointments received a follow-up?
Vatsala Kapur: What it means is that we are tracking those or the system is able to track those individuals from initiation to completion of whatever care that they need to receive.
So we know that they are getting what they need and it is leading to a better outcome in terms of their health.
So a lot of times what happens with systems that are in place is that, and I think this is something that as individuals, all of us have experienced, we go into a doctor’s office and they make a referral, but it’s up to us to follow up on that referral. And oftentimes that provider doesn’t close the loop on what’s happened. And that’s what this system really allows us to do.
Anastassia Gliadkovskaya: Do you have a sense of what happens to unnecessary readmissions or health care utilization as a result of the platform and closing the loops on these referrals?
Vatsala Kapur: Our Bamboo Bridge outcomes, which are beyond exciting from our perspective in terms of the impact that our navigation has had. With one of our providers, we’ve seen 50% of individuals completing a validated screening assessment, 46% of patients attending three or more appointments. We know that stickiness with a provider is really important to improvements in health outcomes, and that three is the magic number based on the research in terms of getting folks connected to a provider that they trust and that they’re going to continue to see over time. So that number is very significant, that 46% number.
We’ve also seen a 20% decrease in, ED and inpatient visits.
And especially for this population, this last data point is really exciting.
There’s there was a 5 times increase in patients keeping their appointments. So, one of the issues that often happens with individuals with behavioral health conditions is that they’ll set up the appointment, but they won’t complete it. So that’s really exciting. We worked with a health plan, and we’re able to see a jump from the 34th to the 95th percentile in improving the follow-up after hospitalization HEDIS measure and a 74% of scheduled appointments that were attended by the members that we navigated and a 43% decrease in readmission. So, we know that this saves money and it saves lives.
Anastassia Gliadkovskaya: Yeah. That’s really significant. I’m curious since you work with plans, what are some of the main strategies here that they’re working through as they think about care navigation? So, they engage with Bamboo. I’m assuming outreach, perhaps multichannel outreach as part of the conversation, engaging providers, I would imagine as well to make sure that they’re you know, closing the loop and things like that. What are some of the strategies that plans are currently deploying here?
Vatsala Kapur: Yeah. I mean, it’s all the modalities, phone, text, chat, whatever works best for the individual.
And also to your point, coordinating with the provider, helping with scheduling. I think, again, all of us as individuals have experienced the challenges of scheduling appointments with providers. So we help with that.
And also making sure that there’s follow-through and that the individual goes and sees that provider.
So, it’s really building a trusted relationship with that individual, and it’s very much in the name of our initiative, Bamboo Bridge. It’s really being a bridge to help them get to definitive care and treatment.
Anastassia Gliadkovskaya: And do you engage with pharmacies as well for the prescriptions piece?
Vatsala Kapur: To the extent that pharmacies are part of the prescription drug monitoring program and where we have states that have approved work with and through the prescription drug monitoring program, pharmacies are part of that ecosystem.
Anastassia Gliadkovskaya: And you mentioned criminal justice, folks who are who have justice involved events. Can you just explain a little bit more where that comes into this ecosystem?
Vatsala Kapur: So, we have access to data on when individuals are getting both admitted and discharged from jail. And we know from the research that, especially in that moment when they get released, there’s a very high risk of an acute event happening. And so, we’re able to leverage that data to reach out to that individual and get them get them into treatment and find services for them. It may be a halfway house. It may be connecting them with their family and community, whatever it might look like. But really, our top priority is making sure that they don’t end up back in a situation where they’re having a drug overdose. That’s kind of priority number one.
Anastassia Gliadkovskaya: And in cases where someone is uninsured, are you working with the social services organizations to coordinate those? Yeah.
Vatsala Kapur: We have for instance, in the project in Delaware, we have a network of social care providers that we’re able to access. So, part of what we do is really help to not just build out the navigation function and leverage the technology to support that, but also build out the network. We believe that’s really important. We believe it takes a village to really help these people stabilize and move on to leading the fullest lives possible. And so that involves the social care system. And so, part of our network building initiatives are very much focused on ensuring that those social care providers are there to be referred to when needed.
Anastassia Gliadkovskaya: So, it does sound like it’s important to have a localized network depending on the state that you’re operating in.
How many states is Bamboo currently in?
Vatsala Kapur: We are in terms of our behavioral health products, we’re in about 5 states for crisis 988, about 13 for our BIH Hub and OpenBeds. And then we have this nationwide ADT network, and we’re in every state in the US with that data.
Anastassia Gliadkovskaya: And BIH, that’s what exactly?
Vatsala Kapur: BIH is the Bamboo Intelligence Hub, and it’s our longitudinal care platform that we’ve deployed in Delaware. And in Delaware, it’s called DTRN360, but it’s in our parlance internally, we call it the Bamboo Intelligence Hub.
Anastassia Gliadkovskaya: Got it. So, you’ve referenced this a couple of times, the fact that this platform having this type of real-time visibility and referral management system helps save costs all around. How do you think about the future of where this type of technology is going in supporting value-based care and population health management, being able to proactively and holistically manage the total cost of care for a patient?
Vatsala Kapur: I think that having real-time data and the right technology is essential to optimizing the promise of value-based care. I think that there have been lots of valiant efforts over the years to improve the value-based care ecosystem. And, you know, we really believe that this is just another part of the greater solution. I think there’s also opportunities as we look ahead with AI to really help individuals get the follow-up appointments that they need through leveraging AI, helping using AI to help support better interventions with payers and providers. So, I think there’s a lot of promise with AI, and and we’re already starting to implement some AI in the work that we do, but lots more coming in the future.
Anastassia Gliadkovskaya: That’s exciting. It strikes me as interesting that, you know, on one side, you have payers that do have a lot of data and often like to gatekeep that data. And on the flip side, you have providers and they have a lot of data. But these systems don’t necessarily talk to each other, even if that data is available in aggregate at the state level.
And I just think it’s interesting that it takes a third party like Bamboo to come in and kind of integrate all this data into one place and make it workable. What do you think about that, and what does that say about our current system?
Vatsala Kapur: Well, I think that there’s value in the particular experiences of both payers and providers. I think that there are ways in which they both contribute to the solutions of what we need in terms of improving healthcare delivery, improving health outcomes.
Health plans tend to think about issues related to care navigation in the context of population health management, and that’s just that’s their purview. And there’s value and that’s an important perspective. And providers are very much thinking about the individual patient that’s right in front of them and what that individual needs.
And I think that the challenge and opportunity as we look ahead is to really bring those parties together to create a system that works for the individuals that need the care and also doesn’t debilitate the broader system. When we think of the fiscal pressures that exist right now with the Medicare trust fund as an example, there’s also a financial imperative to do something about this at the population level, at the policy level, as well as, of course, keeping the patient at the center of everything.
Anastassia Gliadkovskaya: Well, to close, what are some national benchmarks or standards that are either available now or perhaps are in the works or that you would recommend to help scale care navigation across payers?
And I know we’ve been talking about commercial payers to a large extent, but across government payers as well.
Vatsala Kapur: I was really excited about the report that came out. Mathematica produced it on behalf of ASPE, the assistant secretary for planning and evaluation at HHS. It came out last fall. And from my perspective was a wonderful indication of the fact that the federal government, HHS in particular, is really focusing on care navigation as an important ingredient in improving the lives of Medicare beneficiaries and to the degree that the federal government has a role to play in Medicaid programs, Medicaid as well. One of the comments that the report writers made in that report was that while individual health plans are creating internal standards and internal processes to navigate people to care. There aren’t industry standards, and that’s really something that I think the current administration could do at the federal level that would really help to support broader adoption of care navigation. What are some of the things that I believe are really essential in that area?
I think they include standards for competencies, standards for appointment timeliness, performance metrics, and then for there to be baselines for those metrics and accountability standards that are set that are industry-wide.
And one of the most important things for individuals with behavioral health conditions is long-term engagement.
And so when we think about competencies and standards and metrics, we really need to be thinking about it not in a short window of time, but over a period of time that actually makes sense for this particular subset of the population.
And then the last thing that I think is is always critically important is is to think about benefit design.
If care navigation isn’t part of benefit design, it’s very hard to incent providers and payers both to adopt it. It’s it’s it it doesn’t become a central approach. It becomes something that is being done a little bit on the side of the of the desk. And so, I I really hope that there can be a meaningful benefit design conversation and adoption.
And I really do believe that Medicare is at the cutting edge and is tends to be the trendsetter for commercial plans as well as for Medicaid. And so, I think there’s an opportunity for the federal Medicare program to really take leadership in this area.
Anastassia Gliadkovskaya: Fascinating. Well, I think we can pause there. Thank you so much, Vatsala.
Host: Thank you for listening to Podnosis. I’m Eyla Ellison. You can find out more about this topic in our show notes at fiercehealthcare.com. Look for podcasts. And don’t forget to tune in every Wednesday morning to Podnosis, where healthcare is our beat.