Anxiety & Worry
Trips to the doctor can instill anxiousness in anyone – even for the most routine appointments. But when a patient receives a life-changing diagnosis such as cancer or multiple sclerosis, they assume a tremendous burden that complicates their life in a myriad of ways. In addition to living with the disease itself, patients with complex conditions manage all the elements of being a “specialty patient”: appointments for tests, imaging, and visits to different specialists. They also have to navigate the world of high-cost specialty medications and the requisite paperwork and phone calls to insurance companies that go with them.
Those pressures can put specialty patients at risk for mental health issues, but traditional models for treating complex diseases often lack an easy access point for mental healthcare.
I recently spoke with Kishen Patel, Clinical Pharmacist at Shields Health Solutions (ShieldsRx), about the importance of making mental health a cornerstone of specialty patient care. Shields has partnered with more than 850 hospitals across the country to improve therapy management and care coordination for complex patients through an “integrated care” model that brings all aspects of specialty care under one roof.
Gary Drenik: What does “specialty patient care” entail and how do specialty disease states impact mental health?
Kishen Patel: After specialty patients receive their diagnosis, they inherit a burden of responsibility that includes managing appointments, prescriptions, paperwork, follow-ups, and more. Without the proper support system, patients can suffer unexpected side effects or fall behind in their treatment, which can result in disease progression and hospitalizations.
Patients with specialty conditions like cystic fibrosis, autoimmune diseases, cancer, HIV/AIDS, or multiple sclerosis face an increased risk for depression and anxiety for a variety of reasons. They may express a sense of loneliness or feelings of being a burden on their loved ones. Patients can also experience a loss of self, identity, or life purpose. Certain medications for treating specialty conditions can also put patients at a higher risk of depression. At certain times, pharmacists can provide patients a platform to vent and let out frustrations, anger, or sadness.
Drenik: What can provider organizations do to integrate mental health into specialty care? What is “integrated” care?
Patel: In a non-integrated model, a patient who receives a cancer diagnosis, for instance, needs to find a specialist for their type of cancer in another facility and they need to find a specialty pharmacy to fill their prescriptions. Issues can arise in this scenario because the physician who made the original diagnosis, the specialist and the specialty pharmacist all reside in different facilities, and they likely have little to no communication between them. If the patient stops taking their medication, the specialty pharmacist is not connected to the prescribing physician and has no way of knowing if the physician stopped prescribing the drug or if the patient is non-adherent. Likewise, if a patient experienced a mental health issue during treatment, the care team may have a hard time identifying it because they only see the patient episodically.
The integrated care model unites all components of the clinical care team, creating a holistic support system around the patient that combats the fragmented nature of complex care. At ShieldsRx, we work with health systems to integrate outpatient specialty drug therapies into existing care models. That builds a cohesive ecosystem between specialty clinics and the outpatient pharmacy, creating a streamlined workflow and improved patient experience. By supporting patients with the resources they need – from financial aid to appointment scheduling with providers or social workers – and helping them stay adherent to their medications, Shields’ integrated model has been shown to reduce the cost of care for patients by 13%.
Drenik: How does an integrated care model identify patients at risk for mental health issues?
Patel: Integrated care is specifically designed to address every element of the patient journey. It builds relationships between each member of the care team and the patient so the care team can proactively identify any issues that arise, including mental health concerns.
Our risk assessments start with evaluating the patient’s condition, home environment and prescribed medications to make sure we have a holistic view of factors that can impact their mental health. We adapt our care model and screening questions to fit the condition, lifestyle, and care journey of every patient to provide the right care at the right time. Through these assessments, the integrated care model becomes personalized for the patient’s needs. It also encourages open and honest communication, helping to identify mental health risk factors. In a recent Prosper Insights & Analytics survey, over a quarter of respondents between 18 and 24 stated they were either “unhappy” or “totally unhappy” with their health, a fact that highlights the increasing need for mental health awareness in young people.
Prosper - Happiness Level With Health
Drenik: What advantages does integrated care have in impacting mental health for complex patients?
Patel: Integrated care builds an element of trust between the patient and their care team that can facilitate discussions about mental health. We often hear from patients about having feelings of wanting to seek help, but not knowing where to look. By providing the right resources at the right time and building a relationship to help them feel comfortable, patients will feel more inclined to give their care team a call when they aren’t feeling well, experience side effects or need to have their feelings heard and validated. It allows the care team to intervene and change treatment plans accordingly because they are truly integrated into every step of the care journey.
Drenik: How do you envision the future of treating mental issues in an integrated care model setting?
Patel: The next step in the evolution of integrated care will come from data liquidity across electronic health records (EHR) systems. We have already seen examples in health systems such as Henry Ford Health, which has successfully integrated their internal clinical software with their EHR, Epic. By making data systems interoperable, integrated care teams can more effectively collaborate across specialties – an oncology team working with a mental health team, for instance.
Centers for Medicare and Medicaid Services (CMS) has proposed and implemented a series of rules since the passage of the Affordable Care Act that have encouraged data sharing. Just recently, CMS published a new rules proposal that calls for the standardization of social risk factor data, such as poverty, food security or race/ethnicity data, which may contribute to mental health concerns. A recent Prosper Insights & Analytics survey showed more than one in five adults feel more anxiety since the onset of Covid-19-related lockdowns, another factor in mental health that deserves dedicated tracking. By giving care teams increased visibility into risk factor data, they can improve the quality of care they offer for mental health.
Prosper - Mental or Emotional Well-Being
Drenik: Is there anything else you’d like to add on this topic?
Patel: In specialty pharmacy, we know about 20% of all prescriptions don’t get filled and we know a large portion of those are preventable through effective intervention. Fortunately, the integrated care model has proven effective at opening the lines of communication between patients and their care team and addressing health issues in a timely manner. That line of communication is also critical in identifying and treating mental health through a multi-disciplinary team view, encouraging collaboration across all members of the patient’s care team. As we work toward more holistic patient care that includes mental health, we need to keep integrated care models in mind as a pathway to meeting unique patient needs.
Drenik: Thanks, Kishen for your insight on integrated care and its potential to dramatically improve access to mental health resources for patients.
