A white paper reveals that Banner University Health Plans’ use of a novel interactive platform-plus-support center with members after discharge from emergency room or inpatient care resulted in a substantial reduction in subsequent inpatient costs and emergency department use. Analyzing the experiences of 1,170 members aged 18-103 years and comparing that data with a control group that did not access the digital platform, BUHP realized savings of $847 per member per month over a six-month period on this group of high-cost members.
The white paper was authored by Drs. Thomas M. Ball and Sandra Stein, BUHP’s former and current chief medical officers. Ball’s research has been funded by NIH and he has authored multiple peer-reviewed journal publications, including healthcare economic analyses. Stein is board-certified in child, adolescent and adult psychiatry, and they have both partnered to integrate behavioral and physical health programs to better manage health plan-covered lives.
BUHP, which covers more than 200,000 Medicaid, Dual Eligible Medicare, and Long-Term Care lives in Arizona, engaged health technology company Pyx Health to address members’ behavioral health needs and overcome social barriers to care. Analysis of plan utilization patterns and medical expenses had clearly demonstrated the independent impacts of general mental health conditions – such as anxiety and depression – and serious mental illness on increased medical expenditures, including hospital admissions and emergency department use.
Consistent with national trends, a small percent of BUHP high-utilizing members accounted for a disproportionately high percentage of medical spend, and presence of behavioral health co-morbid conditions was a significant cost driver. “Multiple chronic conditions are associated with increased medical expenditure, but it is the associated behavioral health co-morbidities, stressors and social barriers to care that drive avoidable unnecessary utilization,” Ball and Stein wrote.
BUHP selected Pyx Health as a partner to address specific barriers to successfully managing the needs of their Medicaid members:
1) Low engagement rates, as when members are contacted about specific conditions, such as diabetes, they often want to discuss basic needs (known as social determinants of health, or SDOH), such as transportation, food, housing or family stressors;
2) Failure of traditional outreach methods, such as letters or phone, in order to provide 24/7 engagement and support for members when they are available and motivated for change; and,
3) Continuing engagement of members in order to impact not only short-term utilization, but also alter longer-term avoidable utilization.
The Pyx Health platform overcame all three obstacles, decreasing inpatient costs by 51 percent, and emergency department use by 41 percent. The authors note, “Since we had implemented multiple interventions focused on emergency department utilization in the past with negligible impact, we were particularly surprised by the degree of cost savings resulting from on-going lower emergency department use. We believe the long length of engagement with Pyxir [Pyx Health’s digital ‘friend’] by members (median=66 days) along with access to on-going support as needed, explains these successful results.”
The Pyx Health option proved particularly appealing to members. Forty percent of those who were offered the service following a crisis enrolled in the Pyx Health program – a rate that was much higher than BUHP’s experience with traditional methods.
Members who scored as lonely on the UCLA-3 screen used the platform differently than those who did not score as lonely. The former were much more likely to engage with Pyxir between midnight and 5 a.m., whereas members who were not lonely were much more likely to use the platform from 5-7 p.m. Cost-effective access to the Pyxir technology 24/7 was deemed as critical to success. Furthermore, members who scored as lonely most frequently reported moods of “worry”, “in pain” or “sad”, all of which would be expected to lead to avoidable emergency department use.
“The high degree of interaction with Pyxir outside normal business hours [makes it] clear that 24/7 accessibility is critical and most cost-effectively provided through the use of the Pyxir chatbot,” the authors note. Further, “it is plausible that the success of this program is partially explained by Pyxir engagement of members suffering from combinations of loneliness, isolation, behavioral disorders, emotional distress and/or sleep disturbance.”
The Pyx Health digital solution reduces loneliness and social isolation by connecting with at-risk individuals outside of the traditional care setting. Providing critical and timely interventions and addressing social determinants of health, Pyx Health cares for health plan members when they are most vulnerable, especially after a transition of care or a healthcare event.
Pyx Health founder and CEO Cindy Jordan observed, “The white paper proves that by addressing loneliness, health plans improve their members’ health outcomes. Still, the U.S. is far behind countries in Europe and elsewhere that have recognized loneliness and social isolation as chronic conditions that should be treated as such. The U.S. medical system will benefit greatly from a physically and mentally healthier population, with attendant health care cost reduction, obtained by treating loneliness and social isolation.”