The widespread adoption of telehealth and remote care during COVID-19 has led to improvements in access to healthcare, but new research from SMU assistant professor of information technology and operations management Vishal Ahuja shows that locating providers in the same office can improve outcomes, especially for mental health.
Ahuja’s research focuses on operations and analyzes how physical proximity, or lack thereof, in Veterans Health Administration providers impacts costs and outcomes. He is taking lessons from other industries that have long touted the benefits of co-location to affect high-risk patients with diabetes and mental health issues. Dating back to the 1970s, management research has shown that co-locating employees can create serendipitous interactions that can lead to innovation.
For high risk patients who have multiple providers, co-locating them in the same office or facility can lead to discussions about a patient that can lead to better, more coordinated care. Co-locating mental health with primary care for these patients can reduce hospitalizations, length of stay, and 30-day readmissions to the hospital, his research found. It would also decrease suicide ideation and attempts.
The RAND Center for Military Health Policy Research found that 20 percent of the vets who served in Iraq or Afghanistan suffer from major depression or post-traumatic stress disorder, and 19.5 percent of those veterans suffered traumatic brain injuries, while 25 percent of them show signs of substance abuse. The VA says that veterans are twice as likely to die from suicide as civilians.
Having primary care and mental health services located in the same location can improve convenience for patients, turning multiple trips into one. The facility is one the patient is familiar with, and they aren’t faced with navigating a new and often confusing space. Co-location reduces stigma for patients who don’t want to have to talk about seeing a mental health professional and can just tell others they are visiting their primary care provider while visiting their psychiatrist, therapist, or counselor while they are there.
Physical proximity would also reduce healthcare costs, which continue to rise unsustainably toward one fifth of the country’s GDP. Much of those costs are incurred by a small group of high risk individuals. A study from the Agency for Healthcare Research and Quality found that one percent of the population is responsible for 22 percent of medical costs, and the healthiest half of the country accounted for only 3 percent of healthcare spending. Vets are disproportionately poorer and lower-skilled than the civilian population, and often face barriers to care. Investing in co-location could save costs down the line by keeping these mental health issues from becoming expensive crises.
The research looked at over 300,000 patients over 11 years who suffer from diabetes and show evidence of mental health and found that co-location resulted in a 2.4 percent decrease in length of stay, saving $1.5 million for the cohort alone.
The solution isn’t as simple as just distributing centrally-located mental health professionals into primary care clinics, though that is part of the plan. The VA has several community based outpatient clinics through the region, and rotating mental health professionals through those locations could address some of these issues, increasing communication between providers and improving care. “The high degree of expertise required those experts are typically in one location,” Ahuja says. “We should think about how to increase the communication between the providers of the high-risk patients, as usually the providers are working in their own silos.”
But Ahuja emphasizes that continuity or care is just as important as co-location. Patients shouldn’t be shifted to a new mental health provider just so they can be co-located with a primary care provider. Telehealth has given many access to mental health that would have lacked it before and has also helped patients avoid stigma, and those relationships should be maintained if possible. “There’s actually a chance that forcing myself to go to where my PCP or, or my mental health provider is might be even counterproductive if it breaks my continuity,” Ahuja says. But for those who were able or willing to go to the primary care appointments but never followed through with a mental health referral, co-location could be what gives that patient the care they need.
The benefits of colocation can also be transferred to the civilian population, and more systems are beginning to decentralize care. The RedBird development in southern Dallas will offer primary care colocated with a number of other specialties, and Parkland has also co-located comprehensive breast cancer care in its new facility rather than spread out over several locations, as it was before. Children’s Health is partnering with school districts to add telehealth options to schools, who have also started serving as food banks. Allowing consumers to access multiple types of care pays dividends for the patients and system as a whole.
It is easy to get deep into the weeds of patient care and not consider other solutions that may enhance outcomes, Ahuja says. But in an age of increasing costs and increasing need with a limited supply of providers, efficiencies need to be found. “Our tendency is to find a medical cure or find a medical way, but there is often a much more simple approach. The operational solutions can ease things up.”
Read Ahuja’s full research here.