The Schizophrenia Readmission Challenge

By Monica E. Oss, Chief Executive Officer, OPEN MINDS

The average all-cause 30-day readmission rate in the U.S. is 14%. The average 30-day readmission rate for schizophrenia is 22%, ranking seventh in the conditions with most frequent hospital readmissions. High rates of relapse and readmission have been documented to be bad for the long-term prognosis of consumers with schizophrenia.

And for specialty provider organizations moving to performance-based reimbursement models, the mental health readmission rate and all-cause readmission rates are one of the most frequent factors in reimbursement performance penalties and bonuses. In fact, 29% of all specialty provider organization value-based reimbursement (VBR) arrangements have readmission rates as a measure.

These statistics—and potential solutions for decreasing the readmission rate for consumers with schizophrenia—were the focus of the session, Measurable Improvements In Care: The Power Of Collaboration, at The 2022 OPEN MINDS Technology & Analytics Institute. The panel featured Lilli R. Correll, LPC, Vice President, Payer Solutions Development for Genoa Healthcare; Jason Kan, PharmD, Vice President of Product for Genoa Healthcare; and Suzanne F. Conroy, Senior Director, National Clinical Value Optimization for Optum Health Behavioral Solutions. Their focus was on collaborative models to increase consumer access to medications for schizophrenia and increase consumer adherence with medication.

Optum Health Behavioral Solutions is a division of Optum, a technology-enabled health services company that delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum, which is part of UnitedHealth Group, has 60,000 doctors in 2,000 locations nationwide.

To address the issues with symptom management for schizophrenia, Optum partnered with Genoa Healthcare and used a 6-step model developed by the Health Plan of Nevada as a guide for their program. They looked at ways to support patients, families, treatment teams, and points of care coordination opportunities.

Optum created heat maps to locate members that lived near outpatient mental health clinics and hospitals, which were also near Genoa locations. In addition, they considered state requirements and then chose 10 markets for the program.

For other health and human service executives looking to develop a collaborative model to reduce hospital readmissions for consumers with schizophrenia, the speakers had some advice—go into the community, identify barriers, and educate to improve adherence.

Go into the community: “We set up live listening sessions in Ohio,” said Ms. Conroy. “We had a clinic, prescribers, their facility, the health plan, and the drug manufacturer together, so everyone was at the table so we could hear about the challenges that the prescribers are facing. We wanted to learn what can we do to help so that we can make sure that the solutions are unique to their market. We also learned about patient considerations because there’s a fear of side effects, of past experiences with long acting injectables or any injections. Sometimes the patient has agreed to start or restart a LAI, but if the family is not in support of that then may talk the patient out of it. So there are considerations for the family as well as the patient. How the medication and the treatment plan is presented to the patient is very important and the communication that occurs is key and needs to be tied to the goals of the patient.”

Identify barriers: “There’s a stigma of care that there’s a lot of work involved with prescribing LAIs,” said Mr. Kan. “How do we simplify the authorization process?” To that end, Mr. Kan stated that pharmacists can be of great help in this area. They can provide education on prescribing LAIs to providers, and in many states they can supplement the existing care model by administering the LAIs. Mr. Kan also noted that payers can help by educating how to navigate systems to improve patient adoption. And Optum is aligned with the goal of reducing barriers. As noted by Ms. Conroy, “We’ve been working on clearing the pathway for providers, and how we can make it easier if a patient and provider decides to start an LAI.”

Ms. Correll also pointed to Genoa’s efforts to ensure patients receive all their needed medication at once, which eliminates the need for multiple trips to the pharmacy that may contribute to lack of adherence. “Let’s say you just started on a new antidepressant, and you’re taking 10mg this week, and in two weeks you’re taking 15mg,” she said. “And two weeks from then and you’re taking 20mg. Adherence packaging can be challenging. As can be seen in this example, eliminating barriers is valuable.”

Educate to improve adherence: When it comes to helping those with schizophrenia, adherence is the ultimate goal. That’s where education and collaboration are key. “We focused on provider support and communication,” said Ms. Conroy. To address this, as part of its partnership with Genoa, Optum partnered with Johnson& Johnson to provide training to providers, webinars for patients, and in person education for patients and families. They are working with pharmacies/pharmacists, providers, health plans, patients, and families, all to build relationships to improve access and eliminate barriers to LAI treatment adherence for persons with schizophrenia.

For this collaboration, the very early findings are that adherence rates are high and hospitalization days and emergency room visits are lower.

The focus on readmission rates—and how to keep consumers in the community—is likely to continue by both payers and the health plans managing their benefits. In many market areas, the raw ingredients of good consumer services are there. But, as our speakers noted, it’s just a matter of putting them all together.