HLM: Can these screenings be done at hospitals where resources are already stretched?
ID: An increasing number of hospitals, including community hospitals, are engaging in various alliances and partnerships with other parts of the health continuum to manage the lives of populations.
Whether it is with insurers or outpatient clinics, the first questions are 'who are the stakeholders in the patients' healthcare and what is the best point of service to screen the patient for depression? So, there is very little question that, from the patients' experience, they need to be screened for depression and they need to be offered services. Exactly who does that and where in the system that happens and how it is managed depends upon the arrangements of those particular health systems. It is hard to answer that question totally generically. A lot of health systems do this in the primary care setting.
HLM: Do you anticipate that this could be mandated at some point by the federal government?
ID: It is a good question and I don't know the answer. Some regulatory bodies like The Joint Commission and others have considered and evaluated some quality metrics that get to behavioral health outcomes and possibly depression. The Joint Commission has established suicide screening as a national patient safety goal and detecting patients at a high risk of suicide is accomplished in part through this measure.
Globally, if we look at trying to enhance value and improve outcomes for patients, this effort to improve value and outcomes is going to drive more health systems to be screening and identifying underlying behavioral health issues. That is an area where overall we haven't done a really great job of meeting patient needs and where the failure to meet patient needs costs us a lot in terms of financial costs, but also more importantly in terms of patients health outcomes.
It's an important opportunity because we can both potentially reduce utilization and improve their health outcomes.