In NYC, Care Providers Collaborate on Digital Health Strategies for Behavioral Health

Coordinated Behavioral Care, a provider-led nonprofit, is trying out new technology and tactics to help patients transition back into their communities.

Healthcare organizations are discovering that they need a lot more data than what can be found in the medical record to treat patients with behavioral health issues, and they're using digital health tools and platforms to improve that process.

At Coordinated Behavioral Care (CBC), a provider-led collaboration of 16 nonprofits in New York City, care providers are using a variety of tools and platforms in treatment, including email and messaging, virtual visits, and ride-sharing resources.

"People do not belong in the hospital," says Barry Granek, LMHC, senior director of CBC's Pathway Home program. "They belong in the community, and we are doing everything we can to make sure that can happen."

CBC is among the hundreds, if not thousands, of healthcare organizations nationwide to take aim at the social determinants of health, those factors that sit outside the clinical realm but have a profound effect on healthcare. They include home environment, transportation, diet, exercise, job security, community trends, finances, and even legal issues.

Barry Granek, LMHC, Senior Director of the Pathway Home program at Coordinated Behavioral Care in New York City. Photo courtesy CBC.

CBC's Pathway Home program is an example of how that strategy is put into action. The program offers a transitional care model for patients going from the hospital or similar institutional setting back into the community. It operates under the assumption that the healthcare landscape is fragmented and siloed, and uses digital health and partnerships—including care coordination and management, expedited housing placement, skills-building and engagement, collaboration and meetings with family and community health services, and even some financial support—to make that transition.

Addressing Engagement Through Motivation

Among the partners in Pathway Home is Wellth, an NYC-based digital health company that targets care plan adherence. With the company's help, CBC built out a digital health platform that uses behavioral economics to address why patients don't follow doctors' orders or health habits. The platform uses an mHealth app to create an on-demand line of communication with patients, reminding them to take their medications, monitor their health, eat healthy meals, and gives patients small financial rewards and video offerings when they meet those goals.

"We focus on motivation," says Granek. The Wellth platform, he says, creates a level of engagement that resonates with patients, especially as they move from a strictly controlled environment to one that gives them more freedom to make choices and develop lifestyle habits. The ability to communicate with those patients at any time and place through digital health gives care providers the opportunity to make an impact when it matters the most—during times of stress, at meals, or when one is supposed to be taking medication.

Wellth's platform is one of many aimed at addressing the tricky topic of adherence through patient engagement, namely by offering rewards and encouragement. Providers have long struggled with finding the right tone or button to push to grab and keep their patients' attention. In the past, those incentives were often restricted by the infrequency of visits to the doctor's office and perhaps reinforced by mailings or the occasional phone call.

Digital health and virtual visits have changed that game, giving providers the opportunity to connect on demand. That's especially true as the nation deals with the pandemic.

When COVID-19 became commonplace in early 2020, healthcare organizations shifted to virtual care to reduce the spread of the virus. In many cases, both providers and consumers tried out digital health for the first time, using mHealth apps and telehealth platforms on mobile devices to keep the lines of communication open and manage care needs.

Those tools and strategies are taking hold now, both by patients becoming accustomed to digital health and providers looking to sustain that connection for care management.

"I think it's going to be more and more important as our world changes," says Granek, pointing to the adoption of digital access technologies in everything from banking and retail to travel and grocery shopping. "We're becoming more comfortable" with the technology.

Alongside that is an understanding that the pandemic has pushed depression, stress, and anxiety to unheard-of levels, in turn, straining the resources of care providers. In-person treatment can't be the only option anymore.

"We need a variety of options," says Granek.

A Strategy for Embracing Innovation

The Pathway Home program sits within CBC's Innovation Hub, where new ideas and technologies are tried out. Granek and his colleagues check out dozens, if not hundreds, of concepts and technologies, looking for ideas that they think can and will work.

"We've seen companies that come to us too early," he says. "They're not fully realized or they come to us for expertise." With the latter, companies see CBC as a place in which to integrate clinicians, rather than including them earlier on.

With the behavioral healthcare palette expanding to address issues outside of clinical treatment, CBC casts its net far and wide for innovative services like ridesharing, or nutrition counseling, or housing placement. Each can play a part in care management, contributing to a program that gives its patients a better chance at positive outcomes.

Granek notes that CBC works with a variety of partners, including managed care organizations (MCO). The company exists as a collaboration of several nonprofits, designed to sit alongside health systems and give consumers more options for care. But it also speaks to the value of working together in a more integrated healthcare network.

To that end, Granek would like to see more interest from payers, many of whom have been slow to embrace digital health without the proof that it's improving outcomes.

"We are seeing that some of them are starting to get into the business," he says. "You need that proof of concept, and you need the data to back it up. And that can take several years to complete all the pilot studies and come back to [payers]."

"We want to be early adopters, but not too early," he adds. "So, we'll choose carefully, shed the things that don't work, and double down on the things that do."

And as much as digital health can be used to address the social determinants of health, it can also serve as a barrier. Not everyone knows how to use the technology needed to access healthcare.

"We spend a good amount of time just teaching people how to use the technology," Granek says. "The resources exist … but they have to be easy to access and use if you want people to use them. And that makes implementation a challenge, because you might have to teach staff how to use [these devices] before you even get to" the patients.

That aside, Granek says CBC's commitment to learn will keep the organization on the right path as the healthcare ecosystem progresses. He looks forward to more partnerships in the future, perhaps some integration with social media channels to reach patients in their comfort zones and wants to create a more complete map of available resources in NYC, perhaps by integrating with location services.

"We want to manage the in-between and provide [support] around the visits," he says.

And that's a lot of ground to cover.