Forge Health Integrating behavioral health and physical health care

For Forge Health patients with behavioral disorders and/or substance use conditions if there is a co-existing physical condition that is included in the plan of care.

New York-based Forge Health, which provides a range of outpatient behavioral health services, takes a “holistic” approach to care, including physical health and social determinants of health.

Millions of Americans have both physical and behavioral health or substance use conditions, according to the National Alliance on Mental Illness. Integrating behavioral health and physical health care reduces fragmentation in care, and fragmentation is associated with poor health outcomes.

Forge Health offers outpatient behavioral health and substance abuse services through telehealth and in offices located in Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania and Virginia.

Forge Health has been able to reduce the use of medical services like emergency room visits because the organization’s care model focuses on both mental and physical health, says co-founder and CEO Eric Freeman.

“We have the ability to reduce utilization on the physical health side because we have a unified, fully individualized approach to care. In the treatment plan for one of our patients, only improving their mental health or substance abuse symptoms is important, but that’s not all. If they have a co-morbidity, we include it as part of the treatment plan. For example, if one of our patients has diabetes, we make sure he sees an endocrinologist. If he sees an endocrinologist, they stick to the treatment plan, if they don’t, it’s time for clinical intervention,” he says.

Forge Health model

Multidisciplinary teams are a cornerstone of the Forge Health care model, Freeman says. “We don’t allow any of our suppliers to operate in a vacuum or operate alone. The multidisciplinary care team includes licensed mental health therapists as well as a psychiatrist or psychiatric nurse practitioner. We also have care coordinators who help patients coordinate their care with physical health providers and addresses the social determinants of health. The care team works together on each patient’s care. There are weekly clinical rounds and care team members are available to discuss and coordinate patient care.

The care coordinator plays an essential role, he says John Rodolico, PhD, Chief Scientific Officer at Forge Health. “Therapists and psychiatrists on the multidisciplinary team cover a lot of bases, but they can’t cover everything. The care coordinator coordinates everything that falls outside the core team focus.”

Clinicians and care coordinators share responsibility for addressing the social determinants of patient health, Freeman says. “We have community partners. We have a vetted list in each of our markets of non-profits, community organizations and government agencies. We help our patients connect with the right service.”

Data analytics is an essential element of the Forge Health care model, Freeman says. “Everything we do is electronic. So we have the ability to track data like treatment progression. We have standard assessment tools that allow us to track a patient’s symptoms, such as their depressive symptoms, their trauma symptoms, and their addiction symptoms. We can look at this data and see how the patient’s condition is progressing over time. Based on this assessment and tracking data, we can re-evaluate our treatment plans if necessary.”

Forge Health uses four primary patient assessment tools: BAM or Brief Addiction Monitor for substance use disorder, PHQ-9 for depression PCL-5 for trauma and GAD-7 for concern.

Data analytics associated with these patient assessment tools are useful both internally and with external healthcare provider partners, Rodolico says. “These are assays that are used across the field, particularly the PHQ-9, PCL-5 and GAD-7, which are used in many organizations. So these analytics can be used not only internally but also externally with other vendors. For example, a first responder may come in and be very high on the PCL-5. They go through the Forge Health program. At the end of this care, they may have a drop in their PCL-5 score, but they should still be monitored. If everyone signs, we can give the PCL-5 data to the referring clinician. This way the new clinician can see the improvement and where the patient needs to go for treatment. “

Unique aspects of Forge Health

Streamlined care delivery is a hallmark of Forge Health, Freeman says.

“The behavioral health care industry is full of point solutions, which is not how our model works. We’ve created a one-stop shop for behavioral health. So if a patient comes to us with a mental health problem and a substance use disorder, we can effectively treat that patient for both conditions without having to coordinate care with outside providers. With other providers, they may only be able to treat mental health conditions and must coordinate with a substance abuse provider. With our multidisciplinary care teams, we have the ability to provide psychotherapy as well as assessment and medication management services. We do all of this in-house,” he says.

Forge Health has a mature approach to virtual care, says Rodolico. “Forge Health is ahead of the curve in virtual care. Many behavioral health organizations have embraced virtual care since the start of the coronavirus pandemic because they were forced to work virtually. Our executive group is looking to the future, and we were doing virtual care long before COVID-19 hit us.”

The ability to deliver high-quality care in person or virtually is important to Forge Health, Freeman says. “Being able to have a hybrid model is critical for us. Patients can receive care in person or through telehealth modalities. The ability to do both is somewhat of a unique offering of Forge Health. Sometimes patients request personal visits; sometimes, patients request hybrid visits; sometimes patients just want to be virtual.”

Unlike many behavioral health organizations, Forge Health does not rely on grant funding to fund care, Freeman says. “We are in network with every major health insurance company. We receive Medicaid, Medicare, veterans benefits and TRICARE for active duty military. No grants and no self-pay. All services are paid for by one’s health insurance. Generally, we offer fee-for-service, but we also have value-based agreements.”

Related: Behavioral health hospital launches coronavirus unit

Christopher Chaney is the senior editor for clinical care at HealthLeaders.

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