Maryland’s Carroll Hospital is redirecting behavioral health patients who frequent the ED to more appropriate county health services.

Photo: Partnership Reduces Behavioral Health Challenges in the ED
The 193-bed Carroll Hospital Center is the sole hospital in Westminster, Md., a small city in a rural region. A lack of public transportation and long distances between some residential areas and primary care physicians makes Carroll Hospital’s ED the provider of choice. As a result, some patients visit the ED as many as 100 times per year.

After determining that people with mental health and/or substance abuse challenges were among the most frequent ED users, Carroll Hospital sought out more effective local, low-cost alternative approaches to helping these patients get the care they need.

“We decided to supplement our capabilities with resources in the community,” says Bob Edmondson, chief strategy officer, Carroll Hospital Center.

Fortunately, Carroll Hospital did not have to venture far to find appropriate partners. “There are county programs for both mental health and substance abuse. We were able to partner with them, tie them into our emergency department case managers, and get the patients the services they needed,” says Edmondson.

Developing Partner Solutions

Now, when potential mental health and/or substance abuse patients visit the ED, Carroll Hospital’s team of psychiatric social workers and case managers evaluate the patients for referrals to the Next Step recovery support program, which is part of a county program called the Partnership for a Healthier Carroll County, says Sharon Sanders, Carroll Hospital’s assistant vice president for clinical integration. The Next Step provides housing, counseling in daily living and pre-employment skills, and social support networks to individuals seeking mental health and substance abuse recovery services. The program is funded by Carroll County and client fees.

In addition, the hospital employs navigators who are stationed throughout the community and can refer these patients to the proper resources, such as Next Step, before they come to the ED. 

Ensuring Follow Up

Referring mental health and/or substance abuse patients to treatment services is half the battle. Ensuring that they receive the intended care is the other half. To avoid the potential pitfalls these patients run into when trying to access services, the Carroll County health department offers a program called Peer Support, which assigns a specialist to help referred patients navigate through the system.

“For example, if someone shows up in our emergency department and needs to get to the Next Step program, the Peer Support specialists can help arrange transportation,” says Sanders. Because the specialists are recovered substance abuse patients who are trained to work with people going through the same experience, they have the special skills and empathy necessary to smoothly transition patients to appropriate care.

Reporting Results

The behavioral health and substance abuse referral program is one of several initiatives that are contributing to Carroll Hospital’s success in reducing unnecessary ED use. In a little over a year, Carroll Hospital has reduced the number of patients who use the ED more than three times a month by 1.2 percent, from 7.7 of ED patients in FY12 to 6.5 percent in the second quarter of FY13.

In addition, the volume of psychiatric evaluations done in the Carroll Hospital ED has dropped by approximately15 percent, lending additional proof that the hospital’s community navigator program is leading mental health and/or substance abuse patients to the most effective care before they even reach the ED.

Taking in the Bigger Picture

Carroll Hospital’s ED strategy is part of a wider population health initiative that includes medical homes, a physician hospital organization, wellness programs, and medical care transition resources to reduce readmissions. Carroll Hospital is partnering with state resources on these other population health initiatives, as well as tackling some of them on its own.

In addition to improving patient care, Carroll Hospital stands to see a financial return from instituting population health management. Under Maryland’s unique all-payer rate structure, Carroll Hospital is capped on total hospital-related inpatient and outpatient revenue. Therefore, any savings from a decline in ED utilization or readmissions will go directly to the hospital’s bottom line, says Edmondson.

Access an hfm article on Maryland’s all-payer rate structure: Maryland’s All-Payer System: A Delicate Balancing Act

To gain the rewards of implementing population health, providers don’t have to implement a full array of initiatives on their own. “The underpinning of population health is looking at the demographics and needs of your community and developing programs and services in conjunction with local partners to expand and manage the continuum of care,” says Edmondson.


Betty Hintch is editor, newsletters and forums, at HFMA.

Interviewed for this article:

Sharon Sanders is assistant vice president for clinical integration, Carroll Hospital Center, Westminster, Md.

Bob Edmondson is chief strategy officer, Carroll Hospital Center, Westminster, Md.

Publication Date: Thursday, September 26, 2013