Transforming Behavioral Healthcare the most disabling disorder before

Transforming Behavioral Healthcare the most disabling disorder before age 50 11.4 M Americans 35% did not receive mental health services in past 12 months Medicaid FY17 spent $576B with $282B spent in State managed care 20% of Medicaid beneficiaries have a BH diagnosis and 50% of the expense page 02 poor outcomes driven by lack of measurement

RELAPS E RATE COMORBIDI TY COST FAILURE TO DIAGNOSE Lack of outpatient care and follow-up places burden of care on patient leading to over utilization of urgent care and hospitalization (Olfson et al, Arch Gen Psych, 2012) Lack of objective diagnostic measurement leads to inadequate treatment of mental illness and increases cost of managing medical condition (Hogan, Psych Serv 2003) Lack of detection in high-risk groups leads to failure to treat with long-term disability

(Addington et al, Psych Serv 2016) page 03 digital phenotyping a new kind of biomarker RAW FEATURE S Machine Learning Pattern Identification Feature Extraction DIGITAL BIOMARKERS DIGITAL PHENOTYPE Passive, objective, continuous assessment of mood and cognition

Signatures for prediction and preemption page 04 tracking brain health in a 48 year old woman under care for bipolar disorder with psychosis detecting deterioration to prevent crisis I'm doing a lot better. I was experiencing a lot of auditory hallucinations. They made it difficult to sleep which made things progressively worse. I checked myself into the hospital. They adjusted my medications, gave group therapy, and monitored me. I believe I slept for 12 hours each night 3 days in a row. What a relief! The hallucinations finally subsided.

page 06 crisis services continuum Peer Support Mobile Crisis Team Walk-In Clinic Hospital Emergency Dept. Outpatient Provider Family & Community Support Crisis Telephone Line Crisis Services Continuu m Crisis Planning Crisis care is an expensive way to deliver care It does not support recovery

goals and community tenure Detox Intensive Outpatient Prog Hospitalization The long-term outcomes tend to be poor Crisis care is focused on respond-and- page 07 crisis prevention services what if we could detect deterioration before it became a crisis? DETERIORATION DETECTION ESCALATION & INTERVENTION FURTHER DETERIORATION

IMPROVEMENT CRISIS RESPONSE page BH VISIT OR TELEPSYCHIATRY 08 why it works Integrated care delivery is essential in reducing crises in SMI and SED Coordinate d Care Co-Located Care Integrated Care Todays models coordinate provider workflows that are health-system centric and an

obstacle to accessing care Early access to integrated services can reduce symptom burden, avert crises and to safely navigate patients to appropriate county services We bring integrated care to the patients, in their journey, where and when they need it page 09 Mindstrong continuum of care integration Between Visits Bridge care between clinic visits, move integrated care to where patients live

CARE PLAN ADHERENCE 24x7 CARE TEAM ACCESS PROMOTIONG RECOVERY GOALS Care Transitions Care transitions are vulnerable times for patients and anxious times for providers SAFELY NAVIGATE TRANSITION MEET HEDIS MEASURES ACCESS AND MONITORING EARLY DETECTION Care Collaboration Bring medical/behavioral care to the patient, in their journey, when and where they need it

CARE IN PLACE CLOSE GAPS IN CARE CARE PLAN ALIGNMENT WITH PCP CARE PLAN ALIGNMENT WITH BH (where there is established care) page 010 passive detection of clinical severity show results comparable to clinical assessment MEDICARE ADVANTAGE PATIENTS Age (mean std) 50 11 years Age range 29 79 years

M:F 16 : 45 MDD : BP : SCZ Rural : Urban 30 : 26 : 5 46 : 15 2018 ER visits per patient 3.1 2018 IP admits per patient 0.8 A psychiatrist in your pocket Will digital phenotyping lead to better health outcomes? page 011

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