The Southwest Texas Crisis Collaborative is Having a Positive Impact on Our Community
Oanh Maroney-Omitade, vice president for clinical operations
On Jan. 31, I was honored to speak at The Health Cell’s 2019 State of the Industry event, alongside Sarah Hogan from the South Texas Regional Advisory Council (STRAC). We presented on the Southwest Texas Crisis Collaborative (STCC), a unique and unprecedented partnership between local health systems, mental health care providers, public safety agencies and philanthropy that is improving the continuum of care for the most vulnerable residents – unfunded and underfunded patients experiencing mental illness, homelessness and/or chronic illness.
San Antonio is home to over 350,000 individuals in the safety net population – people who may not have insurance, live at, below or near the poverty level and are otherwise considered vulnerable. This is a population that often does not receive the care, or the quality of care that they need. San Antonio, like many other communities, had previously experienced the same bureaucratic and logistical obstacles to providing this population with the care they need. That is when community partners came together to form the STCC.
The Collaborative brought together local health systems, mental health care providers, public safety agencies, city and county government, nonprofits, and philanthropic partners to develop a vision and a plan for how to close the gaps in the continuum of care and provide this population with access to the care they urgently need.
Methodist Healthcare Ministries took the lead by committing to funding the collaborative with nearly $20 million over five years to cover the initial year of STCC's operations and infrastructure, as well as four additional years of programming and initiatives. In a unique and unprecedented move, the city’s six competitor hospital systems invested a collective $8 million, with additional funding from Bexar County and the San Antonio Area Foundation, as well as the leveraging of state funding.This collection of resources has allowed the Collaborative to develop and implement new and innovative solutions to improve access to care for some of our most vulnerable residents.
There are multiple players involved in providing access and delivering care to this population throughout the community. STRAC serves as the “backbone” of the Collaborative and keeps everyone connected and working toward the established goals. With all of the key players at the table, the Collaborative has developed five key initiatives.
1. Enhance the MEDCOM Law Enforcement Navigation program
Enhancing the MEDCOM Law Enforcement Navigation program expedites access to psychiatric care for individuals who are experiencing a mental health crisis, but who are otherwise medically stable. Instead of taking all patients to the nearest emergency room, the MEDCOM coordinator can direct the officer to the closest, most appropriate mental health facility for treatment, depending on age, gender and bed availability. This leads to less people taking up beds or space in a crowded ER and allows the patient to get the help they need faster. On average, 800-900 patients were navigated directly to psychiatric care each month in 2018. We have seen a 97 percent adoption rate of this practice among 26 area law enforcement agencies, including the San Antonio Police Department and the Bexar County Sheriffs’ Office.
2. Decrease Overutilization of 911 residents at Haven for Hope
Haven for Hope holds the distinction of being the number one address for 911 calls in San Antonio. The focus of the second initiative we implemented in 2018 was to decrease the overutilization of 911 from residents at Haven for Hope and to decrease the rate of EMS transports to emergency rooms for conditions that could be managed otherwise. For this initiative, we established an Acute Care Station at Haven for Hope and the San Antonio Fire Department dedicated a paramedic trained in their Mobile Integrated Health model to the site each shift. The paramedic is on-site in the evening hours and able to respond to 911 calls and make an assessment about how to best treat the patient. In the majority of cases, the patients have been treated on-site and released and/or referred to the CentroMed clinic site at Haven for Hope for follow-up care. There are, of course, situations where the patient's condition necessitates transport to the hospital. Having the paramedic responding to 911 calls from Haven saves time and critical resources. This initiative has resulted in a decrease in the EMS transport rate from Haven for Hope from 70 percent in 2017 to 17 percent in 2018. When an ambulance transport costs about $900 and the triage in an ER costs about $1000, this translates into a roughly calculated savings of over $665,000 in 2018 alone.
3. Expand the Psychiatric Emergency Services unit
The third key initiative that the Collaborative launched is the expansion of the Psychiatric Emergency Services (PES) unit, an emergency room focused specifically on psychiatric crisis intervention. Patients may arrive at the PES by law enforcement or with a friend or family member. They see a psychiatrist within four hours of arrival and the average length of stay is 48-72 hours. Some patients are admitted to the inpatient unit, but the majority are discharged directly back to their home environment. The expansion of the PES provided capacity to allow us to implement an inter-facility transfer program. Using MEDCOM as the navigator, local emergency departments could transfer medically cleared patients to the PES via an “auto accept” process. In just 10 weeks of implementation, 922 patients were successfully transferred from an emergency department to the PES. Previously, it could take hours to days to transfer a patient from the emergency department to psychiatric care. The auto accept process has decreased the wait time to about two hours.
4. Provide Transitional Step-down Housing support
In late 2018, we welcomed Crosspoint, Inc. as a provider to the Collaborative with the opening of a behavioral health diversion program for individuals with a mental health diagnosis transitioning out of jail or inpatient hospitalization. Clients are able to stay up to 180 days, and receive 24/7 residential support, individual and group behavioral health services, and case management.
5. Develop the TAVConnect technology platform
We’ve also been developing the TAVConnect technology platform to help connect the dots and providers in the system of care, and to address patients’ social determinants of health, thereby facilitating better patient outcomes. We have 8 healthcare providers online and using the system. We expect to deploy TAVConnect to additional Collaborative partners in 2019.
Although the STCC is still relatively new, the Collaborative has achieved many early successes. But, what is most exciting, is the improved access to appropriate care we have provided for the neediest in our community.
This is leading to improved outcomes for all of the partners involved, but most especially for the patients as well as the communities we serve. We at Methodist Healthcare Ministries hope this unprecedented collaboration helps others outside San Antonio see what we already know to be true about our community: Through collaboration and partnership, we will do all the good we can, for as many as we can – regardless of ability to pay. This Collaborative is a pivotal and transformative moment for our community’s system of care -- we are proud to be a part of It. Onward!