One in three New Jerseyans who go to an emergency room every year are suffering from a mental health condition, according to hospital data, a sign that people are not getting help before problems escalate.
Horizon Blue Cross Blue Shield of New Jersey, the state’s largest insurance provider, announced Thursday it has signed a $1.5 million contract with a technology company that will mine medical records for clues that show which patients mental health needs are going untreated.
One of those red flags could be frequent emergency room visits, said Allen J. Karp, Horizon’s senior vice president for Healthcare Management.
Quartet, a four-year-old company based in New York, will notify primary care physicians when it finds a patient with potential unmet psychological needs. The doctor’s staff would contact the patient for follow-up. Quartet would help by tapping into a network of behavioral health providers to make appointments, Horizon officials said.
Quartet, working in five other states, said its services save money — $2 for every $1 Horizon invests, Karp said.
“There’s a disconnect between medical and behavioral health,” Karp said. “By providing tools for primary care physician and identifying members up-front who have a behavioral health issue, this will save money down the road.”
So far, 50 primary care physician offices have volunteered to work with Quartet and another 200 have expressed interest, Karp said. Since the collaboration began with Quartet Tuesday, one Horizon policy holder has been identified for follow-up care, Karp said.
“More than 42 million adults in the U.S. have a chronic physical condition and an accompanying mental health issue that exacerbates the illness, reduces quality of life, and increases medical costs. This is simply unacceptable,” Quartet President David Liu said in a statement.
“Horizon is a progressive and innovative insurer that recognizes the valuable role that technology can play in improving health outcomes. We jumped at the chance to team up with them to help New Jersey residents and are confident this relationship will yield many healthier and happier people.”
State and national studies say people often do not get mental health care because they cannot find an available provider in their insurance network and can’t afford to pay out of their own pocket or for out-of-network rates.
Patients in New Jersey were nearly 10 times more likely to use out-of-network behavioral health providers than for medical or surgical care in 2015, nearly double the national average, according to a recent study by the national health care consultant Milliman.
The acute shortage of psychiatrists is another obstacle.
A survey of insurance provider networks by the Mental Health Association in New Jersey in 2014 found only half of the 1,550 psychiatrists were accepting new patients.
Karp acknowledged a shortage of psychiatrists and psychologists in Horizon’s network. Efforts are underway to recruit more, he said. “We’re also looking at reimbursement,” as in improving it.
Primary care doctors were paid 22 percent more than mental health providers, and surgical and specialty physicians received as much as 19 percent more, according to national billing data from 2013 to 2015.
Karp said Quartet will make other options available — from referring patients to licensed clinical social workers, to using “telemedicine” visits, to lining up psychiatrists and psychologists to consult with primary care doctors by phone.
“With Quartet, primary care doctors will have new tools to more easily identify patients with behavioral health needs associated with their medical conditions and connect them to the specialists best suited to address those needs,” Karp said.