How a County Public Health Department in California dramatically increased access, while bringing down total costs of care. 

Summary

The Public Health Department manages a population of 430,000 people, in a region with agricultural output of over 4 billion dollars. The migrant Latino population greatly depends on the health department to get access to care. However, demand for Spanish speaking psychologists is high and it is hard to get them to relocate to remote areas. 

Using Tess the Public Health Department was able to increase quality of care by offering 24/7 on-demand mental health support in Spanish and English. Access to care was increased by 166% at a user satisfaction level of 89%. 

Customer Introduction

The Public Health Department provides access to care to anyone in need. A lot of seasonal workers who come to the region are critical for local food production. However, these jobs are low paid and do generally not come with health insurance. The Public Health Department helps anyone, regardless of having health insurance, or being a legal or illegal resident. Through state funded grant studies, the public health department found that increasing free access to care effectively lowers the total cost of care for their population.

Main Metrics

1. 166% increase in access to care
2. 100% decrease in wait times
3. $580,000 estimated decrease in cost of care
4. Unlimited access to Spanish language support
   

The Challenge

Due to the shortage of budget and counselors in the region wait times were often higher than 6 months to a year. Outsourcing part of the mental health treatments to traditional behavioral health providers misaligned incentives, increased cost, and was not able to resolve the issue of access to care. Not being able to provide timely access to care, in turn further increased the total cost of care of the population. This situation caused an increase in workload for existing staff, causing feelings of overwhelm and burnout. 

How It Affected Total Cost of Care

Total Cost of Care was affected in two ways: (1) directly lowering behavioral health care cost (2) indirectly lowering total cost of care through increased access to behavioral health support. 

The Solution

Tess is a mental health text support service. Most such services are essentially groups of counselors who send text messages back and forth with patients. However this limits the amount of people you can reach due to budget and hiring constraints. The way Tess is different is that it offers the same text support chat, however it is fully automated by our Artificial Intelligence system which repeats pre-written mental health chats. 

A lightweight integration was created to exchange data on usage metrics, in order for the case managers to feel confident that handing out Tess helps people. Whenever a person is in crisis one of our counselors takes over the conversation, and notifies the Health Department of the incident. As Tess is available through toll-free SMS and through Facebook Messenger people would even sign up their friends and family, to improve overall access to care. This was possible due to the total population management approach taken by the Health Department, to ensure the service is available free of charge for anyone within their region. 

The Results

In this scenario, Tess facilitated an increase of 166 percent in access to care. Clients experienced a decrease of 100 percent for wait times. Also, the county estimates that the cost of care was decreased by $580,000. The county had formerly been spending $2,000 for eight-session treatments. The user satisfaction level for Tess was calculated at 89 percent. 87.5% of the population moved towards recovery, with symptom reduction by up to 50%. Additionally, when necessary referrals to (crisis) counselors were made. Tess helped the remaining 12.5 percent of the population decrease the level of symptoms by 50-100%. The benchmark for a successful treatment by a counselor is a reduction of 50% or more. This shows that for these individuals the cost of care would normally have been $2,200 - whereas with the use of Tess only $5 per month. This opens up a budget to give access to many more in need. 

Conclusion

The Health Department did not just decrease their total cost of care, but they far surpassed their original goals and also improved access to care and quality of care. This means they are better able to serve their population and use their budget in a more cost effective way.