Forge Health Integrating Behavioral Health and Physical

For Forge Health patients with behavioral health and/or substance use conditions, if there is a comorbid physical condition that is included in the care plan.

New York City-based Forge Health, which provides a range of outpatient behavioral health services, takes a “full-person” approach to care, including physical health and social determinants of health.

Millions of Americans have both a physical health and a behavioral health or substance use conditions, according to the National Alliance on Mental Illness. Integrating care for behavioral health and physical health decreases fragmentation in care, and fragmentation is linked to poor health outcomes.

Forge Health offers outpatient behavioral health services and substance abuse services via telehealth and at offices located in Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, and Virginia.

Forge Health has been able to drive down utilization of medical services such as emergency room visits because the organization’s care model is focused on both mental and physical health, says co-founder and CEO Eric Frieman.

“We have the ability to drive down utilization on the physical health side because we have a unified, full-person approach to care. In a treatment plan for one of our patients, just improving their mental health condition or their substance abuse symptoms is important, but it is not everything. If they have a comorbid medical condition, we include that as part of the treatment plan. For example, if one of our patients has diabetes, we make sure they are seeing an endocrinologist. If they are seeing an endocrinologist, they are adhering to the treatment plan; if they don’t, it is time for a clinical intervention,” he says.

Forge Health care model

Multidisciplinary teams are a cornerstone of the Forge Health care model, Frieman says. “We don’t let any of our providers work in a vacuum or work alone. The multidisciplinary care team includes licensed mental health therapists as well as a psychiatrist or a psychiatric nurse practitioner. We also have care coordinators who helps patients coordinate their care with physical health providers and address social determinants of health. The care team works together on each patient’s care. There are weekly clinical rounds and care team members are available to discuss and coordinate care for patients.”

The care coordinator plays an essential role, says John Rodolico, PhD, chief science officer at Forge Health. “The therapists and psychiatrists on the multidisciplinary team cover a lot of bases, but they cannot cover everything. The care coordinator coordinates anything that falls outside the main hub of the team.”

The clinicians and care coordinators share the responsibility of addressing the social determinants of health for patients, Frieman says. “We have community partners. We have a vetted list in each of our markets of nonprofits, community organizations, and government agencies. We assist our patients in getting connected to the right service.”

Data analytics are an essential element of the Forge Health care model, Frieman says. “Everything that we do is electronic. So, we have the ability to track data such as progression of treatment. We have standard evaluation tools that allow us to track a patient’s symptoms such as their depressive symptoms, their trauma symptoms, and their addiction symptoms. We can look at that data and see how a patient’s condition progresses over time. Based off that evaluation and tracking of data, we can re-evaluate our treatment plans if necessary.”

Forge Health uses four primary patient assessment tools: the BAM or Brief Addiction Monitor for substance use disorder, the PHQ-9 for depression, the PCL-5 for trauma, and the GAD-7 for anxiety.

The data analytics associated with these patient assessment tools are helpful both internally and with external healthcare provider partners, Rodolico says. “These are analytics that are used across the field, particularly the PHQ-9, PCL-5, and GAD-7, which are used across many organizations. So, these analytics can be used not only internally but also externally with other providers. For example, a first-responder can come in and be very high on the PCL-5. They go through the Forge Health program. At the end of that care, they can have a dip in their PCL-5 score, but they still need to be monitored. If everyone signs off, we can give the PCL-5 data to the clinician to whom we have handed off the patient. That way, the new clinician can see the improvement and where the patient needs to go in care.”

Unique aspects of Forge Health

Streamlined care delivery is a hallmark of Forge Health, Frieman says.

“The behavioral health care industry is filled with point solutions, which is not how our model works. We have created a one-stop-shop for behavioral health. So, if a patient comes to us and they have a mental health issue and a substance use disorder, we can effectively treat that patient for both conditions without having to coordinate care with outside providers. With other providers, they may only be able to treat mental health conditions and have to coordinate with a substance abuse provider. With our multidisciplinary care teams, we have the ability to provide psychotherapy as well as evaluation and medication management services. We do it all in-house,” he says.

Forge Health has a mature approach to virtual care, Rodolico says. “Forge Health has been ahead of the curve on virtual care. Many behavioral health organizations have adopted virtual care since the beginning of the coronavirus pandemic because they were forced to operate virtually. Our executive group has been looking to the future, and we were doing virtual care long before COVID-19 struck us.”

Having the ability to provide high-quality care in-person or virtually is important at Forge Health, Frieman says. “The ability to have a hybrid model is critical for us. Patients can receive care in-person or via telehealth modalities. Having the ability to do both is a somewhat unique offering at Forge Health. Sometimes, patients want visits in-person; sometimes, patients want hybrid visits; sometimes, patients only want to be virtual.”

Unlike many behavioral health organizations, Forge Health does not rely on grant funding to finance care, Frieman says. “We are in-network with every major health insurance company. We take Medicaid, Medicare, Veterans Affairs benefits, and TRICARE for active-duty military. There are no grants and no self-pay. All services are paid by someone’s health insurance. In general, we are fee-for-service, but we also have value-based arrangements.”

Related: Behavioral Health Hospital Launches Coronavirus Unit

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.