Mental health and substance use disorders remain underdiagnosed and undertreated in the United States. An easy-to-use tool that interfaces with physicians’ EHR and fits seamlessly within practice workflow, the GreenLight Assessment System is alleviating barriers to behavioral health care.
The 2015 National Survey on Drug Use and Health, published by the Substance Abuse and Mental Health Services Administration in September 2016, estimated that 43.4 million American adults experienced a mental health disorder and 20.8 million Americans ages 12 and over experienced a substance use disorder within the past year. Of the 43.4 million people with mental health disorders, fewer than half accessed mental health services within the same time frame. The number of people who received help for a serious mental illness — 65.3 percent — is higher, yet still highlights a need for improvement.
“It remains a challenge to identify and treat these patients,” says Rodney Hamilton, MD, CEO of GreenLight. “Primary care physicians are the clinicians best positioned in the healthcare system to identify and either treat behavioral health conditions or refer patients for treatment, but they’re also one of the most overburdened groups.”
“If physicians don’t ask, patients aren’t going to tell. By enabling physicians to ask the right questions in a way that’s reimbursable and respectful of their workflow, GreenLight offers a win for physicians, a win for patients and a win for a healthier society overall.”
— Rodney Hamilton, MD, CEO of GreenLight
An Innovative Solution
The GreenLight Assessment System differs from traditional paper-based behavioral health screenings in several ways. To administer the GreenLight questionnaire, for example, physicians give patients an iPad at the beginning of their visit. Patients use the iPad to complete an electronic assessment similar to an internet quiz or survey, enhancing patient familiarity and candor.
“People are often more honest when completing a survey or posting something online than they would be face to face,” Dr. Hamilton says. “Similarly, people typically respond more transparently when answering questions on a device than if they were asked questions verbally.”
The GreenLight assessments are scientifically validated, standardized and reimbursable. The iPad comes with a variety of preloaded screening tests — including the PHQ-9 screening for depression and the GAD-7 screening for generalized anxiety — that take no more than seven minutes to complete. As soon as patients complete the assessment, physicians can access color-coded results, as well as recommendations about how to manage the patient if he or she screens positively for a mental health or substance use disorder.
“Before you enter a patient’s room, you look down at your EHR to check pulse and blood pressure,” says Kevin Spencer, MD, Chief Medical Officer of GreenLight. “This tool is just like that — it’s easy to glance at your EHR and see each patient’s color-coded result and assessment score. If there’s a significant concern, it tells you that in large print.”
Once physicians identify patients in need of behavioral health care and initiate treatment, they can repeat the GreenLight assessment as needed to evaluate the efficacy of and make any adjustments to the treatment plan.
“Many of my colleagues ask why they should use GreenLight when they can download a screening tool from the Centers for Medicare & Medicaid Services that asks the same questions. The answer is simple: The CMS tool doesn’t give you the feedback about the patient that you get with GreenLight.”
— Tom Garcia, MD, GreenLight Advisory Board Member, past president of the Texas Medical Association and Houston Medical Society, and practicing cardiologist
Beyond the workflow-friendly nature of the GreenLight Assessment System, the tool also helps physicians better navigate the evolving healthcare landscape.
“So much of where medicine is headed in value-based care requires physicians to report on their quality,” Dr. Spencer says. “One of the quality measures for both Medicare and many commercial plans is annually screening patients for alcohol abuse and depression. GreenLight enables you to capture data with an objective score, follow up and then assess yourself in terms of how well you’re actually doing in helping people get better.”
Results in Real Time
To date, more than 1.4 million GreenLight assessments have been administered to nearly 500,000 patients. Dr. Spencer has used GreenLight in his primary care physician practice for nearly two years. Every patient who presents for an annual wellness visit completes the assessment, as do patients receiving treatment for a mental health disorder or chronic pain. Since he began using GreenLight, Dr. Spencer has identified patients with depression and passive suicidal conditions that may have otherwise remained undetected and untreated.
“One patient took the assessment during a primary care visit and received a perfect score, which always raises suspicion,” Dr. Spencer says. “Several weeks later, the patient came into the office for a follow-up visit and asked to take the assessment again. The patient told me he was severely depressed and was doing poorly, but he had no idea we cared enough to ask these questions or had the expertise at the primary care level to manage depression. He repeated the assessment, and we began treating his depression.”
“The most important reason to incorporate a tool like the GreenLight Assessment System is the societal realization that behavioral health problems are prevalent and underdiagnosed, and that we’re currently poorly resourced to treat them. This tool allows us to identify patients who need a higher level of care.”
— Kevin Spencer, MD, Chief Medical Officer of GreenLight
Tom Garcia, MD, GreenLight Advisory Board Member, past president of the Texas Medical Association and Houston Medical Society, and practicing cardiologist, has experienced similar results. Though he was initially skeptical when he was invited to try the tool a little over three years ago, GreenLight has become an integral part of his practice because it allows him to identify the extent to which patients are struggling with depression and anxiety and refer patients for psychiatric care as needed.
“Many times, compliance issues can be drilled down to a behavioral health problem, such as anxiety or depression,” Dr. Garcia says. “If you can get a patient’s depression and anxiety under control, suddenly the problems you’re observing with compliance, hospital readmission, and control of congestive heart failure, diabetes, COPD and other chronic conditions can be stabilized.”