An innovative model of behavioral healthcare for older adults with serious mental illness, substance use disorders, and dementia.

Introduction: Older adults with serious mental illness (SMI) experience higher rates of medical comorbidities, mortality, hospital readmissions, and total healthcare spending when compared with Medicare beneficiaries without SMI. Although telehealth provides an opportunity to overcome barriers to behavioral healthcare access, older adults face unique challenges when accessing and utilizing telehealth services. We present Author Health's care model, which integrates virtual-first behavioral health care with an interdisciplinary approach to health-related social needs (HRSN) screening and intervention in older adults.

Methods: We launched an innovative behavioral healthcare delivery model in collaboration with primary care for Medicare Advantage recipients with SMI, substance use disorders (SUD), and dementia. All patients completed an intake with an MD/NP and were offered screening for HRSN at entry using the Accountable Health Communities HRSN tool. Primary diagnosis was assigned and categorized into SMI/SUD/dementia and non-SMI. Logistic regression was used to quantify the odds of food, housing, and transportation insecurity explained by SMI/SUD/dementia versus non-SMI behavioral health conditions.

Results: A total of 2301 patients completed an intake from January 2023 to March 2024. Moderate/severe depression (40%) was the most common primary target condition at intake, followed by dementia/Alzheimer's disease (12%) and bipolar disorder (5%). The rates of housing insecurity, food insecurity, and transportation insecurity were 27%, 30%, and 21%, respectively. Within our sample of Medicare Advantage participants in Florida, patients with SMI/SUD/dementia were 1.42 times (p < 0.05) and 1.58 times (p < 0.01) more likely to report housing insecurity and food insecurity, respectively, when compared with those with mild/moderate behavioral health conditions.

Conclusion: Author Health provides a blueprint for behavioral health services that remove barriers and provide tenacious, consistent, and whole-person virtual-first behavioral health care tailored to the unique needs of older adults. Our sample of Medicare Advantage participants in Florida suggests SMI/SUD/dementia may be a predictor for HRSN independent of socioeconomic status and race/ethnicity.