Oak Street Health : Why Behavioral Health is Critical to Oak Street Health’s Innovative Primary Care Model

Oak Street Health (NYSE: OSH) - a rapidly growing, multi-setting primary care company that specializes in caring for seniors - is making behavioral health a critical part of its value-based care strategy to improve outcomes and the lives of its patients.

Based in Chicago, Oak Street operates over 125 locations across 20 states. It integrates behavioral health across its footprint using the IMPACT collaborative care model, built around a mix of in-person and telehealth visits.

The integration of primary care and behavioral health services have the potential to save the U.S. health care system tens of billions of dollars each year. A 2014 report from actuarial consulting firm Milliman, in fact, found it could save upwards of $48 billion annually.

Oak Street is a full risk value-based primary care provider that focuses on treating the whole patient. It emphasizes preventive care, wellness and mental-health monitoring and maintenance to improve outcomes and lower the total cost of care.

"When value-based care models are set up successfully for the patient, they can have their whole care addressed," Katherine Suberlak, the vice president of clinical services for Oak Street Health, told Behavioral Health Business. "The sustainability that we're focused on is in the patient getting better."

The company estimates that about 60% of its patients can benefit from its behavioral health services. And for those that are utilizing them - it's working.

According to the company's latest investor presentation, 43% of its patients are seeing a significant reduction in depressive symptoms using its collaborative care model, compared to 19% of patients using a traditional behavioral health care approach.

Integrating behavioral health

After signing up for services, Oak Street patients see a care team made up of a primary care physician and a behavioral health specialist. That team, which can include a psychiatric consultant, then assesses them for conditions like depression and substance abuse.

Even after the patient's initial assessment, regular screenings for behavioral health conditions are integrated into the overall care model along with other routine services such as blood-pressure checks and wellness check-ups.

Of those screened, almost half are at risk of a behavioral health experience, according to Suberlak. That figure has grown as a result of the COVID-19 pandemic, she noted.

Oak Street's depression screening rate is at 98% for annual wellness visits, Suberlak said.

"We serve individuals that have disproportionately experienced stressors, isolation and loneliness," she said. "We're taking the high screening rate results with caution, and then also with intervention."

Individuals who need services are directed to internal specialists that tailor an appropriate care plan, which could include a psychiatrist or a range of services that might be available to them in the community.

"The specialist will investigate further if this is a stressor that is situational," Suberlak explained. "That's where treatment plans and intervention comes in."

While it has brick-and-mortar clinics, Oak Street also uses social workers and community health workers to provide follow-up services to patients in homes and community settings.

"We're fortunate to have those resources where we both have medical social workers and community health workers working like health coaches and integrating the care team," Suberlak said.

Shifting to a hybrid approach

Oak Street has seen a rise in demand for behavioral health services as a result of the pandemic - and it's not alone. Among adults 65 and older, one-quarter have reported having experienced anxiety and depression during the pandemic, according to the Kaiser Family Foundation.

Oak Street was primarily built using retail locations to meet with patients. It started to integrate telehealth in 2017, and the pandemic has made it lean heavily into a hybrid model for treating behavioral health.

"It really allows us to scale or expand our reach as a specialty that is both under-resourced and very hard to staff," Suberlak said. "That's also consistent with the collaborative care model that we have integrated, which is that you take that highest resource and you really safeguard that for your most at-risk patients."

Telehealth tools have helped Oak Street and other providers stretch clinical capacity, but in-person services remain critically important - and often preferred. In a recent survey from digital health seed fund company Rock Health and the Stanford University School of Medicine, for instance, over 60% of respondents said they would rather receive mental health services in an office setting.

Oak Street's own reliance on digital services comes as Medicare telehealth claims have exploded by over 3,000% during the pandemic. That figure could rise as the federal government has expanded the number of locations where Medicare recipients can receive telehealth services.

Oak Street is working to scale its hybrid care delivery model and made a $130 million purchase of virtual speciality provider RubiconMD in the fall of 2021. The company allows primary care physicians to virtually consult with specialists and is being integrated into the care model to provide additional capacity for behavioral health services.

Oak Street has previously said that each virtual visit saves the company between $500 to $800 in medical costs

"This approach has the potential to meaningfully improve patient care and outcomes, patient experience and convenience and Oak Street financial performance," Oak Street co-founder and COO Geoff Price told Fierce Healthcare last year.

The shift to telehealth has also helped Oak Street deal with workforce shortages for behavioral health workers, but it still is having to get creative to attract and retain them.

Subelrak said it's providing its workforce with more flexibility while allowing more licensed clinical social workers to meet with patients remotely, instead of in their homes. However, she said that the company's efforts are strained due to Medicare not reimbursing licensed clinical professional counselors for their services.

"We are limited on who we can hire that can support our beneficiaries," she said. "We're looking at ways that we can be innovative to make sure that we're constantly creating access for our patients related to mental health."

Collaborative care model provides flexibility to drive outcomes

One of the biggest differences between Oak Street's model and more traditional primary care or mental health providers is the flexibility to measure how patients are responding to care.

"We don't have to pull the patient back into the office to continue to have quality outcomes," Suberlak said. "In the collaborative care model, we can iterate or increase treatment, and it does not require that bricks-and-mortar piece to do it."

Oak Street's regular behavioral health assessments track how patients have responded to care at intervals like six weeks and six months. They are also used to determine whether treatment has been adjusted accordingly in response to how the patient has or has not progressed during their time of care.

"While we are a value-based provider, one of our benefits is working with community partners," Suberlak added. "We can use our relationship with the patient if there is risky behavior or misuse. Or if we need to escalate to a higher level of care, we can connect that patient to that service provider [in the community]."

When it comes to treating depression, Suberlak said that patients typically see a measurable reduction in severity after the six-week mark.

"We're reducing their episodic experience of depression by at least one severity experience," she said. "If it's major depressive disorder, [we are] reducing it to moderate [and then] reducing it to mild."

Suberlak also claims that almost half of Oak Street patients are seeing a sustained reduction in depression after six months.

"I think that success is from being able to respond to the patient's desire to both connect in-center, but then proactively following up and connecting with them out of center in between visits, whether it's telephonic or on the telephone," she said.

The relationship with the patient and the ability to do further assessments are critical parts of the model to drive evidence-based care.

"This is building on the evidence-based model of collaborative care," Suberlak said. "We can engage with them in the primary care appointment, and then proactively follow up and treat in a timely manner."