North Carolina's first behavioral health urgent care center significantly reduced ED volume and health disparities and improved patient outcomes, according to a case study from the American Hospital Association (AHA). Advisory Board's Sophia Duke-Mosier outlines two key strategies that contributed to the center's success. 

The role of specialty outpatient care in behavioral health care

Inside the Guilford County Behavioral Health Urgent Care Center

In 2021, North Carolina-based Cone Health partnered with Guilford County to open the Guilford County Behavioral Health Urgent Care Center — a 16-bed facility that offers crisis behavioral healthcare, an on-site pharmacy, outpatient services, and peer support.

The center was founded to serve community members who are uninsured or enrolled in Medicaid. During the first quarter of 2023, it served more than 12,000 patients. According to Archana Kumar, Cone Health's medical director, many of these patients are unhoused or incarcerated — a portion of the population that is often overlooked in the area.

The behavioral health urgent care area is open 24/7, which helps patients avoid costly ED visits and provides them holistic care in a therapeutic environment. Since staff can conduct lab work and manage patients' care needs onsite, just 10% to 15% of patients are sent to the ED for medical clearance, Kumar noted.

"We do not rush patients with a behavioral health crisis to the EDs for medical clearance," Kumar said. "Emergency Medical Services can bring patients here."

When an individual arrives at the center, a psychiatric specialist, behavioral health social worker, or medical provider creates a care plan based on the patient's specific needs.

If the staff determine that a patient will be better served by outpatient care, they refer them to an outpatient provider. Typically, low-acuity patients are admitted to the center's crisis unit for three to five days, and patients that require further inpatient psychiatric care are transferred to Cone Health's behavioral health hospital.

According to AHA, the center has seen impressive results within its first 18 months of opening, including a 30% reduction in Cone Health's ED volume. In addition, AHA noted that the center has "boosted provider education and enhanced their diagnostic assessment tools to ultimately reduce patient misdiagnoses and health disparities," as well as reducing stigma behind behavioral health conditions. 

"[T]he Center has reduced length of stay and decreased behavioral health crises presenting to the ED," AHA noted. "Those ED bays can now be used for medically complex patients, improving throughput and patient satisfaction." 

2 reasons this approach works 

By Sophia Duke Mosier

Since its launch, the Guilford County Behavioral Health Urgent Care Center has implemented several strategies aimed at improving access to care and reducing disparities. In particular, two strategies have contributed to the center's success:

1. Investing in an expanded care team

Provider organizations often face the challenge of an insufficient supply of the "right" behavioral health providers — meaning practitioners who are in a specific location, have capacity to accept new patients, have the right expertise required, and have training to provide care with cultural humility.

Cone Health and Guilford County rose to the challenge by leveraging an expanded behavioral health care team to fill gaps in care. The center's staff is composed of members across the care team including psychiatric specialists, behavioral health social workers, licensed peer support specialists, and traditional medical providers. 

2. Embedding cultural humility in diagnosis practices

It is essential for providers to embed cultural humility practices within their organizations to reduce bias and health disparities. Providing culturally humble care requires ongoing learning, self-reflection, and skill building to understand a patient's cultural context through their own lens.

The center implemented cultural humility practices after Cone Health leaders discovered that Black patients were diagnosed with schizophrenia at four times the rate of their white counterparts.

To reduce this bias and address disparities, leaders deployed improved assessment tools that encouraged clinicians to think more critically about patients' medical histories to avoid a misdiagnosis of catatonic events like schizophrenia.

As a result, misdiagnoses of schizophrenia declined and patients with schizophrenia were connected to outpatient services and long-acting medications injectables to help with stability.  

For more information on how providers can meet patients' behavioral health needs and address health disparities, check out Advisory Board's tactics for provider organizations to build a stronger behavioral health system. (AHA News, 6/20; American Hospital Association case study, accessed 6/28)

Download the cheat sheet to learn about the different types of specialty outpatient care programs, their financial models, and which patients they can best serve.