Developing a systemwide behavioral health product formulary
The demand for behavioral healthcare has surged since 2020—and across the country health systems are still trying to catch up. Many patients face barriers like cost, stigma and limited provider availability. But while organizations work to close those gaps in care, another opportunity exists: rethinking how supplies and products support behavioral health patients.
From a supply chain perspective, there are ways to deliver more economical and consistent products for this unique patient population, whose needs can differ from acute care patients.
Why behavioral health requires different products
“From a clinical standpoint, there are certain supplies you wouldn’t use for behavioral health patients due to the risk of self-harm,” says Jared Dougherty, DNP, MBA, RN, CENP, CCRN-K, Senior Director of Clinical Resource Analysis at HCA Healthcare. Safety protocols are critical to providing these patients with high-quality care—and it requires looking at supplies through a different lens. Something as seemingly benign as a shampoo bottle with sharp edges can pose a risk to behavioral health patients. “We want to make it easy for health systems to obtain supplies while following evolving regulatory requirements.”
Behavioral health patients also experience care differently than those in acute settings. “The latter typically wear a hospital gown and are in a patient room for the majority of their stay. Behavioral health patients are able to wear plain clothes in a more communal setting and can attend sessions for five or more hours per day,” explains Laura Hollis, DNP, RN, NE-BC, Assistant Vice President of Behavioral Health Nursing Operations for HCA Healthcare’s TriStar Division. “Getting well involves more than just taking medications and procedural treatments.”
For instance, behavioral healthcare involves not only clinical supplies but also therapeutic items such as markers, pens and paper. These must be evaluated for safety just as rigorously as other products and equipment. On the flip side, many items in the med/surg formulary are designed to meet infectious disease protocols that may not be applicable to behavioral health. For example, says Hollis, CHG bathing wipes are used with patients to prevent central line-associated bloodstream infections (CLABSI), but most behavioral health patients are not at risk for CLABSI. Instead, they may benefit more from access to fresh and clean-smelling soap—a product that can help preserve dignity and improve mood during their stay.
“If we’re able to think outside the box, we can seek care items that positively affect behavioral health patients’ moods while in our facilities and still keep them safe,” adds Hollis.
Building a safer, smarter formulary
Products like Play-Doh and coloring books are used therapeutically in behavioral healthcare, but they aren’t typically available for purchase in a group purchasing organization (GPO) contract. Instead, facilities often turn to commercial retailers like Amazon. Including these types of products in a standardized formulary would help leverage potential financial savings—and improve safety.
“Behavioral health patients are such a specialized population that has grown so much over the years,” says Dougherty. “It makes sense for us to develop a focused Supply Chain initiative for this patient population that takes the need for different products into account.” That means working with existing suppliers to expand their offerings and collaborating with contracted distributors to find creative solutions and improve access.
HCA Healthcare has a detailed product review process and an internal committee that meets monthly to evaluate new product requests. “By having a standing member of that committee be someone representing behavioral health,” says Dougherty, “we’re able to handle projects, carve out special product needs and have conversations that address real-world challenges.”
For example, ACE bandages often come with either tacks or Velcro. From a behavioral health perspective, Velcro is the safer option—tacks present a potential risk for self- harm. “It’s all about providing a level of care, safety and consistency in practice for patients and staff,” says Hollis.
“We need to make decisions for all patients,” adds Dougherty. “Every emergency department and med/surg unit includes behavioral health patients, too.”
Hollis agrees. “Since the COVID-19 pandemic, people are much more aware of behavioral health, mental health and wellness. Whether you enter a hospital for a knee replacement, heart surgery, as a staff member or a visitor, you or someone you know can be impacted by mental health challenges.”
“Every emergency department & med/surg unit includes behavioral health patients, too.”
Creating consistency across the system
The pandemic reshaped the healthcare workforce, bringing in a younger workforce demographic and introducing new political and operational complexities. The pandemic also emphasized the importance of supply chain flexibility in emergency scenarios. When natural disasters threaten supply operations, HCA Healthcare Supply Chain teams respond. “We have 16 warehouses across the country,” Dougherty says. “If one warehouse is impacted by a natural disaster, we would have supplies from alternative sources to assist impacted facilities. Response to these events is not just about bringing supplies from a different location—we have to consider the impact of bringing different products that caregivers may not have seen before. That’s what we want to avoid.”
In addition, HCA Healthcare Supply Chain can provide consistent execution and clear standards of care that are critical for safety. “When there is a recall or change needed for a specific product, that message can be consistent and heard throughout the organization,” says Hollis.
Using data to drive smart decisions
Dougherty has reviewed product usage data from HCA Healthcare facilities to establish a starting point for the development of a Behavioral Health National Product Formulary. “We have a lot of data at our fingertips and we’re working to understand it from divisions that have a lot of behavioral health patients,” he says. This baseline helps the Supply Chain team identify how standardized purchasing already is—and where there are opportunities for improvement.
“HCA Healthcare is a data-rich company,” adds Hollis. “The ability to utilize, optimize and transition data-driven insights is an opportunity for the healthcare industry as a whole.” Developing a behavioral health formulary sets an example not only for GPO members but in support of safer care for behavioral health patients across the country—and the world.
The work is drawing interest throughout the industry. “At HealthTrust Advisory Board meetings, my colleagues are excited to learn what we’re developing,” Hollis says. “They want to understand how this could help reduce risk within their own systems.” Dougherty says smaller health systems can especially benefit. “They may not have access to robust data, so they look to larger systems that do. This formulary can offer them a path forward.”
Communicating across the system
Integrating behavioral health into a health system’s broader communication is key. “We use the HealthTrust Huddle online resource to ask questions and find helpful tools that support all of HCA Healthcare’s integrated delivery networks,” says Hollis. “It’s a great way to share strategies and stay aligned.”
As HCA Healthcare Supply Chain continues building this formulary, members will have the opportunity to add behavioral health-specific products to their contracts.
Participating health systems will receive an analysis of their current product usage and be able to identify opportunities to standardize and optimize their supply chain for behavioral health populations.
HCA Healthcare will be sharing this initiative at HealthTrust University later this year, spotlighting how supply chain innovation can improve care for one of the nation’s most vulnerable patient populations.
PLANNING TO ATTEND HTU IN AUGUST? Be sure to sign up for the HealthTrust University Conference education session—Getting Psyched Up: Developing a Systemwide Behavioral Health Product Formulary—and hear more from Laura, Jared and their co-presenters. Not attending HTU? Visit the public education site at healthtrustpg.com/education to view this content after HTU in Q3.
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