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Well Being Trust | Annual Report | Clinical Transformation 11 Well Being Trust started its clinical transformation work inside our initial partner-investor, Providence St. Joseph Health. In 2017, we worked with system leaders to establish a Clinical Performance Group—a multiyear learning collaborative that addresses three of the most pressing and cost-driving challenges within the health system: • Integrating behavioral health into primary care • Transforming substance use treatment and services • Finding better ways to care for people with mental health issues in the emergency department. The majority of behavioral health issues are addressed by primary care providers, but without proper support systems, the care provided is often suboptimal. Primary care providers typically lack the training, resources and time to adequately care for individuals with behavioral health and addiction issues. Inadequately treated and undiagnosed behavioral health issues have a profound effect on the ability to successfully treat other chronic conditions, affecting patients' motivation, understanding and engagement with the totality of their health—and dramatically increasing the total cost of their care. Pain in the Nation calls us to action, especially with regard to how we treat those suffering with addiction and substance use disorders. Treatment services are often underfunded, leaving those in need of care waiting days or weeks just to begin the first stages of their journey to recovery. New therapies, including medications for opioid use disorder, offer hope, but without targeted peer supports they are difficult to implement. As the opioid crisis intensifies, many individuals have also lost their jobs, families and even housing, leading to deaths of despair across the country. Creating new pathways for care, including standardized screening tools, developing clinical pathways for withdrawal and maintenance management, and building resource networks within communities are key to responding to the call. In the United States, the emergency department remains the first point of entry for many individuals who have mental health care needs. One study found that one in eight visits to emergency departments are for mental health and substance use. 9 Through our investment and partnership with the Institute for Healthcare Improvement, we are working to understand the opportunities to remove barriers and accelerate the convergence of mental, physical and social health considerations in the emergency department. 10 The goal is to begin to support the health and well-being of more people in the places they most often seek care for mental health needs, and then go "upstream" and find ways we can prevent those individuals from showing up in the emergency department in the first place. Nine leading health systems are participating in the initiative, including Adventist Health, Allina Health, Ascension, Kaiser Permanente, Maine Health, Memorial Hermann, Northwell Health, Orlando Health and Providence St. Joseph Health. This work will result in field-tested comprehensive change packages that provide road maps to scale and spread solutions.

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