When it comes to behavioral health/primary care integration, we are often forced to fly into unchartered areas in an effort to meet the needs of our patients and ongoing health care reform. Newaygo County Mental Health (NCMH) and Family Health Care (FHC) have been working collaboratively since 2010 to provide integrated health care. NCMH clinicians provide outpatient therapy services within two FHC federally funded Teen School-based Health Centers. NCMH recently added two Integrated Behavioral Health Clinicians to the FHC health center in White Cloud. This webinar will provide an overview of how primary care health centers and community mental health centers can partner to improve physical and behavioral health for their community.
2. Why integrate care?
70% of all PC visits have psychosocial drivers
50% of patient w/diabetes will suffer from
depression
90% of most common complaints have no organic
basis
67% of all psychoactive agents are prescribed by
PCP
80% of antidepressants are prescribed by PCP
3. Why integrate care?
Individuals with serious mental illness die more than
25 years earlier than general population
Only 1in 4 patients referred to specialty MH/SA
make the first appointment
Seven of the ten leading causes of death (heart
disease, cancer, stroke, chronic lower respiratory
disease, accidents, diabetes and suicide) have a
psychological and/or behavioral component
4. Picture this…..
The woman with chronic pain starts using a few coping
skills and stops abusing her pain meds
The man with diabetes starts checking and recording his
blood sugars daily and recognizes the impact his food
choices are having on his blood sugar.
The obese child you have been treating looses 8lbs.
70% of the patients you refer to specialty MH/SA
treatment actually follow up and participate in tx.
The man with schizophrenia and heart disease starts
walking daily and takes his medication as ordered. He
even starts eating a few healthy foods daily.
7. How we got here……
Executive Level Support and Space
Getting to know your co-pilots
Meeting of the Minds
Identified IBH Champions
Joint Interviews
Flying without a pilot’s license
8. What does our plane look like?
School based clinics
IBH services provided by NCMH clinician at White
Cloud Family Health Care (WCFHC)
Co-located NCMH access at WCFHC
NCMH “liaison” role for patients/consumers served
by both NCMH and WCFHC
9. Our Flight Manual
IBH Clinical Protocol
Referral Process
Patient flow
Quadrant Model
Documentation
10. Quadrant Model
Quadrant I
Patients with low behavioral health and low physical health needs
Served in primary care setting
Example: patients with moderate alcohol abuse and fibromyalgia
Quadrant II
Patients with high behavioral health and low physical health needs
Served in primary care and specialty mental health settings
Example: Patients with bipolar disorder and chronic pain
Note: When mental health needs are stable, often mental health care can be transitioned back to primary care.
Quadrant III
Patients with low behavioral health and high physical health needs
Served in primary care setting
Example: patients with moderate depression and uncontrolled diabetes
Quadrant IV
Patients with high behavioral health and high physical health needs
Served in primary care and specialty mental health setting
Example: patients with schizophrenia and metabolic syndrome or hepatitis C
12. Our initial flight data…..
Start date May 18th
136 IBH contacts
19 min is average length of contact
6 NCMH direct referrals
4 referrals to other CMH centers
4 NCMH potential referrals but were not completed
(patient not interested in services, guardian not
present to seek services, etc)
13. Referrals By Quadrant Type
Q4 High BH
High PH
18% Q1 Low BH
Low PH
26%
Q3 Low BH
High PH
14%
Q2 High BH
Low PH
42%
16. “NCMH liaison” Role
45 contacts in September alone!
Two IBH clinicians
Assigned to specific NCMH clinical teams
Attend daily or weekly team meetings
Primary gatekeeper between NCMH and WCFHC
Records requests
Psychiatric consults
Advocating for NCMH consumer’s physical health needs
Overall care coordination
*Success Story!!
A work in progress
17. “NCMH liaison” Role
Co-located access at WCFHC site
Full access screening is completed at WCFHC at
time of appointment with PCP
*Success Story!!
18. When Turbulence Hits….
Technology
Difficult to do concurrent documentation
Two Separate Medical Records
Medical Provider’s World View
Behavioral Health?......
To Screen or Not To Screen?
Two different funding structures
Billing, coding questions – who is the “go to”person?
19. Next Steps
Record Review/Needs Assessment of mutual
consumers/patients
Create collaborative patient/consumer PH and BH
goals/outcomes
Identify specific populations and provide evidence
based interventions
Securing primary care services for NCMH consumers
with no PCP (on site or at FQHC)
Billing, Billing, Billing, Billing, Billing
Expand – future sites
21. Sources
Robinson and Reiter 2007
Colton and Manderscheid 2006
Mauer 2006
Kroenke et al 1989
Karen Way 1999
Centers for Disease Control and Prevention 2005
Contact sbowman@nmch.org for full citations