[PC-BH-Integration] integration proposals

[Bill Schlesinger]

Co-location resulted in high no-show rates, a sense of isolation both
perceived and real between medical and mental health providers, medical
records that did not reflect mental health treatment or needs and vice
versa, and very little measurable improvement.  In the co-location setting
of El Paso MHMR our medical providers had no access to the medication or
vitals from MHMR nurses.  In the primary care co-location the mental health
provider had no access to the medical chart.  In neither case did medical
and mental health providers share fully the responsibility for the patient
as a whole.

Becky's question on strategic planning is more involved.  She wanted to know
outcomes; our PHQ-9 rates showed about 65% of the patients enrolled in the
collaborative care program decreasing symptoms by 40% or more.  We can pull
the stats out of our report for anyone who's interested, but the interesting
part of comparing us to other Hogg-funded sites was that we massively
overloaded our care manager (up to 150 case load vs. 30-40 case loads in
another site) while only seeing only slightly lower rates of decreased
symptoms.  The key is the function and role of the care manager in the
system.  That person pulls the patient, the medical provider, the therapist
and the consulting psychiatrist into a team in which each person's ability
to fill their role is enhanced, and their 'shooting in the dark' decreased.

Our strategic plan included funding -- we received a services expansion
grant which has stabilized the program - expansion which we will do by
supervising community health workers to fill the care manager role in
another clinic site - and 'flipping the model' into one EPMHMR outpatient
clinic which will become fully ours vs. a co-location site.  We'll absorb
their staff, and we believe that our FQHC Medicaid and Medicare rates will
cover the additional costs of integrated care through a family nurse
practitioner who will both provide the care and link with the primary care
provider of those persons who choose to continue with a current primary care
provider outside our system.  We intend to pass on the medication savings
from our 340(b) pharmacy pricing to EPMHMR under a separate contract for
reimbursement.  

EPMHMR has created another approach to at least sharing information.  They
track their diagnoses with a local Medicaid HMO that also carries a locally
funded (Hospital District) primary care program for persons with incomes
less than 100% of federal poverty level.  The HMO compares medical and
mental health diagnoses electronically, and identified a pregnant patient
who was about to be given strong anti-psychotic meds contra-indicated in
pregnancy.  The entire cost of the system set up was recovered by the
hospital district and the MHMR Center in avoiding the complications that
would have ensued.  The mom and baby are doing well, instead of being
devastated by the fragmentation of a medical system intent on doing good.

We'll be glad (off list or on list) to share more details with anyone
interested.  

Bill Schlesinger
Project Vida
3607 Rivera Ave
El Paso, TX 79905
(915) 533-7057 x 207
(915) 490-6148 mobile
(915) 533-7158 fax
bschlesinger.pv at tachc.org


-----Original Message-----
From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Blount,
Alexander
Sent: Wednesday, January 28, 2009 8:53 AM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] integration proposals

As someone who trains mental health professionals to work in primary
care
(http://www.integratedprimarycare.com/Certificate%20Program_Email.htm) I
am not surprised to hear you say the co-location doesn't work, but I
wonder if you would be willing to say a bit more about what is behind
that statement.  I think it could be helpful to people who are earlier
in the process.

Alexander Blount, EdD
Clinical Professor of Family Medicine and Psychiatry
University of Massachusetts Medical School
Director of Behavioral Science
Department of Family Medicine and Community Health
Editor, Families, Systems, & Health
O. 508 856-2147, F. 508 856-1212
blounta at ummhc.org
http://umassmed.edu/fmch/faculty/Blount.cfm?start=0 
http://www.IntegratedPrimaryCare.com 

-----Original Message-----
From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Bill
Schlesinger
Sent: Tuesday, January 27, 2009 10:44 PM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] integration proposals

We've been working with the Hogg Foundation for Mental Health for about
three years.  We're an FQHC and using the care manager model similar to
IMPACT.  We tried co-location - it didn't work.  We've been funded for
service expansion funds from HRSA which stabilized the project.  I'll be
glad to respond to specific requests for information -- the Hogg website
has
a lot of the model information at
http://www.hogg.utexas.edu/programs_ihc.html


Bill Schlesinger
Project Vida
3607 Rivera Ave
El Paso, TX 79905
(915) 533-7057 x 207
(915) 490-6148 mobile
(915) 533-7158 fax
bschlesinger.pv at tachc.org




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