eSolutions: Care Coordination, July 2012
July eSolutions: Care Coordination
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
Feature: Care Coordination: The Heart of Integration
Grant Profile: The Providence Center
Quick Tips: Improve Communication with Your Partners
New from CIHS (SBIRT, Behavioral Health Homes)
CIHS Webinars (Motivational Interviewing)
Care Coordination: The Heart of Integration
Laura Galbreath, MPP, CIHS Director
Most of us have had to navigate a complex network of medical providers, labs, hospitals, and community services for a loved one or ourselves. It is not easy. And if a person is dealing with two or more chronic conditions — plus poverty, food insecurity, and other social determinants of health — they face even greater challenges in navigating the healthcare system. It is no wonder that most doctors agree high costs and poor outcomes inevitably result in a fragmented, disjointed system of care.
This is why we see care coordination at the heart of many healthcare redesign strategies, including primary and behavioral healthcare integration, the patient-centered medical home, and healthcare neighborhoods. As one of its 10 rules for healthcare system redesign, the Institute of Medicine (IOM) in 2001 called for care coordination for patients across conditions, services, and settings. According to the IOM, research demonstrated that care coordination increases efficiency and improves patients’ health outcomes and satisfaction with care. The vision for coordination of care is clear. Now, the country must engage in the hard work of making this vision a reality — implementing research-based policies and practices and building care coordination into system redesign.
But how does the vision for care coordination become reality in the new paradigm that drives health reform efforts? The IOM described care coordination as “encompassing a set of practitioner behaviors and information systems intended to bring together health services, patient needs, and streams of information to facilitate the aims of care.” Physicians are informed of patient’s diagnostic results and treatment history; nurse care managers can transmit patient information to primary and specialty care providers in real time; community resources are fully engaged with primary care providers in supporting care for the people they serve. In practice, coordinated care is different depending on the treatment setting, patient needs, and resources available. For an older adult who resides in a rural area and suffers from multiple chronic health conditions, care coordination will look different from coordinated care for an individual living with HIV/AIDs in an urban area who is otherwise healthy. While different, each situation achieves the underlying goal of coordinated care — matching services and information to patient needs.
Behavioral healthcare providers play a vital role in realizing this vision of coordinated care. As state Medicaid programs develop person-centered health homes to meet the needs of individuals with mental and substance use disorders, behavioral healthcare providers will be expected to demonstrate that they can coordinate and provide access to care management, care coordination, and transitional care across settings. For many, this means working towards integrating primary and behavioral healthcare while remaining mindful of the many forms that care coordination may take and the variety of professional roles that may be involved. Coordinated care may involve nurses, health coaches, and peer support specialists, as well as doctors and medical technicians. In addition, care coordination can be implemented in a variety of settings such as clinics, the patient's home, or other community settings.
Care coordination is not new. The behavioral health field, for example, has extensive experience in case management to support recovery and self-management of mental illness. Primary care providers are also well acquainted with the idea. "Health navigators" were an approach initially developed by the American Cancer Society for the primary care community to help impoverished individuals negotiate barriers to cancer treatment. Models to support coordinated care such as the patient-centered medical home have been in place since the late 1960s. While the healthcare payment infrastructure and state and federal regulations have not historically aligned to support coordination approaches, current health care redesign efforts are recognizing the financing structures needed for improved coordination. How providers and policymakers work together to maximize and leverage care coordination within these models becomes a critically important issue.
As primary and behavioral healthcare providers strive to integrate services, care coordination will support systems-wide efforts to reduce emergency room visits and hospital stays, one of the greatest cost-drivers for the health care system. Based on the foundation of care coordination, primary and behavioral health care integration will make huge inroads in achieving the goal of “triple aim” to improve the health of the population, improve the patient experience of care (including quality, access, and reliability), and reduce or at least control costs.
Learn more about care coordination at www.integration.samhsa.gov/workforce/care-coordinationor contact CIHS directly for technical assistance.
PBHCI Grantee Profile: The Providence Center
Care Coordination Begins with “No Wrong Door”
The Providence Center in Rhode Island — where they have built integration into the DNA of the entire organization — attributes the improved health outcomes of the consumers they serve to the trilogy of care coordination, treatment, and consumer engagement.
The organization partners with the Providence Community Health Centers, an FQHC, to ensure seamless care coordination for their clients. When the look at care provision and care coordination, their main goal is to ensure no member of their community faces a wrong door when accessing needed behavioral health and/or primary care. Case managers coordinate medical care for individuals with behavioral health problems; licensed social workers serve as care coordinators when patients enter through the 'medical door.' They employ psychiatric nurses to help coordination care and embed medical nurse care coordinators in community support teams to help address four key chronic illnesses: diabetes, heart disease, hypertension, and obesity. And each staff members does as much as they can to coordinate care for all consumers needing primary or behavioral healthcare.
Like all of SAMHSA’s other Primary and Behavioral Health Care Integration grantees, the Providence Center is ahead of the curve in preparing for the future healthcare marketplace through ensuring seamless care coordination with primary care partners. Yet, they face hurdles just as any early adopter would — sustainability being a primary barrier. Rhode Island was the second state to receive approval for a Medicaid Health Home State Plan Amendment. And while this offers them greater opportunities for reimbursement of integrated services, options to ensure their integrated model can sustain itself are not assured. And, the workforce isn't there yet. There are few professionals trained in care coordination or experienced at working in an integrated setting or with other health disciplines.
For now, however, the Providence Center is primed for success. And as the adage goes, success breeds success.
Learn more about SAMHSA’s Primary and Behavioral Health Care Integration program. For more on the Providence Center, visit www.providencecenter.org.
Quick Tips to Improve Communication with Your Partners
One barrier to care coordination, and the integration of primary and behavioral healthcare in general, is language and culture. The primary care, mental health, and addiction fields each have their own, and when working together, differences often bubble to the surface. If unaddressed, this barrier can hamper care coordination and, ultimately, the care individuals receive.
Consider that behavioral health professionals say "recovery," while primary care professionals say "wellness." Behavioral health professionals provide "case management" services, while primary care staff provide “care coordination." What’s even more startling is that behavioral health professionals intend "behavioral health" to encompass mental illnesses and substance use disorders. Yet, many primary care professionals interpret the term to mean behaviors related to health behavior, like unhealthy eating, tobacco use, etc.
In his widely popular book, “The Four Agreements,” Don Miguel Ruiz articulates four general guidelines that primary and behavioral healthcare providers can use to lay a solid groundwork when coordinating care:
- Be impeccable with your words. Clarify your partnership’s goal and recognize that you have created a process that requires constant nurturing and communication.
- Don’t take anything personally. Disagreements will occur. Learn to manage the process, not the personality, and recognize and understand your differences.
- Don’t make assumptions. Involve both boards, schedule weekly administrative meetings, hold regular treatment team meetings, communicate between team meetings, and create a specialized data collection position.
- Do your best. Involve state and local stakeholders, seek training for staff in care coordination, bring in outside experts such as CIHS for guidance, and engage other organizations that do similar work.
For more on care coordination, visit www.integration.samhsa.gov/workforce/care-coordination or contact CIHS directly for technical assistance.
New from CIHS
CIHS Announces 2012 Addressing Health Disparities Leadership Program
CIHS is soliciting applications for the 2012 Addressing Health Disparities Leadership Program. Selected participants will join a 7-month program of 20 middle management-level staff working in community behavioral health and primary care organizations with populations experiencing health disparities.
CIHS Releases New SBIRT Issue Brief
SBIRT: Opportunities for Implementation and Points to Consider provides an overview of SBIRT’s benefits and core components, opportunities for implementation in healthcare settings that have become available through the Affordable Care Act, and potential obstacles to implementation.
CIHS Releases New Paper on Behavioral Health Homes
CIHS’s new paper, Behavioral Health Homes for People with Mental Health & Substance Use Conditions: The Core Clinical Features, prepares behavioral health provider organizations to become health homes by outlining the essential clinical features. In addition, the paper introduces several real-world examples of how behavioral health provider organizations are successfully implementing the clinical features of a health homes around the country.
AHRQ Launches Academy for Integrated Behavioral Health and Primary Care
The Agency for Health Research and Quality’s (AHRQ) has established the Academy for Integrating Behavioral Health and Primary Care, a ‘go to’ source for analysis and synthesis of integration information related to research, workforce development, policy, financing and sustainability, clinical and community, and HIT. Read the Academy’s full article for CIHS to learn more about the Academy, its resources, and their new site featuring a searchable database of integration literature published since 2010, literature from as early as 2000 on research gaps found in the literature, and materials not made available through traditional publishing avenues.
Financing of Behavioral Health Services within Federally Qualified Health Centers
A new study from Truven Health Analytics, Financing of Behavioral Health Services within Federally Qualified Health Centers, describes the current financing and delivery of mental health and substance abuse services and the future incentives for FQHCs and behavioral health providers to promote service coordination and integration. Funded by SAMHSA, this study is intended for state substance abuse directors, mental health directors, and their consumer and provider networks.
Wellness Solutions 1.0: Uncensored Innovation in Philadelphia, September 4-5
The Hope Concept Wellness Center will host its inaugural education and outreach mental health conference, Wellness Solutions, in Philadelphia, September 4-5, 2012. Speakers will include acclaimed author Robert Whitaker.
The Value of Tele-Behavioral Health Integration in the Medical Home and ACO
Medical groups and hospitals struggle to provide consumers timely access to evidence-based and sustainable behavioral health services. The National Council Value in Technology Program and Access Psychiatry Solutions will host a free webinar to provide healthcare decision makers with actionable information on tele-behavioral health technology, logistics, evidence-based practice, and sustainability. The webinar will occur on Wednesday, August 8, 2012, at 1:00 PM (Eastern). Register today.
Words of Wellness
The monthly Words of Wellness newsletter featuring information and resources to help people achieve and maintain wellness is available. This issue includes articles on arts and physical wellness, as well as insomnia.
Tobacco Dependence Program
The Tobacco Dependence Program out of the University of Medicine and Dentistry of New Jersey is dedicated to reducing the harm to health caused by tobacco use. The program particularly aims to provide expertise on quitting smoking for those who need it most. This is done through education, treatment, research and advocacy.
Engaging People in Discussions about Health-related Changes
When: August 15, 2012, 2:00–3:30 pm (Eastern)
Presenter: Jeremy Evenden, MSSA, LISW-S, Consultant and Trainer, Center for Evidence-Based Practices at Case Western Reserve University
Engaging People in Discussions about Health-related Changes is designed for those who serve people with behavioral and/or primary healthcare needs (e.g., clinical staff, support staff, peers). Participants will learn about the change process and important considerations when engaging people in behavior change discussions. Register today. Registration is free, but space is limited.
Check out CIHS’ past webinars, including:
Billing for Integrated Health Services Webinar
On June 12, Kathleen Reynolds, Senior Consultant for CIHS, presented on the financial viability and sustainability of integration efforts through appropriate and accurate billing for services. The webinar also featured the state-based Interim Billing and Financial Worksheets developed by CIHS. The slides and recording from the webinar are now available.