Transcript Slide 1
Models of Medical Care
in the Psychiatric Setting
Jason Cheng, MD
Jeanie Tse, MD
Institute for Community Living, Inc.
Wellness, Resilience, and Recovery for All Philadelphians:
Integrated Care in Philadelphia
June 25, 2013
Objectives
At the conclusion of this presentation, participants
will be able to:
Describe two models of integrating medical care
into psychiatric settings
Strategize how to modify electronic health
record systems at their home institutions to
support integration
Institute for Community Living
NYC not-for-profit
>100 programs, 10,000 consumers:
housing, case management, ACT, PROS
(NY only), clinics, shelters & health home
Founded Health Care Choices FQHC
In housing and case management:
>70%
schizophrenia / schizoaffective
Primarily paraprofessional workforce
Person-centered care
“The patient is the source of control” (IOM)
Goals and values determine how care is
Patient
provided
Self-management
Self-Mgmt Co-Loc/ Pthwys/
Workbooks Care
MedRisk
Mgmt
Mgmt
Integrated
Electronic
Tx Plan
PCP
Nurse
Care
Manager
Psychiatrist
Person
Specialists
Entitlements
Peer health coach
Care management
Develop and maintain rapport with patient and
provider
Educate the patient and family
Monitor symptoms and communicate findings to
provider
Develop and maintain a self-care action plan
Maximize adherence to the treatment plan
through negotiation of solutions to treatmentemergent problems
Bureau of Primary Health Care
Health Disparities Collaborative
Nursing-supported care management
Medical risk screening at intake
Risk stratification and treatment planning
in collaboration with nurse
Acute
risks
Adherence issues
Need for higher level of care
Monthly multidisciplinary review
Nursing-supported training of behavioral
health workers
Billing
Codes for physical exam, health
monitoring and complex care management
Physical exam billing if external PCP?
Health monitoring rate (billed by
MD/PA/NP/RN) is half that of
psychotherapy rate (billed by SW)
Peer health coaching not reimbursable
Electronic Tools
Single EHR
Health Risk Screening
Healthy Living Questionnaire
Physical Health Goal Planner
Healthy Living Workbook
Healthy Living Clinical Pathway
Primary care vs. behavioral health culture
Medical vs. psychosocial models
Top-down vs. consensus decision-making
Physician vs. social service leadership
What’s the bridge?
Self-management
Nurse care management
Summary
Nursing-supported care management can bridge
a number of gaps between primary care and
behavioral health
Electronic tools can help support decision
making and provision of care within integrated
settings
Reimbursement of integrated care still needs to
be addressed
ICL’s Integrated Health Team:
Sonia Barolette, RN
Shivonne Blake, CDM
Jason Cheng, MD
Ruth Chiles, RD
Judy Chong, CASAC
Elisa Chow, PhD
Elizabeth Cleek, PsyD
Cindy Freidmutter, JD
Drew LaStella, PhD
Eduard Levy, MD
Jimmy Lindsey, CSCS
Rosemarie Sultana-Cordero, MA
Marcia Titus-Prescott, RN
Jeanie Tse, MD
Matt Wofsy, LCSW-R
and numerous program staff
Please feel free to contact me at [email protected]
Bibliography
Druss BG, Rohrbaugh RM, Levinson CM, et al: Integrated medical care for patients
with serious psychiatric illness: a randomized trial. Archives of General Psychiatry 58:861–868, 2001
Horvitz-Lennon M, Kilbourne AM, Pincus HA. From silos to bridges: meeting the general health care needs of adults
with severe mental illnesses. Health Affairs, 25 (3): 659-669, 2006
Kilbourne AM, Pirraglia PA, Lai Z, et al. Quality of General Medical Care Among
Patients With Serious Mental Illness: does co-location of services matter? Psychiatric Services 62:922–928, 2011.
Mauer, B. (2006). Behavioral health/primary care integration: The Four Quadrant Model and evidence based practices .
Rockville, MD: National Council for Community Behavioral Healthcare., 2006.
(http://www.thenationalcouncil.org/galleries/businesspractice%
20 fi les/4%20Quadrant.pdf/ )
McGuire J, Gelberg L, Blue-Howells J, et al: Access to primary care for homeless veterans with serious mental illness
or substance abuse: a follow-up evaluation of colocated primary care and homeless social services. Administration and
Policy in
Mental Health 36:255–264, 2009
Pollack DA, Raney L, Vanderlip ER. Integrated Care and Psychiatrists. Handbook of Community Psychiatry
(McQuistion HL, Sowers WE, Ranz J, Feldman JM, Eds.). Springer, New York, NY 2012