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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