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Behavioral health adding new twist to the medical home concept
e-Reports, April 1, 2013
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Your community may soon benefit from this pilot project to improve care for adults with both a mental disorder and a medical condition Untitled document

In Bloomington, the patient-centered medical home* began taking on a new look two years ago. That’s when Centerstone, the nation’s largest community mental health center, offering care in Tennessee and 17 Indiana locations, won a federal grant to pilot a behavioral health home model. Community mental health centers in Indianapolis and Greenwood also received grants.

The goal is to integrate physical health care and mental health care to help patients with dependency problems or serious mental health issues live longer. “People with chronic mental illness die 25 years earlier than their peers, principally from chronic physical health issues, not mental health problems,” advised Bob Siegmann, M.B.A., L.C.S.W, with Centerstone’s Indiana leadership team.

Yet, 28 percent of Centerstone’s patients have no primary care provider and 62 percent use the emergency department as a source of primary care services. Through the behavioral health home pilot, however, area patients are now finding help with their health care needs. They’re getting support to adhere to recommended treatments and encouragement to improve their lifestyles.

Person centered health care home development

How it works
Centerstone has approximately 150 mental health case managers and rehabilitation specialists in Indiana who are now trained as health navigators. Their task is to serve as health and wellness coaches, assisting patients with serious mental illness to adopt good health practices to improve any chronic health conditions.

The focus is on five key areas: nicotine dependence, obesity, hyperlipidemia, diabetes and hypertension. The navigators assist patients in setting health goals and accessing services needed to reach those goals. To prepare, Centerstone staff members are educating themselves on diseases like diabetes, so they can help their patients with disease management.

“We are making our employees much more alert to the physical health of our patients,” said Centerstone’s Maren Sheese, L.C.S.W. “We want to connect with the health care community and collaborate to meet our patients’ needs.”

The clinic staff is getting reimbursed by Medicaid for care coordination, which is important if the program is to endure when the grant ends. And there’s hope that when the behavioral health homes produce reductions in hospitalizations and ED visits, payers will pay attention and reimburse for discharge planning and care coordination – in that behavioral health setting.

BE Well shows success
Centerstone’s Building Exceptional Wellness program, or simply BE Well, monitors and helps patients improve their overall health and well-being. Laboratory studies, peer support, dietetics counseling and nicotine withdrawal assistance are provided as needed.

An electronic tool, called a Medical Flowsheet, was developed initially for BE Well with IT support. The tool, which assists in tracking of health indicators over time in the electronic health record, allows case managers to also do health indicators tracking in areas like sleep, weight and tobacco use.

Updates are communicated to the patient’s physician. “We are succeeding in getting doctors to work with us,” said Sheese, who is the BE Well project director. 

Activities are netting success, according to Sheese. A year after enrolling in the program, 78 percent of weight-loss patients had maintained their average reduction of 12 lbs. Within six months, patients had significant reductions in blood pressure, total cholesterol and markers of diabetes risk.

“We’re gathering significant outcomes data to show how physical health improvements have helped with mental health,” said Sheese.

But a split has existed in recent decades between behavioral health and physical health care delivery, noted Siegmann. But with the behavioral health home pilot project, things may be changing toward providing mental health care in coordination with physical health care.

“We will start to see a lot more integration for better treatment of patients with less severe mental health issues, such as depression and anxiety,” Siegmann said. “Models that integrate care to treat medical and mental health co-morbidities have proven effective in improving outcomes and decreasing costs.”

* See the three-part series on the patient-centered medical home in the Nov. 19, Dec. 3 and Dec. 17, 2012, issues.

Alerts offer opportunity to prevent readmissions
HealthLINC, Bloomington’s regional health information exchange (HIE), is playing a key role in the behavioral health-centered medical home pilot. The HIE is getting grant funds to do real-time care alerts to the behavioral health care management team, aimed at reducing rehospitalization rates and unnecessary use of the ED.

Centerstone provides the hospital and HealthLINC a patient panel, and the HIE enters the names into its system. When a patient on the panel enters the hospital or visits the emergency department, the behavioral health team is alerted.

“We can then get involved in coordinating care on discharge, along with other physical health care providers,” explained Centerstone’s Maren Sheese, L.C.S.W.

So often, mental health patients aren’t able to follow discharge orders for their physical condition and end up being readmitted, Sheese explained. “The alerts help us follow up promptly and help the patients manage their conditions.”

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