AUSTIN, Texas—(Monday, Aug. 15, 2011)—Cenpatico is committed to making integration of physical and behavioral health a priority. Over the past two years, Cenpatico has worked with its behavioral health providers in Arizona to create facilities that offer behavioral and physical health services at a single location. Integrated health care is important for everyone but creating the most appropriate avenues of access for persons with serious mental illness is a key focus area for Cenpatico. Individuals with serious mental illness die on average 25 years earlier than the general population.[1] Eighty-seven percent of years of life lost to premature death by the mentally ill are due to chronic disease, especially infectious, pulmonary, and cardiovascular diseases, and diabetes.[2] Yet this population is less likely to seek adequate primary medical care and typically will have less than one PCP visit per year. They are more likely to seek psychiatric services through mental health service agencies. Given the alarming mortality data, Cenpatico embarked on a campaign to develop new methods of integration to meet these individuals where they are by creating a behavioral-health-primary-health home model of service. Cenpatico focused these efforts in Arizona, and is working to incorporate this as a best practice for all markets.
Cenpatico hosted events and educational sessions for provider agencies in Arizona to discuss the importance of integrated care, the various approaches to integration, and education on the changes in healthcare system due to the Accountable Care Act. Cenpatico asked Intake and Coordination of Care providers to develop formal work plans for integrating care. Cenpatico provided resources, including, research studies and models of integration. As the work plans were developed, four models of integrated care were selected. The four models include placing physical health providers in behavioral health facilities, placing behavioral health providers in physical health facilities, behavioral health providers employing physical health staff and locating them in their behavioral health facilities, and behavioral health providers employing physical health providers located in adjacent facilities. Four agencies that have made great strides in implementing integrated care:
Pinal Hispanic Council (PHC) in collaboration with Sun Life Family Health Center (Sun Life), a federally qualified health center (FQHC), have created a reverse co-location health integration model in which Sun Life will imbed a medical physician within PHC with special focus on individuals with Serious Mental Illness. PHC and Sun Life have partnered together for twenty one years and, together, feel that medical integration is a natural next step to ensuring both entities are prepared for the future.
Arizona Counseling & Treatment Services, L.L.C. (ACTS) believes that addressing both the physical and behavioral health needs of people allow for a more comprehensive and collaborative treatment experience. ACTS has formed co-location partnerships with regional Federally Qualified Healthcare Clinics in Southern Arizona; these include the Sunset Community Health Center and Canyonlands Community Health Clinic. David Waples, CEO of ACTS, is committed to bringing the vision of integration to Southern Arizona. The organization is working to establish the framework of a Biodyne-Consultative type model. A co-located ACTS Behavioral Health Representative in these facilities will afford ACTS the opportunity to serve the ‘whole person’. ACTS and their partners are dedicated to improving the overall health, wellness, and quality of life of the individuals they serve.
Southeastern Arizona Behavioral Health Services (SEABHS) has developed medical integration plans to improve the overall health and care of the people served. Recognizing that data indicates that persons with serious mental illnesses had higher incidences of chronic illnesses and shorter life spans, SEABHS developed its plan to integrate primary health with behavioral health services by making medical services available in the same location as the behavioral health clinic.
In the SEABHS- Safford, AZ outpatient clinic, the staff made modifications to the physical space for medical services, developed policies and billing procedures for medical services and obtained medical license. Provision of services in this model would assure an integrated electronic record, services available under one roof.
In the SEABHS-Sierra Vista outpatient office, the organization pursued integration in collaboration with the Chiricahua Community Health Center (CCHC), an FQHC serving Cochise County, Arizona. They developed a memorandum of understanding between the agencies permitting utilization of the CCHC mobile van at the SEABHS office to provide medical services to behavioral health participants. In addition, wellness activities such as blood pressure checks, diabetes screenings and other health education activities are provided during the visit in the outpatient clinic. Behavioral health staff accompany patients to their medical appointments and ensure communication between providers.
The Mountain Health & Wellness (MHW) commitment to providing integrated primary care, behavioral healthcare and wellness services was borne out of the experience of CEO Rob Evans and his Executive Team’s knowledge of the field. Several years ago, Evans established a program in a major hospital’s level one trauma unit to intervene in the substance abuse issues of those admitted to the hospital. The issues became clear concerning the medical and financial consequences of untreated behavioral health and substance abuse disorders as a major cost generator to the healthcare system. More importantly, patients were not doing well in terms of quality of life when treated only for their physical injuries.
MHS considered three questions prior to making the decision to move forward with integration: Is it the right thing to do for the people that we serve? Is it sustainable? How do you make it happen? Having answered yes to the first two questions, the idea of building an Integrated Healthcare Organization was presented to the MHW Board of Directors in January of 2008. The Board approved this ambitious strategic initiative and the staff began the process of answering question number three: How do you make it happen?
MHW leadership studied the literature on integration, consulted with other healthcare providers and formed a plan to move forward. The plan called for the construction a new 35,000 sq. ft. building that included primary and behavioral health care clinics as well as a pharmacy and space to provide Yoga, Tai Chi and other means for engaging patients in wellness activities. After completing the building, the challenges around staffing primary care providers, process mapping for integrating care, developing an integrated Electronic Health Record (EHR) and entering into contracts with commercial funding sources began.
On June 1, 2011 MHW saw its first primary care patients in the new building. In addition, MHW now provides integrated care on a second campus for its patients designated as being persistently and chronically mentally ill.
“There is incredible enthusiasm throughout MHW and throughout the community concerning our opportunity to improve care for folks through integrated service delivery”, said CEO Rob Evans. “We have received incredible support and encouragement from our funding sources, including Cenpatico, as well as from many commercial insurance carriers. We are out of the blocks with the wind in our sails and having more fun doing this work than any of us imagined. As we discovered when we answered our original question number one, this is simply the right thing to do for people.”
A patient at MHW commented, “My previous primary care doctor has no understanding of my psych problems, so that makes it difficult for me to get good care. Since doctors coordinate care with my psych providers, I definitely want to make an appointment!”
An woman who had recently lost her husband came in to MHS for a well woman visit. She commented that she loves her doctor, and that it made her feel important when he listened and had a behaviorist speak with her. She felt that the behaviorist was phenomenal and made her understand a great deal about the grieving process, and that she had no idea she would “not only be listened to, but heard as well.”
Another patient commented, “The best thing about this is that I can get my psych meds and my health needs taken care of under one roof by people who talk to each other.”
Cenpatico continues to monitor the development of these integrated care models in Arizona. They also offer technical assistance and support including guidance on licensure issues, sharing of medical records, billing for services and more. Cenpatico plans to extend their care integration models to the other markets where they do business and encourage providers to create integrated models of care where members receive physical and behavioral health services in a single location.
About Cenpatico-
Cenpatico is a multi-state managed health care company based in Austin, Texas. It is a subsidiary of Centene Corporation, a Fortune 500 Company. Since 1994, Cenpatico has been dedicated to serving in the public sector only and has approximately 1.7 million members across the country. The company’s public sector healthcare specialties include behavioral health, school-based services, specialty therapy and rehabilitation, community reentry and more utilizing a local approach to service coordination and delivery. We are committed to innovative solutions and designing programs tailored to improving functional outcomes with our members. Find us online: www.cenpatico.com
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[1] National Association of State Mental Health Program Directors, “Measurement of Health Status for People with Serious Mental Illnesses” (2008), available at http://www.nasmhpd.org/general_files/publications/med_directors_pubs/NASMHPD%20Medical%20Directors%20Health%20Indicators%20Report%2011-19-08.pdf.
[2] Center for American Progress, “Mental Health Care Services in Primary Care, Tackling the Issues in the Context of Health Care Reform” (2010) available at www/americanprogress.org.
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