A Changing Behavior in the Primary Care World

Posted 27 Julio 2009 by aborgmeyer & filed under Blog, Provider News.

Two Valparaiso-area community health centers are asking an important question: If your body comes
fully assembled, why shouldn’t your healthcare? That thought is fueling HealthLinc Community Health Center’s seamless partnership with Porter-Starke Services, a community mental health center, to integrate behavioral and physical health services in the primary care environment—a trend receiving growing support in the medical community.

“So much primary care is behavioral, and many of the presentations are rooted in the stresses of people’s lives,” said Dr. Dennis Freeman, CEO of Cherokee Health Services, which serves patients in Knoxville and other parts of eastern Tennessee. “And a lot of intervention needs to be behavioral as well.”

Cherokee has been a pioneer in this area, thanks to Freeman’s decades-long belief in the benefits
of integrated care. By the mid-1980s, Cherokee had hired its first behavioral health consultant. “We’ve been at it a long time and it’s really catching on across the country,” Freeman said.
Cherokee has hosted many healthcare organizations who want to learn more, including Beth Wrobel,
HealthLinc’s CEO. About two years ago, Wrobel became aware of the integration concept and began working more closely with Porter-Starke’s behavioral health experts. The result? The right expert sees the patient sooner and helps take care of the problem earlier.

“It has freed up our physicians and nurse practitioners to better take care of the medical needs because so many of the needs are tied to mental or behavioral health issues,” Wrobel said. In Cherokee’s model, a behaviorist, usually a psychologist, is embedded within the primary care
team. That removes some of the fear patients might have of seeing a mental health professional and
adds to the number of people who actually get the behavioral health consulting they need.

“There is so much stigma attached to behavioral care that when patients are referred, less than 20 percent even make it to an appointment,” Freeman said. “We just bring it into the primary care environment and it’s a model that patients now prefer.” In fact, more than 90 percent of
Cherokee’s patients say that’s how they would prefer to receive care, according to Freeman.

“It helps us do a better job of taking care of common problems,” said Dr. Tim Ames, Medical Director
at HealthLinc—problems like patients who have high blood pressure or diabetes and who smoke.
“If they’d like to quit but don’t know how to or are under too much stress, that’s when it’s convenient to page our behavioral health consultant, introduce him as an expert at stopping smoking and have him start the conversation,” Ames said. “At the very least, I think it shows patients that we take this seriously, and we’re not just going to issue useless advice like, ‘Please stop smoking.’ We give specific guidance on how to do that.” The bottom line, Wrobel said, is that the managed care approach can achieve better coordination of care and hold down costs. “Models like this make a whole lot of sense,” she said. “It’s another set of hands that helps the whole body.”

The Lake Ridge school system in Gary has begun an initiative to offer school-based health clinics that
integrate physical and behavioral health in the primary care environment—a first for the area. They have teamed up with Gary Community Health Center and Southlake Community Mental Health Center to offer a coordinated approach to healthcare for Lake Ridge students. “We’ve been in discussions for
over two years concerning this initiative,” said Dr. Sharon Shirley, Lake Ridge Schools superintendent.
“We are creating a health facility that would help us keep kids well physically and mentally. A lot
of our families do not have health insurance. In this program, all children are served— whether they
are insured or not.”

The program will roll out in phases. The first phase will deal with Lake Ridge Schools students
and staff. If successful, they will open access up to the community, according to Shirley. Initially, the clinics will focus on health checks for athletes and physicals for kindergarteners. “This school system serves a high population of lower-income people on Medicaid, people who are otherwise
going without healthcare,” said Dan Smith, director of Child and Adolescent Services at Southlake
Community Mental Health Center in Merrillville. “Lake Ridge has noticed a huge absenteeism
rate and poor academic performance. A lot of kids are missing school because they are not being
provided basic healthcare.” He added that it’s important to integrate behavioral and physical
healthcare because physical problems often present because of an underlying mental issue, or vice versa.

“With the way the economy has been, there is a big need for healthcare, especially for uninsured people,” Smith said. “As far as an integrated care model, this is a first.” Janet Seabrook, M.D., executive director of the Gary Community Health Center, agrees. “There’s a lot of anxiety and
depression going on right now with the stresses going on at home, the loss of jobs, not being able to
participate in as many after-school activities,” she said. “That trickles down to the children through
absenteeism, dropping out, receiving poor grades, needing to get an after-school job. There are things we can do to assist the school and the community. If we’re treating the children, we’re treating the community.”

“We’re just so happy for a community like ours, an urban school, to be able to service our children,”
Dr. Shirley added. “I think it’s an ideal situation, especially in our schools where we don’t have fulltime nurses. Keeping children well will help improve attendance and help more kids stay in school.”

Download a PDF version of this article as it appeared in our 2009 Integration Issue Provider Report