Special Features

Rocky Mountain High-Performance Integrated Care

In the Rocky Mountain states of Utah, Idaho and Nevada, there has emerged a sterling example of how a forward-looking, nonprofit, large healthcare system can provide high-quality integrated medical and behavioral health services. Intermountain Health (IH) has transformed its primary care from a traditional PC approach into an integrated, team-based model. IH’s integrated team-based approach provides identification, treatment and management of both chronic physical and mental health concerns, resulting in improved quality of care, patient satisfaction, and cost outcomes.

Intermountain Healthcare (IH) is a fully integrated health care delivery system that for the past 20 years has produced high-performing patient outcomes (e.g. health-related quality of life; functionality; access to care; patient satisfaction; clinical symptoms) and at lower cost. IH delivers integrated med/psych care to its patients through a data-driven culture of clinical and operational team care.

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Brenda Reiss-Brennan Ph.D., APRN.

Major Milestone – Administration Includes Integrated Med/Psych Care on its Agenda

After 10 years of dedicated advocacy at the federal level, working with numerous collaborators, NHMH is pleased to report that the issue of integrated mental health-medical care is included in the Administration’s March 1, 2022 White House Mental Health Strategy (link below). Go to p. 4, Connect Americans to Care section, bullet #2. This is a meaningful, substantive development, not rhetoric or politics. While the funding the WH proposes will still have to be passed into law by Congress, and we believe that is likely, in any event the federal health agency (HHS)’s testing of new payment models to reimburse medical doctors for providing mental health care in their practices, can now go ahead. Another major milestone in NHMH’s mission-journey to make effective mental health care available to all Americans in their primary care clinics.


Harvard Helps Local Boston Area Primary Care Practices Integrate Behavioral Health Services

Harvard Medical School may be a large academic medical center but its Center for Primary Care (CPC) has long recognized the need to deploy its expertise to help improve the quality of healthcare delivered in local primary care practices. Which is important since primary care is the place where all Americans go for healthcare and as such is the backbone of our national health system.

The CPC has successfully completed two practice change programs in the Boston and surrounding area. Both are consistent with the federal government’s current efforts under CMS/CMMI (Medicare) to reward primary care doctors who improve the quality of their care delivered, as well as patient satisfaction, while also cutting care costs. (See Comprehensive Primary Care Plus and Primary Care First models https://innovation.cms.gov/initiatives/primary-care-first-model-options/).

The first CPC initiative was a 2012-2014 Academic Innovation Collaborative (AIC) that helped teach diverse local internal medicine and family medicine practices how to provide high-quality and cost-conscious care. The second was the 2013-2016 Alice Rosenwald Mental Health Integration Initiative to improve patient care by integrating behavioral health (mental health + addiction) treatment services into the participating local teaching practices.

The Challenges: As part of a nationally-ranked academic medical center, the CPC understands the substantial, unprecedented challenges facing present and future primary care physicians (PCPs). HMS students are stepping into a healthcare landscape marked by transformative change, new innovations, new roles and relationships, new procedures, and new expectations, most, if not all of which, are long overdue.

Today’s young physicians must be prepared to be not just stewards but agents of change of our healthcare delivery system. Moreover, they will need to sustain that role throughout their medical careers, boldly and innovatively shaping and defining new car delivery approaches founded on strong scientific evidence base. While simultaneously keeping their primary focus on the needs of their patients. Among the changes young primary care doctors face are:

System change: The U.S. healthcare system is moving from a care delivery and payment fee-for-service model to a value-based model commencing to increase investment in primary care where scale-able value can be demonstrated.

New Provider Accountability: PCPs are being asked to accept (and get paid for) accountability
for the quality of care and cost of care of their defined patient populations.

New Roles and Relationships: Care delivery is moving to multi-disciplinary team-based care with new relationships between PCPs and other providers, including behavioral health professionals such as psychiatrists, psychologists, with formalized collaborative protocols creating common understandings and processes, improving information-sharing and patient referral tracking, care planning, and care coordination.

New Clinical Tasks: Care management outreach led by care managers consulting closely with
PCPs and the care team, will become a core part of team’s work, educating, counseling and
helping patients overcome the social barriers that impede healthy behaviors.

New Technology Support Tools: New tools like smartphones, sophisticated EHRs, patient
registries, AI, tele-health platforms, health sensors, large-scale data analytics, and need to
ensure clinicians have affordable high-functioning electronic and data systems.

New Science: Individual patient genetic information to guide care plus new
bio-medical-engineering devices.

AIC: The CPC’s Academic Innovation Collaborative under the direction of Dr. Russell Phillips, CPC Director, involved 19 practices across 6 academic medical centers affiliated with HMS and nearly 260,000 patients and 450 residents. Hospital-based and community-based primary care teaching practices were coached and trained on building high-functioning care teams, managing populations of patients, and engaging patients in care and healthy behaviors. Areas of focused attention found to be key were leadership development, ensuring sufficient practice-level resources, and meaningful engagement with patients.

HMS continues to teach its medical students to lead change through Student Leadership Committees where students learn how to function as a true multi-disciplinary care team which wraps around a patient in a coordinated, collaborative way. At HMS, the stress is on students learning to take advantage of a whole team assisting them and letting go when a health problem may indicate the PCP does not lead, rather a nurse, social worker, care manager, etc.

MHII: The CPC’s Mental Health Integration Initiative aimed to improve patient care by integration of behavioral health services into primary care practices in Boston area. The CPC supported Harvard- affiliated practices as they began to implement team-based, measurement-based care for depression and anxiety highly prevalent in patients with chronic medical conditions such as diabetes and cardiovascular disease. They concentrated on depression screening and care management protocols to ensure that all patients who could benefit from mental health services, received them. The program developed a technology platform for clinicians allowing PCPs and their care team to tele-conference with other providers and specialists and patients.

Health policy-makers have long known that clinical practice change must develop organically from sites themselves. In Harvard’s MHII program, the seven local participating practices to advance along a behavioral integration pathway that is evidence-based and sustainable.

In a noteworthy echo from the past, Alice Rosenwald, the granddaughter of Sears Roebuck co-founder and CEO Julius Rosenwald, who transformed public education for black Americans in the deep south through his philanthropy, continued that family tradition funding the CPC’s MHII program. Ms. Rosenwald enabled the MHII to integrate behavioral health care (mental health + substance use) into HMS-affiliated community primary care clinics in the Boston area. Philanthropy, like medicine, adjusting to meet the needs of the times.

San Francisco's Fragmented Mental Health Services Are Literally Killing Its CitizensSan Francisco’s fragmented city services are harming – and killing – the most vulnerable,S.F. Chronicle, Michael Cabanatuan Sep. 27, 2022 “A small number of San Franciscans — almost all of them unhoused — are responsible for overly heavy use of both the city’s medical and legal systems — but the systems’ fragmented approach is failing, according to a new study. The study, from the nonpartisan California Policy Lab and the Benioff Homelessness and Housing Initiative at UCSF, shows that a small group of people are repeatedly cycling in and out of both the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems.The systems provide fragmented care that fails those who use it, the study’s authors said, and one finding backs that up: Nearly one in four of the people with heavy use of both systems in 2011 were dead by 2020, “reflecting how vulnerable these individuals are and how high the stakes are for improving the systems that support them,” said co-author Dr. Hemal Kanzaria, medical director at Zuckerberg San Francisco General Hospital and an associate professor of emergency medicine at UCSF.The study underscores what health care workers and public hospital officials told city leaders in July — that far too many people struggling with severe mental illness and addiction cycle through San Francisco’s overburdened emergency rooms, failing to get long-term help, and at a high cost to the city. For instance, just five people in the past five years accounted for 1,781 ambulance transports, possibly up to 2,000, at a cost of $4 million.The study’s authors called for a more coordinated approach, such as connecting people released from the emergency room or jail with housing and continued care. “Our research highlights the need for coordinated, evidence-based interventions to address these individuals’ complex needs, promote stable housing, and prevent poor health outcomes including untimely death,” said co-author Dr. Maria Raven, chief of emergency medicine at UCSF Medical Center and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs.The study looked at 10 years of data from 270,000 people who used the city’s acute medical care or legal systems between 2011 and 2020. It narrowed its focus to two groups of people who had interactions with both systems in the same year, one from 2011 and one from 2020, to investigate trends among frequent users of city services.The study is unusual, researchers say, because it links data from multiple agencies to see how people are using critical city services including mental and physical health care and housing over a several-year period.Among the study’s findings, according to the Policy Lab:• About 24% of the 2011 group continued their high use of both systems the following years but their use declined each of the following years. • Between 80% and 90% of the people in the 2011 and 2020 groups had substance use problems and many also had chronic mental and and physical health issues. • More than 90% of the individuals in both groups had been booked into jail for a felony and a misdemeanor. • The research team determined that many of the people in the 2020 group were in San Francisco in 2011 and had contact with both health and criminal legal systems in the prior 10 years. For example, 30% of the 2020 cohort was booked into jail in 2011.” Michael Cabanatuan is a San Francisco Chronicle staff writer, email: mcabanatuan@sfchronicle.com ... See MoreSee Less
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NHMH Salutes the Passing of American Scientist Dr. Paul Greengard, a Pioneer in Brain Research and Mental Health Treament. We owe Dr. Greengard a great debt for his incredible, break-through work, and his amazing life of service.


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