Transcript Integrated Care in the Real World

Integrated Care in the
Real World
presented at the
NIDA CTN CTP Caucus Meeting
Washington, D.C., March 15, 2011, by
John G. Gardin II, Ph.D.
Director of Behavioral Health & Research, ADAPT, Inc.
Administrator, SouthRiver Community Health Center
Clinical Assistant Professor, Oregon Health Sciences University Medical School
This project was funded by HRSA/DHHS Rural Health Outreach Grant #1D04RH06903-01.00
ADAPT, Inc.
Incorporated in 1971
Serving 3 counties
SUD: OPT, Res (adult/adolescent)
MH: OPT (adult/adolescent)
Gambling
Corrections/Drug Court
Prevention
Primary Care +
HRSA RHO Grant
May 2006-May 2009
To develop an integrated care model situated in
free-standing, primary care private practices in
Roseburg, Oregon
Results
Screened approximately 2,000 patients/year (20% of total patients per
year)
Providing treatment to about 15%; 50% of these were Medicaid
patients
30% of Medicaid patients provided 70% of utilization (“frequent
flyers”)
64% showed significant improvement (HADS)
Overall medical utilization by Medicaid patients decreased by 13%
For “frequent flyer” Medicaid patients, decreased medical utilization
by 33%
Overcoming Barriers
Full-time co-location of BHC in clinic
Modified SBIrT model
Staffed by LCSW
Establishment of RHC FQHC-LA FQHC?
Adaptation to medical clinic schedule/routine
“Open” cases; brief sessions; available; M&G
Behavioral Medicine billing codes (96150-96155)
Use of EBPs
What is Working
Medical Assistants
Overbooking - 50% no show rate
Increased appropriate use of psychotropics
15-20 minutes session/brief therapy
Use of Behavioral Medicine Codes
Continuing Challenges
Training issues with CMAs
Training issues with providers
Schedule challenges
Same-day appointments
Poor penetration of SUD involved patients
eMR and confidentiality
Dr. John Gardin
(541) 672-2691
[email protected]