Transcript Integrated Care in the Real World

Integrated Care in the
Real World
presented at the
NIDA CTN Steering Committee Meeting
Washington, D.C., September 21, 2010, 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
To develop an integrated care model situated in
free-standing, primary care private practices in
Roseburg, Oregon
Barriers to Integrated Care in the
Primary Care Setting
Lack of time
Lack of skills
Beliefs and attitudes about SUD/MH
Lack of confidence in SUD/MH treatment
HIPAA/42CFR Part 2
Billing, records
Sustainability
Overcoming Barriers
Staffed by LCSW and establishment of FQHC LA
Full-time co-location in clinic
Adaptation to medical clinic schedule/routine
“Open” cases; brief sessions; available
Modified SBIrT model
Behavioral Medicine billing codes (96150-96155)
Use of EBPs
Results
Screened approximately 2,000 patients/year (20% of total patients per
year)
Providing treatment to about 15%; 50% of these are 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%*
“Frequent flyers” had significantly less (p<.01) medical utilization after BHC
sessions for both OPT and ER visits
Low utilizers had more visits after BHC contact (not significant)
Dr. John Gardin
(541) 672-2691
[email protected]