Initiative aims to boost integrated care

New grant program targets providers that integrate primary and mental health care

0 | Foundations, Health Care Delivery, Mental Health, Safety Net

Heartland Community Health Center, a Lawrence safety-net clinic, has begun integrating mental and physical health services for its patients. Pictured here are nurse Natasha Otto, seated, and Ruby Ellis, the clinic's chief operating officer.

Heartland Community Health Center, a Lawrence safety-net clinic, has begun integrating mental and physical health services for its patients. Pictured here are nurse Natasha Otto, seated, and Ruby Ellis, the clinic's chief operating officer.

— Amid national concerns that the seriously mentally ill are dying from preventable diseases, a leading Kansas healthcare philanthropy is about to make a down payment on a multi-year initiative aimed at integrating physical and mental health services for safety-net patients.

Within the next couple weeks, the Sunflower Foundation expects to open a competitive grant program that Chief Executive Billie Hall said likely would provide more than $1 million in funds to selected health providers focusing on integrated patient care. Foundation officials expect to award the grants by March.

“When we made the decision to get into this particular area,” Hall said, “we knew it would be a long horizon. We know we are in for five, maybe 10 years, depending on how things go in our state.”

The foundation’s board chose the initiative as a major priority about 18 months ago.

To date, Hall said, the foundation has spent about $50,000 sending some providers from different Kansas clinics to visit Cherokee Health Systems in Tennessee, which has 43 clinical sites in that state and a history of melding medical and mental health services.

Integration can mean having mental health and primary medical care agencies housed in the same building, said Melody Martin, a program officer with the foundation. But that is not the only way to do it, she said.

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Karin Denes-Collar, left, is a behavioral health specialist employed by Bert Nash Community Health Center in Lawrence, but she offices at Heartland Community Health Center as part of the safety-net clinic's efforts to integrate mental and physical health services for the clinic's patients. Denes-Collar is shown here consulting with Dr. Raul Morffi, the clinic's medical director. She said consulting with the clinic's medical staff about patient care is now part of the daily routine.

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For instance, community health centers in Lawrence and Newton now have social workers or behavioral health specialists who work alongside the clinics’ medical teams.

At Heartland Community Health Center in Lawrence, behavioral health specialist Karin Denes-Collar technically is employed by Bert Nash Community Mental Health Center, which is located several blocks to the west of the clinic. But her office is at Heartland, where she consults daily with the medical staff about the conditions of various patients.

For example, she said, a patient with diabetes might also suffer depression in ways that could hinder the treatments for the underlying medical conditions. A homeless man with a chronic physical malady likely also struggles with a range of other problems that compound the illness. Assistance with those problems might best come from a social worker.

Reconnecting kinds of care

Area providers and national experts alike say that better coordination of care is essential to proper treatment for the mentally ill.

In an April 2009 paper, the National Council for Community Behavioral Healthcare said that persons with serious mental illness were dying 25 years earlier than the rest of the population largely because treatable conditions — such as diabetes and cardiovascular disease — had gone unmanaged.

“The bottom line is that the mind and body are connected,” said Tim DeWeese, director of clinical services at the Johnson County Mental Health Center in Mission. “And so the more physically healthy you are, the more mentally healthy you are going to be and vice versa. I think it’s really just reconnecting the two things. I don’t know where we got off base.”

The Sunflower Foundation is building upon a pilot project started two years ago by a subsidiary of the Association of Community Mental Health Centers of Kansas in collaboration with the Kansas Association for the Medically Underserved (KAMU)

Providers from nearly a dozen communities, including Heartland in Lawrence, were part of the pilot, said Connie Hubbell, director of governmental affairs at KAMU. The participants collected data for about a year starting in early 2011.

Undertaken with little funding, Hubbell said the pilot yielded results that were encouraging nonetheless. For instance, data compiled on 81 patients indicated an 8 percent reduction in monthly expenses per patient.

“So we know it’s out there,” she said. “We know it can happen. The integrated model is cost effective, it does save money, and it’s much more appropriate for the patient.”

Integration in action

One of the biggest challenges, Hubbell said, is successfully melding the consultative atmosphere of mental health with the often-frenetic pace that goes with providing primary care in a safety-net clinic.

Jon Stewart, chief executive of Heartland said his staff was so busy that “you put track shoes on them. You’ve got them moving all day long.”

But he also said that the integrated approach to dealing with patient needs, “at the end of the day is a pretty simple concept: We try to do what’s best for the patient.”

Karla Roth is a licensed specialist clinical social worker that serves as the behavioral health consultant at the Health Ministries Clinic in Newton. There, she is part of a three-person team that works through a contract Health Ministries has with Prairie View Community Mental Health Center, also in Newton.

In and out of exam rooms throughout the day, Roth said she has screened patients who have had no previous psychiatric treatment. She said with the integrated approach she has seen these patients feel better, get jobs, and become better parents.

Roth, Stewart and others went to Cherokee Health Systems in Tennessee on a Sunflower Foundation trip in August.

From that visit, Stewart said, he realized that Heartland needed to relocate the behavioral health specialist closer to the medical exam rooms. He said he also would like to maximize the use of a psychiatrist, as Cherokee Health Systems does, by making them available to several doctors through phone consultations.

In the Kansas City area, integration efforts are proceeding outside the pilot and the initial Sunflower funding.

At the Johnson County Mental Health Center, DeWeese said officials were hoping to forge a partnership with the Department of Family Medicine at the University of Kansas Medical Center. The mental health center is also forming interdisciplinary teams centered on psychiatric diagnoses.

Meanwhile, a coalition of mental health providers is surveying safety-net providers as a first step toward fostering more integration among mental health and primary care providers. Coalition members are sifting through responses to the survey, said Scott Lakin, director of the Regional Health Care Initiative.

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Amy Campbell of the Mental Health Coalition of Kansas

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Care integration in KanCare

Some mental health advocates said the state’s move toward full-scale managed care for its Medicaid population — dubbed KanCare by the administration of Gov. Sam Brownback — might boost the cooperation already taking place or developing between medical and mental health service providers. The launch for KanCare is scheduled for Jan. 1, pending federal approvals and related developments.

Amy Campbell, lobbyist for the Kansas Mental Health Coalition, said she was encouraged by some of the group’s early discussions with the administration. But, she said, actual implementation of KanCare would be the test of its effectiveness.

“Are we going to incentivize true health homes and true wrap-around care that ensures a variety of services for an individual’s particular needs, including their physical health needs,” she said.

Or…“the fear, of course, when you hear ‘managed care’,” she said, “is that this will be more of the same: restrict services, make it one-size-fits-all, this is what you get. If it doesn’t work for you, gee, we are sorry.”



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