RI Primary Care Pilot Program Seeks to Remove Behavioral Health Stigma, Treat More Patients in Need

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PROVIDENCE, RI – For some Rhode Islanders living with depression, anxiety or substance-use disorder, getting behavioral health support may seem like the impossible. Knowing where to begin, or how to communicate a need for help, isn’t easy. That’s why the Care Transformation Collaborative of Rhode Island is working with primary care practices throughout the state to help eliminate patient barriers to behavioral health care by identifying and treating patients who may never have received help elsewhere.

The Care Transformation Collaborative of Rhode Island (CTC) has launched a new pilot program to support integrating behavioral health services into the primary care setting. The effort recognizes and builds off of the trusted relationship patients have with their primary care teams, and introduces behavioral health treatment into the primary care setting.

Participating practices have begun universal screenings for mental health and substance-use disorders for all patients in their practices. Those who are identified as having moderate depression, anxiety, substance-use disorder, or co-occurring chronic conditions are then connected to a behavioral health provider within their primary care practice. Patients receive treatment, and if they are in need of ongoing care, they are connected with the appropriate long-term treatment team.

The first pilot cohort, launched in January 2016, includes six primary care practices: Associates in Primary Care Medicine, East Bay Community Action Program (Newport and East Providence), Providence Community Health Center – Chafee, Tri-Town Community Action Agency, and the Women’s Medicine Collaborative. CTC will launch a second cohort in November 2016 with an additional seven practices: Affinity – Family Medicine at Women’s Care, Coastal Medical – Hillside Family Medicine, Family Care Center – Memorial Hospital of RI, Providence Community Health Center (Capitol Hill and Prairie Avenue), University Medicine – Governor Street, and Wood River Health Services.

“Patients living with unidentified behavioral health conditions experience safety risks, avoidable and costly emergency department visits and hospitalizations, and a negative impact on their quality of life,” said Debra Hurwitz, MBA, BSN, RN, Co-Director of CTC. “Through our efforts, we hope to increase access to screening and therefore identification of individuals who suffer from untreated behavioral health conditions. Patients will now be able to receive behavioral health services at their primary care office.”

At Associates in Primary Care Medicine in Warwick, before entering CTC’s pilot program, the mid-sized private practice recognized a need for some patients to receive behavioral health services. They welcomed a psychologist to their office for a half-day every couple of weeks to do intake referrals, and patients would then follow-up off-site. Now, through CTC’s pilot program, a psychologist is at Associates in Primary Care Medicine three half-days each week. As a member of the care team, the psychologist sees about eight patients each day, makes notes directly into patient electronic medical records, and even offers same-day visits.

“The integrated behavioral health program has greatly improved the care we are providing to our patients. Our patients are more comfortable with the mental health referral after meeting the specialist and being introduced by their primary care provider,” said Martin Kerzer, D.O. at Associates in Primary Care Medicine. “Being able to stay in their medical home has greatly improved access, and we are now able to address barriers in our patients’ physical health through the integrated behavioral program.”

Examples of a patients who may benefit from the integrated behavioral health program may be a patient with diabetes who is struggling to cope with motivation to change, or a patient with increased anxiety who would not typically follow through with a referral to a traditional therapist. Through CTC’s pilot program, integrated behavioral health providers can provide behavioral health care access, triage and brief interventions where the patient is comfortable.

“Traditionally, physical and behavioral health have been separate – from the office locations of treatment to payments for treatment. This system of silos has led to care barriers for both patients and providers,” said Nelly Burdette, PsyD, a CTC Integrated Behavioral Health Practice Facilitator and Director of Integrated Behavioral Health at Providence Community Health Centers. “Through this new program, we’re sending the message that behavioral and physical health are equal contributors to a patient’s overall health.”

At the Women’s Medicine Collaborative, a large primary care practice in Providence, patients are given universal behavioral health screening and are connected with Ph.D.-level behavioral health clinicians. The program also has an active residency program with The Warren Alpert Medical School of Brown University.

“I have worked with numerous patients in the primary care office who were experiencing depression triggered by work difficulties,” said Margaret Bublitz, Ph.D., a psychologist in Women’s Behavioral Medicine at the Women’s Medicine Collaborative. “Patients were either in very stressful jobs or struggling to find a job. Their depressive symptoms made it very difficult for them to make a change because they had difficulty concentrating, were excessively fatigued, and felt hopelessness. In primary care, patients received behavioral health interventions that enabled them to reduce stress, improve sleep, and decrease their depressive symptoms to an extent that they felt capable of finding new jobs.”

“What is really exciting about this initiative is our ability to work as a team to improve patients’ overall wellbeing in a primary care setting,” said Joanna MacLean, M.D., a psychiatrist in Women’s Behavioral Medicine at the Women’s Medicine Collaborative. “We’re offering patient-centered behavioral health treatment in collaboration with primary care to help patients achieve their individual goals. As a result, we’re able to provide both physical and mental health care in a setting that’s comfortable for patients and increases engagement and improves outcomes.”

CTC’s integrated behavioral health pilot program hopes to help patients overcome obstacles that have previously stood in the way of behavioral health services. Working with researchers at Brown University, data from the pilot program will be evaluated to understand potential cost savings, efficiency, and improved access to behavioral health services. Pilot results will help CTC determine if similar efforts should be expanded throughout the state.

Pilot practices participate in quarterly learning sessions and monthly on-site integrated behavioral health consultation services. In addition, CTC provides incentive payments to practices based on improved screening and patient outcomes.

Funding for this pilot program was provided by the Rhode Island Foundation’s Fund for a Healthy Rhode Island and Tufts Health Plan.

About the Care Transformation Collaborative of Rhode Island
The Care Transformation Collaborative of Rhode Island (CTC), formerly the Rhode Island Chronic Care Sustainability Initiative, is working with all major health care stakeholders to transform primary care in Rhode Island. Co-convened by the Office of the Health Insurance Commissioner and the Executive Office of Health and Human Services, CTC promotes the patient-centered medical home, a model of primary care that is patient-focused, coordinated, accessible and team-based. The model focuses on prevention, wellness and appropriate treatment, which will lead to improved care, lower costs and better health outcomes for Rhode Island. For more information, visit www.ctc-ri.org.

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