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NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation Behavioral Health Integrated Care Model Organization Overview • Marshfield Clinic Health System is a not-for-profit healthcare system with over 50 care locations, an expansive medical group practice, an ambulatory footprint, and a health plan • The health system covers the entire spectrum of care from wellness to end of life care, with an emphasis on efficient and effective patient-centered care in both public and commercial markets Background Marshfield Clinic experienced difficulty in recruiting clinical psychiatrists, despite overwhelming demand for these services. In order to serve the unmet needs of patients and increase access to care, Marshfield Clinic developed the Behavioral Health Integrated Care Model. This care delivery model also improves the value of care delivered by encouraging appropriate patients to be managed by a PCP and Integrated Care Coordinator, rather than utilizing unnecessary high-cost services. The program is offered to adults, age 18 and older, with a psychiatric diagnosis or question of depression, anxiety, ADD/ADHD, OCD, PTSD, and other disorders. The program was piloted beginning in October 2013 and went into full deployment to all Marshfield Clinic East District primary care in October 2015. During the most recent 10 months, the program has screened over 1400 patients. Of these, 819 are enrolled and being managed through the Integrated Care Model. Program Details • For patients who are enrolled in the program, care is delivered through a collaborative team that oversees the patient’s care: –– Primary Care Provider (PCP) –– Integrated Care Coordinator (ICC) –– Consulting Psychiatrist • The Integrated Care Coordinator (ICC), who is usually an RN, serves as the primary manager of the patient’s care: –– Meets with the patient to complete an evaluation of medical history and symptoms –– Assesses and monitors symptoms through tracking tools –– Acts as a point of contact for all referrals for Behavioral Health Integrated Care & Psychiatry • When primary care physicians (PCPs) need assistance in managing patients’ mental health diagnoses, the patient is enrolled in the Integrated Care Model program An Initiative of the 73 | Behavioral Health Integrated Care Model
NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation –– Reviews patient case with the consulting psychiatrist to obtain recommendations –– Communicates psychiatrist recommendations to the PCP –– Follows up with the patient on the PCP’s care plan, by: -- Implementing stepped treatment, using evidence-based guidelines and weekly case reviews -- Monitoring patient progress -- Making referrals to therapy or psychiatry when necessary This coordinated care team enables a stepped approach to treatment, ensuring that the most effective care is delivered to patients when it is clinically required, based on the patients’ responses to previous treatment approaches. The maximum length of the program is 12 months, and patients are dis-enrolled if they: • Transfer care • Refuse care/services • Remit and have three consecutive months in remission While the outcomes have not yet been validated, Marshfield Clinic expects to see: • A reduction in patient claims for mental health treatment • A reduction in ER visits • A decrease in visits to the primary care The health system is also hoping to work with one of its payers to determine overall change in cost of care to patient after 18 months in the program. Path Forward In the short term, Marshfield Clinic is in the process of expanding the program to one site in the West District: Marshfield Clinic Ladysmith Center. The health system is also collecting outcomes data to determine the value of the program in improving outcomes and reducing costs over an 18 month period. In the long term, Marshfield Clinic aims to demonstrate the value of this program to insurers using outcomes data, with the ultimate goal to achieve reimbursement for this model as a billable service. Reimbursement from insurers would enable expansion of the Integrated Care Model at the health system. • Are released, by physician discretion Value Delivered Marshfield Clinic is currently collecting outcomes data to demonstrate changes in depression and anxiety symptoms for patients enrolled in the Integrated Care Model. Behavioral Health Integrated Care Model | 74
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