2009 06 09 integrated care at medical home
DESCRIPTION
“The right care, at the right place, at the right time.” This is a presentation of the Marillac Clinic (located in Grand Junction, Colorado) model of Integrated Medical Care. This clinic serves the uninsured and under-insured. It is an affordable health care model of a Medical Home. Marillac provide primary care.TRANSCRIPT
IntegratedCareattheMedicalHome
September 25, 2009
970.244.2235
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MarillacClinicGrandJunction,CO
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BriefHistoryofMarillac
• Started in 1987 after United Way needs assessment
• Sponsored by Sisters of Charity Leavenworth
• Shared mission and values with affiliate hospital (St. Mary’s)
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The Medical Home Motto:
“The right care, at the right place, at the right time.”
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Guiding Philosophy:
Meeting several patient needs in one visit results in greater
efficiency for both patient and provider.
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Five Lines of Service - All Under One Roof
• Medical• Mental Health• Dental• Optical• Low Cost Pharmaceuticals
Marillac’sModel
No Wrong Door
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• At or below 250% of federal poverty level
• Mesa County residents
• 20,000 Uninsured in Mesa Co
ClinicEligibility
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PatientPanel-2008
• 7650 Unduplicated Patients
• 29,300 Visits
• 20,000 Uninsured in Mesa Co
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StaffingPattern
• Size: 72 FTE
• 150 Referral Specialists- Sliding Scale
• Lab & Radiology – Sliding Scale
• Annual Budget = $7.5 million
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MarillacRevenueSourcesFY08-09
20%
16%
12%13%
18%
21%
Patient FeesSt. Mary's HospitalSCLHS SponsorshipLocal PhilanthropyTobacco TaxFoundations
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Operations
• LEAN Principles- Use of Impact Grids- Reduce Variability / Eliminate Waste
• Process Improvement- Horizontal teams meet weekly- Reduce variability/Eliminate waste
• Incorporate Patient Feedback
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IntegratedCare-Defined
Medical and Behavioral Health providers work side-by-side to improve clinical and functional outcomes for patients with chronic medical and psychiatric conditions. Psychiatry consultation available.
Major Depression
Anxiety
Panic Disorder
Alcohol
Binge Eating
Any Diagnosis
0% 15% 30% 45% 60%
Prevalence Comparisons
Marillac Clinic vs. PHQ 3000
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Location,Location,Location
Bathroom
Front OfficeReception
MedicalExam
Rooms
MedicalExam
Rooms
MedicalExam
RoomsMedical
AssistantStations
MedicalExam
Rooms
MedicalExam
Rooms
MedicalExam
Rooms
MedicalProviderStations
MedicalExam
Rooms
MedicalExam
Rooms
CaseManager
AddictionsCounselor
Family Therapist& Psychiatrist
Psychologist
Front OfficeReception
MedicalExamRoom
MedicalExamRoom
MedicalExamRoom
MedicalAssistantStations
MedicalExamRoom
MedicalExamRoom
MedicalExamRoom
MedicalProviderStations
MedicalExamRoom
MedicalExamRoom
CareManager
B HealthSpecialist
B HealthSpecialist
B HealthSpecialist
Bathroom
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Outcomes
0%
7.5%
15.0%
22.5%
30.0%
Year 1 Year 2 Year 3 Year 4 Year 4.5
9.00%6.00%
8.00% 8.00%4.00%
Hospitalization E.R. Visit
Utilization of ER and Inpatient Services by Marillac’s Integrated Care Patients
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InpatientPsychiatricCostsJan–Apr2003vs.Jan–Apr2004
75000
156250
237500
318750
400000
2003 2004
112853
341366
Annualized savings:$685, 539
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FiscalSustainabilityvia BlendedFunding
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• Shared savings from St. Mary’s Hospital and Colorado West Mental Health
• United Way
• Foundations
• Patient Fees
FiscalSustainabilityvia BlendedFunding
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AdvantagesofBlendedFunding
• Removes barriers to care
• Patients need to present at only one location
• Encourages development of one treatment plan
• Billing through CPT coding is eliminated
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ServiceDelivery
• Delivery model is spontaneous – introductions, hallway consults
• Both medical and mental health providers expect to be interrupted to assist one another
• All providers work from the same medical record
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AdvantagesofIntegratingMedical&MentalHealth
forPatients
• More convenience• Less stigma, more patient follow-through• Team approach leads to more accurate
diagnoses, higher quality, and more holistic care
• Encourages self-management of illness• Greater satisfaction
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AdvantagesofIntegratingMedical&MentalHealth
forProviders• Better match between provider skills and
patient needs
• Allows development of common treatment plan and consistency between providers
• Enhances knowledge and skills for providers
• Better exchange of information between disciplines
• Shared responsibility for patient care
• Reduces professional isolation
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AdvantagesofIntegratingMedical&MentalHealth
HealthcareSystem
• Simplified record-keeping
• More opportunities for mid-level and mental health providers to leverage physician resources
• Less likely to have duplicative or dangerous medication complications
• Greater emphasis on prevention and early intervention
MarillacClinic
Bridging the healthcare gap