2009 06 09 integrated care at medical home

IntegratedCareattheMedicalHome

September 25, 2009

Steve.Hurd@stmarygj.org

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