Abstract
Chiricahua Community Health Centers Inc. (CCHCI) is a Federally Qualified Health Center (FQHC; tax exempt not-for-profit 501(c)3 organization) founded in 1996. CCHCI has grown into the largest primary care organization serving southeastern Arizona. Nearly 20% of the patients served do not have healthcare insurance, 41% are receiving Medicaid and a small population has private insurance. Cochise County spans more than 6200 square miles and is situated along 100 miles of the US-Mexico border. Cochise County is considered a Health Professional Shortage area for medical, dental and behavioral health services. It is these statistics that encouraged our CEO to pursue using SAMHSA guidelines for integrated care. I am hoping this discussion will benefit those eager to begin with integration by sharing some lessons learned.
Our CEO has led the charge in encouraging more integration by shadowing another FQHC already in the process and then starting the program at CCHCI. We met with the billing department, IT department, Operations, and with the medical health center administrator weekly to begin the implementation. Now we meet regularly with the leadership team at each clinic and monthly with the billing department. We had to determine where we would document within the electronic health record. Notes should not be locked as they are integrated and not considered individual counseling sessions. We had to ensure the medical provider understood this was a part of the visit and not something separate from the medical appointment. Deciding which patient was appropriate for me to see was also a big question. We had to determine the correct codes. Who would reimburse and what was that reimbursement rate? Was it enough to sustain the program? We continued to weigh in on the PHQ2 and the other suicide screenings, but the main focus was on medical concerns. We would pre-schedule patients who had co-morbid diagnoses and who may need guidance for ongoing counseling needs. After the visit, the integrated provider would report the findings to the medical provider.
Successes have included that our now four integrated providers each see about 13-16 pts a day. We preschedule the patient from our list of medical appointments. We receive warm hand-offs from the medical provider of patients who would benefit from a visit on the same day. We have assisted patients with getting into counseling services, with referrals to community resources, and also assist patients with seeing the dietitian and with providing ways to better self-manage their medical concerns. Challenges have included an ongoing difficulty getting medical providers to see the broader skill sets of behavioral health providers. Proper utilization of the integrated behavioral health service has not yet been achieved.
Our next steps at CCHCI include improving New Hire orientation for medical providers to include training in the integrated behavioral health model, and shadowing visits with the integrated behavioral health team at each medical clinic to increase medical staff’s awareness of the power of integration and the ability to effect change on people’s lives through the implementation of this model of care.