National Council Magazine - Winter 2009 - 29

a new collaboration between primary care providers and the specialty behavioral healthcare provider. San Juan County comprises 173 islands and is located in rural northwest Washington State. No psychiatrists practice in the county. Psychiatrically ill residents go without treatment, or the responsibility for evaluating and treating psychiatric illness falls to the primary care providers. The primary medical practice, Inter Island Medical Center, serves the entire region’s healthcare needs and is typical of primary medicine clinics in similar areas. Although patients may present with mental health concerns that the primary care physicians attempt to address, the physicians are among the ﬁrst to acknowledge the need for access to psychiatric specialty care for their patients. Compass Health maintains a clinic in Friday Harbor. This clinic serves a broad range of San Juan County residents and provides both mental health and chemical dependency services. Compass Health has ﬂown a psychiatrist to Friday Harbor on a regular basis, but time and travel costs have now made this option untenable. To address this access problem, Compass Health and the Inter Island Medical Center applied for and were awarded a 3-year, $375,000 Rural Health Services Outreach Grant. With this grant, the two organizations developed and implemented an integrated model of providing psychiatric care through videoconferencing. We put in place state-of-the-art TelePresence video equipment to ensure high-quality interaction between the patient and the psychiatrist. Before providing psychiatric services, both organizations mapped out the speciﬁcs of the clinical process in detail. The key objective was to ensure that all participants (the patients and their family; physicians, nurses, and support personnel; the Compass Health psychiatrist; and support staff) were clear about the clinical process. Everyone participating in the clinical process was actively involved in the design of the practice protocols. Since December 2007, 45 patients have been referred for psychiatric treatment. Twenty-four have completed their treatment and been referred back to their primary care practitioner for follow-up. All patients report being extremely satisﬁed with their telepsychiatry experience. The primary reason given is that they do not have to go “off island” for treatment. Additionally, they note that the telepsychiatry experience is “just as good” as face-to-face treatment. They appreciate having the case coordinator available to assist and support them. The primary care practitioners report that their patients say their experiences with the telepsychiatry application are positive. The practitioners also ap- LESSONS LEARNED > Actively involve the primary care delivery system and the behavioral health delivery system in designing the entire clinical process. > Ensure that psychiatrists are willing and able to use the telepsychiatry application. > Have a case coordinator available to help manage the patient’s needs during the treatment process. > Use state-of-the-art 3D TelePresence technology to make telepsychiatry a real “in-person” experience for both the practitioner and the patient. preciate the ease with which they can access needed psychiatric services for their patients. The Compass Health psychiatrist says he has received a number of positive comments from the patients. He notes, “They’re surprised at ﬁrst at how much it feels like a physically present interview.” He further notes, “Some even seem more able to open up, perhaps because the social distance of the telepresence unit is less intimidating than being physically in the room.” El Paso MHMR Explores Cocase Management, Collaboration, and Colocation Christy Calderon, MA, LPC, Chief Operations Ofﬁcer, El Paso Mental Health/Mental Retardation Authority, El Paso, TX / ccalderon@epmhmr.org B y reaching out to local healthcare delivery agencies and care management organizations, El Paso Mental Health Mental Retardation Center has made strides in lowering costs and improving access. El Paso MHMR Center and El Paso First Health Plans, a local health maintenance organization, have collaborated to provide integrated behavioral health services to consumers. Staff from both agencies operate the program, which uses masters level social workers and professional counselors to identify and treat people with comorbid behavioral and primary healthcare concerns through a cocase management model. A consulting physician and psychiatrist provide guidance with patient treatment protocols. The agencies exchange data, which are recorded and analyzed in a Web-based portal developed speciﬁcally for this collaboration. The portal records clinical and ﬁnancial data, which are then used to analyze resource utilization and costs. Clinical data currently being measured include inpatient psychiatric hospital admissions, emergency room visits and admissions, primary care ofﬁce visits, specialty care ofﬁce visits, prescription utilization by physicians, and laboratory visits. Among the initial outcomes were fewer inpatient psychiatric hospitalizations, a reduction in ER visits for one patient, and excellent customer satisfaction ratings and comments from consumer surveys. El Paso MHMR also plans to collaborate with a local Federally Qualiﬁed Health Center to provide in- tegrated behavioral health services. The proposed plan involves the full integration of an El Paso MHMR outpatient clinic into the FQHC system. This structure results in numerous advantages to behavioral health clients: >> 340(b) drug pricing, which prices medication 30% lower than retail pharmacies. >> Enhanced (cost-based) reimbursement for Medicaid-eligible and Medicare services (with the increased income, FQHCs often provide additional services, such as education and wraparound support for their patients). >> On-site outstationing of Medicaid eligibility workers, which will assist patients who are not enrolled in Medicaid with the enrollment process. NATIONAL COUNCIL MAGAZINE • WINTER 2009/ 29

National Council Magazine - Winter 2009

Table of Contents for the Digital Edition of National Council Magazine - Winter 2009