integrated care in the real world presented at the nida ctn ctp caucus meeting washington, d.c.,...
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Integrated Care in the Real World
presented at the
NIDA CTN CTP Caucus MeetingWashington, D.C., March 15, 2011, by
John G. Gardin II, Ph.D.Director of Behavioral Health & Research, ADAPT, Inc.Administrator, SouthRiver Community Health Center
Clinical Assistant Professor, Oregon Health Sciences University Medical School
This project was funded by HRSA/DHHS Rural Health Outreach Grant #1D04RH06903-01.00
ADAPT, Inc.Incorporated in 1971Serving 3 countiesSUD: OPT, Res (adult/adolescent)MH: OPT (adult/adolescent)GamblingCorrections/Drug CourtPreventionPrimary Care +
HRSA RHO GrantMay 2006-May 2009
To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon
Results
Screened approximately 2,000 patients/year (20% of total patients per year)
Providing treatment to about 15%; 50% of these were Medicaid patients
30% of Medicaid patients provided 70% of utilization (“frequent flyers”)
64% showed significant improvement (HADS)
Overall medical utilization by Medicaid patients decreased by 13%
For “frequent flyer” Medicaid patients, decreased medical utilization by 33%
Overcoming BarriersFull-time co-location of BHC in clinic
Modified SBIrT model
Staffed by LCSW
Establishment of RHC FQHC-LA FQHC?
Adaptation to medical clinic schedule/routine
“Open” cases; brief sessions; available; M&G
Behavioral Medicine billing codes (96150-96155)
Use of EBPs
What is Working
Medical Assistants
Overbooking - 50% no show rate
Increased appropriate use of psychotropics
15-20 minutes session/brief therapy
Use of Behavioral Medicine Codes
Continuing Challenges
Training issues with CMAs
Training issues with providers
Schedule challenges
Same-day appointments
Poor penetration of SUD involved patients
eMR and confidentiality
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