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Integrated Care Model: Overcoming Barriers in Primary Care

Explore a project funded by HRSA/DHHS focusing on integrated care in primary care clinics, overcoming barriers such as lack of time, skills, and confidence in SUD/MH treatment. Learn how this model improved patient outcomes and decreased medical utilization rates.

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Integrated Care Model: Overcoming Barriers in Primary Care

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  1. Integrated Care in the Real World • presented at the • NIDA CTN Steering Committee Meeting • Washington, D.C., September 21, 2010, 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

  2. ADAPT, Inc. • Incorporated in 1971 • Serving 3 counties • SUD: OPT, Res (adult/adolescent) • MH: OPT (adult/adolescent) • Gambling • Corrections/Drug Court • Prevention • Primary Care +

  3. HRSA RHO Grant • To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon

  4. Barriers to Integrated Care in the Primary Care Setting • Lack of time • Lack of skills • Beliefs and attitudes about SUD/MH • Lack of confidence in SUD/MH treatment • HIPAA/42CFR Part 2 • Billing, records • Sustainability

  5. Overcoming Barriers • Staffed by LCSW and establishment of FQHC LA • Full-time co-location in clinic • Adaptation to medical clinic schedule/routine • “Open” cases; brief sessions; available • Modified SBIrT model • Behavioral Medicine billing codes (96150-96155) • Use of EBPs

  6. Results • Screened approximately 2,000 patients/year (20% of total patients per year) • Providing treatment to about 15%; 50% of these are 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%*

  7. “Frequent flyers” had significantly less (p<.01) medical utilization after BHC sessions for both OPT and ER visits

  8. Low utilizers had more visits after BHC contact (not significant)

  9. Dr. John Gardin(541) 672-2691drjohngardin2@mac.com

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