Integrating rural mental health, primary care in Newport
Coordination efforts moving ahead in Pend Oreille CountyMarch 2nd, 2017
Newport Hospital & Health Services and Pend Oreille County Counseling Services started working collaboratively in 2009 to support crisis mental health intervention within our community.
Recognizing that shared community need, we realized our organizations could do more to support comprehensive care delivery in Newport, which is about 50 miles north of Spokane.
Both organizations recognized early on the trajectory of health care reform would require better integration of primary medical care, mental health, and chemical dependency services. It certainly made sense to our providers. However, it became apparent that there were few programs for rural communities and realized any funding would require local support.
Based upon our collaboration on patients in crisis, we also knew we would need to better understand how each other’s systems and cultures worked in order to foster staff relationships. Our goal was to not only enhance the care provided but also foster joint ownership to coordinate care better for patients with significant needs.
In 2012, NHHS received funds through a Regional Care Transitions Outreach grant from the Cambia Health Foundation. The goal under the grant was to identify patients with high-risk chronic conditions and improve health outcomes and/or lower care delivery costs by implementing care transition services and better coordinating care.
Our goal under the grant was to identify individuals with mental or substance-use disorders and jointly address issues that might be contributing to a physical health condition. Ultimately, we wanted to try to build an integrated, collaborative care approach. The assumption was folks who don’t have access to first-line treatments typically will obtain their care through more expensive service areas, such as the emergency room. Providing coordinated access to services and getting upstream to deliver care people need could also reduce the potential need for crisis intervention.
Both of us recognized a great deal of mental health and substance-use treatment occurs in the primary-care setting, where providers often don’t have the time or staff to address behavioral health needs adequately.
Our target was to ensure we would have mental health clinicians on-site to allow a warm handoff between medical and mental health providers in the clinic. Our goal was twofold: Eliminate the barrier of having the patient follow up at a second location with a referral for treatment, and create a means to enable mental health clinicians, medical providers, and the patient to have meaningful dialogue and consultation on a regular basis. Good communication is paramount for quality care coordination, delivering good health outcomes, and creating a positive patient experience.
We started our work under the Cambia program by asking providers which patients they felt might benefit most from care coordination. From there, we expanded to serving 80 patients under the program and experienced a better than 60 percent year-over-year reduction in emergency room visits on those patients. After two years, our grant funds were depleted, but both NHHS and POCCS witnessed measured success. It was enough to justify our continued collaboration.
The two health care organizations have continued to fund mental health providers jointly in the medical clinic five days a week. It is for limited hours, but designed to continue to provide a warm handoff, provider consultation, and on-site follow-up with our shared patients when possible. The goal is to ensure coordinated behavioral health and medical treatment is provided on the same day, as patients are more likely to attend a joint appointment than drive to POCCS following their primary-care visit.
The collaborative relationship between POCCS and NHHS continues to grow around the care coordination model. When NHHS opened its new primary care clinic last August, we included permanent treatment areas for counseling services.
Rather than meet clients in a clinical exam room, counselors meet with them in a warm office environment with dimmable lights and more comfortable furniture. In fact, the entire clinic design promotes coordinated primary-care services. Our exam rooms are located around a central core area that houses all providers and clinical support staff, including care coordinators. The design is intended to promote communication and cohesion across the patient care team.
Since 1921, health care services in Newport have relied on the provider-patient relationship. Our intent is to continue that focus.
Tom Wilbur has been CEO at Newport Hospital and Health Services for the past 12 years. For the past 25 years, he has operated facilities of all sizes—from small rural, to urban tertiary and teaching facilities.