Integrated Care in the Real World presented at the NIDA CTN Steering Committee Meeting Washington,...

Integrated Care in the Real World

presented at the

NIDA CTN Steering Committee MeetingWashington, 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

ADAPT, Inc.Incorporated in 1971Serving 3 countiesSUD: OPT, Res (adult/adolescent)MH: OPT (adult/adolescent)GamblingCorrections/Drug CourtPreventionPrimary Care +

HRSA RHO Grant

To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon

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

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

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%*

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

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

Dr. John Gardin(541) 672-2691

drjohngardin2@mac.com