Models of Medical Care in the Psychiatric Setting

Jason Cheng, MDJeanie Tse, MD

Institute for Community Living, Inc.

Wellness, Resilience, and Recovery for All Philadelphians: Integrated Care in Philadelphia

June 25, 2013

Objectives

At the conclusion of this presentation, participants will be able to:

Describe two models of integrating medical care into psychiatric settings

Strategize how to modify electronic health record systems at their home institutions to support integration

Institute for Community Living

NYC not-for-profit >100 programs, 10,000 consumers:

housing, case management, ACT, PROS (NY only), clinics, shelters & health home

Founded Health Care Choices FQHC In housing and case management:

>70% schizophrenia / schizoaffective Primarily paraprofessional workforce

Person-centered care “The patient is the source of control” (IOM) Goals and values determine how care is

provided Self-management

Patient

Self-MgmtWorkbooks

Pthwys/MedRisk Mgmt

Co-Loc/ Care Mgmt

Integrated Electronic Tx Plan

PCP

Person

Care manager/

counselor

Psychiatrist

Peer health coach

Specialists

NurseCare Manager

Entitlements

FAMILY / FRIENDS

Care management Develop and maintain rapport with patient and

provider Educate the patient and family Monitor symptoms and communicate findings to

provider Develop and maintain a self-care action plan Maximize adherence to the treatment plan through

negotiation of solutions to treatment-emergent problems

Bureau of Primary Health CareHealth Disparities Collaborative

Nursing-supported care management Medical risk screening at intake Risk stratification and treatment planning

in collaboration with nurseAcute risksAdherence issuesNeed for higher level of care

Monthly multidisciplinary review Nursing-supported training of behavioral

health workers

Billing Codes for physical exam, health

monitoring and complex care management Physical exam billing if external PCP? Health monitoring rate (billed by

MD/PA/NP/RN) is half that of psychotherapy rate (billed by SW)

Peer health coaching not reimbursable

Electronic Tools

Single EHR Health Risk Screening Healthy Living Questionnaire Physical Health Goal Planner Healthy Living Workbook Healthy Living Clinical Pathway

Primary care vs. behavioral health culture

Medical vs. psychosocial models Top-down vs. consensus decision-making Physician vs. social service leadership

What’s the bridge?Self-managementNurse care management

Summary

Nursing-supported care management can bridge a number of gaps between primary care and behavioral health

Electronic tools can help support decision making and provision of care within integrated settings

Reimbursement of integrated care still needs to be addressed

ICL’s Integrated Health Team:

Sonia Barolette, RNShivonne Blake, CDMJason Cheng, MDRuth Chiles, RDJudy Chong, CASACElisa Chow, PhDElizabeth Cleek, PsyDCindy Freidmutter, JD

Drew LaStella, PhDEduard Levy, MDJimmy Lindsey, CSCSRosemarie Sultana-Cordero, MAMarcia Titus-Prescott, RNJeanie Tse, MDMatt Wofsy, LCSW-Rand numerous program staff

Please feel free to contact me at JCheng@ICLinc.net

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