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College Health - It's Where the Money Is

Posted By Alan Lorenz; Jennifer Funderburk, Monday, June 9, 2014
Legend has it that the infamous bank robber Willie Sutton, in response to the question, “Why do you rob banks?” replied, “It’s where the money is.” This saying is often repeated for questions where the answer should be obvious – but often is not. Our question here is, “Where is an ideal place to develop collaborative care,” and our “obvious” answer is, “College Health.”

 Our prediction is that all of you who are reading this went to college and likely obtained advanced degrees. Collaborative care practitioners can include doctors, nurses, psychologists, social workers, and a wide array of other health and mental health practitioners. There are also physical and occupational therapists, dieticians, and a variety of allied health professionals. We even have individuals with MBA’s and accounting degrees responsible for managing collaborative care. It is highly unlikely that you do not have a college degree.

Therefore, think back if you ever received health or mental health care at your college health center? If so, what was your experience? How much collaboration was occurring at your health center? We can argue all we want about how collaborative care is cost effective and a better approach to treating our patients, but nothing is more persuasive than direct, immediate, personal experience. It is our opinion that direct encounters with collaborative care will trump intellectual arguments every time. Having a positive collaborative care experience in college can have far reaching effects.

How different would people think about health care if everyone had been a direct recipient of collaborative care at their college health center? Not only are you all college educated, but our legislators and law makers are college educated. How different would the laws of our land be if every member of our government had been the direct recipient of collaborative care? And, not just those in government but extend this to all health care administrators? Our guess is that the world of healthcare would likely be a very different place.

College presents several uncommon opportunities for innovation College Health not only presents an opportunity to provide this type of direct experience with collaborative healthcare early in an individual’s life path, but it also presents several uncommon opportunities for innovation. First, the barrier of reimbursement is reduced and/or eliminated altogether within College Health because there is often a capitated system where students pay a flat “health fee” and then receive care as needed for the year. This removes constraints of third party reimbursement and frees health care professionals to provide care in the way that makes the most sense. Generally in College Health there is no need to figure out how to bill for collaborative services or how to work around common restraints set by insurance policies against same-day visits. In part as a result of this overarching financial umbrella, medical health services and mental health services are often located in the same building. This co-location facilitates collaborative care. The bump in the hallway or curbside consultation, the brief introduction, the ease of access all facilitates collaborative care. Often, there is a shared record and this further facilitates collaboration. 

There is a surprisingly dire need for mental health services in College Health. Across the nation, colleges are scrambling to identify ways to help increase access for mental health services for college students. According to a recent American College Health Association survey as many as 10% of all college students are on psychotropic medications (not including meds for ADD). Collaborative care provides an additional “piece to that puzzle” by opening the door to brief interventions/treatments that can be applied to help prevent or treat mental health symptoms in a population-based framework.

In addition, college students are often developmentally at a stage when mental health disorders tend to show their true colors in the absence of confounding camouflage in the home environment. College students go to the college health center for their escalating symptoms. Why? College students are often living in an unfamiliar city far away from their families and friends when they experience symptoms that trigger the idea that a doctor can help. Therefore, College Health is an ideal setting for collaborative care providers to be a part of the team providing initial care. It also presents the opportunity to do early intervention or prevention work before multiple medical and psychiatric co-morbidities develop.

Mental Health Professionals are often trained in, or in close proximity to, College Health centers. Trainees are a tremendous source of inexpensive, enthusiastic, idealistic creative energy that is available. It’s also an ideal time to teach them good collaborative habits, especially before the less helpful ones get entrenched.

For international students, the College Health Center is often the only place where they feel comfortable seeking help for various biopsychosocial complaints. Collaborative care provides the opportunity to help these individuals in a setting that does not carry the same stigma as specialty mental health care. Therefore, collaborative care can not only provide an avenue to treatment, but also serve as a bridge to more specialized care if necessary. 
College health is an ideal setting for collaborative care providers

So back to our original question: where is an ideal place to develop collaborative healthcare? Our answer is the College Health Center. Let’s not waste the opportunities that exist within this setting and begin to evaluate how we can take advantage of it not only improving the care for college students, but also providing those direct experiences necessary to help give different viewpoints to future legislators, leaders of insurance companies, and healthcare administrators.

Alan Lorenz, MD is a charter member of CFHA and now works at the University Health Service at the University of Rochester where he is an Associate Professor in both the Departments of Family Medicine and Psychiatry.

Jennifer Funderburk, PhD, is currently a clinical research psychologist at the Center for Integrated Healthcare at Syracuse VA Medical Center, an Adjunct Assistant Professor at Syracuse University, and an Adjunct Senior Instructor at the University of Rochester Department of Psychiatry.

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