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My New Year's Collaborative Resolution 2010

Posted By Jennifer Hodgson, Friday, January 1, 2010
Updated: Thursday, June 2, 2011

Each year we make a resolution to do something a little better than the year before and to make good on that promise is always a challenge. Sometimes it is that we set unrealistic goals and for others of us it is that we do not know what goals to set. Most years I profess to hug my children a little tighter (although not possible unless I want to be investigated by child welfare), love my husband a little deeper (something I always can do), and be the best person I can be to those whose lives I touch.

This year my promise is shaped by watching two of our brightest family medicine residents battle cancer. These two women are truly amazing and by the very strength that they have shown in fighting their illnesses, I have learned that every day is a new day and each day we are invited to appreciate the gifts we have before us. Their voices as patients have forced me to listen in new and important ways.

With regard to my collaborative care resolution, I know that I can do several things better so here is one promise among many. I believe that if you can co-create a model of collaboration that the system endorses as a good idea, that you will find the path to implementation may have obstacles but not impasses. The one place where I am weakest is bringing in the voice of the patient into the models we create. Therefore, this year I will work ardently on doing just that and hopefully bringing awareness that this is not a healthcare system providing a service but a system with healthcare services. Patients are a part of the system and not just recipients of it.

So now I challenge you. What is your New Years collaborative care resolution?

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I got mental health parity for Christmas! Why do I feel so disappointed?

Posted By Ben Miller, Thursday, December 31, 2009
Updated: Friday, May 27, 2011

Yes, it is that time of year to look back on what we have accomplished in 2009 and begin to consider what we are going to do differently in 2010 that we didn't do in 2009 (for a real treat, read how much foreign policy has changed in the past 10 years). And we did accomplish a lot. Healthcare made it out of the House alive and out of the Senate on life support. Partisan politics showed us again why political ideologies trump the American public's views on what should be done in healthcare. Let's be honest, it is ultimately about reelection, right? But something had to be done as people are dying from lack of insurance and costs are skyrocketing!

Consider two studies that show the burden of healthcare costs on our pocket books. Most recently, there is a wonderful article in NEJM, but I still prefer the 2005 Graham Center "one-pager" that asks the question "Who will have health insurance in 2025?" The answer, not surprisingly, is "almost no one" as the average healthcare premiums will be more than the average household income. Let me say that again, by 2025, the average healthcare premiums will be more than the average household income. OK, so maybe this is why I am still excited that Congress got healthcare to a point where we can move forward. There are still a few things to watch for, but the next steps are exciting!

We should all prepare to enact our New Year's Resolutions - let's just hope dropping the public option is not a Congressional resolution!

Deep Breath: Let's drill down into where collaborative care fits into all this. As described in apreviouspost, I have been trying to figure out the connection between current policy initiatives and collaborative care. With the dawn of a new year, I still don't know where "we" stand in terms of collaborative care policy and current health reform efforts. I have a few idea though, which when I really think about them begin to give me a better sense of where we are heading.

  1. Mental Health Parity Begins January 1, 2010: It's here, now what? What does parity really mean? How about "parity in reimbursement by private health insurance plans that cover mental health and substance abuse services". This is significant as it will modify the rate of out-of-pocket spending (traditionally higher for mental health than for other medical conditions) and decrease the limits of treatment scope and duration. But is this enough? Parity will reduce some barriers, but not all.
  2. Secretary of HHS, Kathleen Sebelius, is not afraid of using the word integrated: If you have not seen the speech Secretary Sebelius gave on December 16th to a crowd in Maryland, click here. I see this as more significant than mental health parity that the Secretary is talking about "integrated care". What? Who? How? I know, I was equally as surprised that the person uttering these words was not one of the collaborative care faithful. She even names our good friends at Cherokee, Intermountain, and the VA as examples. Something here? Only time will tell.
  3. Both the House and Senate Bills still dichotomize mental health and physical health: There are examples out there of how the House and Senate bills treat mental health. See here for more detail (PDF). Who knows where the final bill will land with what it wants to do with mental health, but a few things we can tell Congress thinks about mental health:
    a. Mental health services should be required in benefits packages;
    b. Insurers shouldn't discriminate against mental health conditions;
    c. Medicaid should be expanded;
    d. Education is important (increase in funds for higher ed and loan repayment programs);
    e. Substance use is a problem (SBIRT not bad)

Unfortunately nothing like:

    a) Services will be paid for regardless of if they are classified as mental or physical;
    b) Primary care will be compensated for treating mental health (i.e., depression screening and treatment); mental health will be compensated for treating physical health (i.e., health behaviors);
    c) There is no such thing as mental and physical health- "It's about the health, stupid!" (if this doesn't make you laugh, read the context).

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Beginning a Conversation about Technology eHealth and Collaborative Family Health

Posted By Gonzalo Bacigalupe, Tuesday, December 22, 2009
Updated: Wednesday, June 1, 2011

As you walk towards the nearest coffee place, what you see are people enthralled with their smartphones. You may have heard or observed teenagers enchantment with texting. You definitely know about Facebook even if you do not have an account or you forgot how to login after having lost the password when your teenage nephew told you how to open an account to check the last Thanksgivings photos.

Someone may have provided with the link to reports of the Pew Internet and American Life Project published by the Pew Research Center. You heard of Twitter, one of the most popular social media tools, which not only helps spread the news but also shape them. In the case of the uprising in Iran in 2009, the images, video, and reports on mainstream media were, for the most part, the product of social media tools-regular citizens carrying smartphones and connected to the Internet. It is just impossible not to notice, something is happening and it seems at times just a fad. Indeed, this blog entry is also an invitation to a conversation with the author and others. Should we care? What does this "social media revolution" have to do with collaborative health care?

Briefly, what is social media or social technologies? Social media is a set of highly accessible tools for anyone with access to an internet connection via phone, computer, and other digital devices. These tools allow anyone not only to observe what others have produced (TV is a good example) but also to engage in the production of media. Through social media, we not only consume information but we also create it. In the case of health care information, it opens up the possibility for all stakeholders to engage in conversation, share information, analyze it collaboratively, and interact more efficiently. Social media tools are also interoperable, live in the "cloud", and for the most part are not attached to a particular device or software; all of which means that we do not need to have one specific device to interact with others.

These tools defy the financial, geographical, and logistical barriers that exist in creating a context for ongoing interaction, collaborative learning, fast access to information, and transparency. Why do so many professionals engage so often with a social media tool like Twitter? Twitter, a form of microblogging, provides a virtual meeting platform for individuals and groups who share similar interest without a large investment travel, time, and membership dues, among many others. Besides meeting individuals you may know "in person," you also meet others online. It has the added benefit of helping busy clinicians or scholars to maintain ongoing communication without the overwhelming demand of an email inbox after a brief period of no internet activity-paradoxically, often an explanation for not adopting microblogging is accompanied by the statement: "I have too much email already".

Social media tools facilitate the development of self-help and support groups. These networks of support can bring people with rare diseases together or towards a new tailored treatment modality. In the clinical-research arena, the recruitment of patients for a clinical trial would be much easier and effective with these tools than an ad in your local newspaper or an NIH sponsored website. Ease of accessibility is a tremendous and not to be taken for granted potential of these technologies. Think of twitter as your digital bulletin board outside your office, but in the case of a social media outlet, your bulletin board is reaching many more offices and at times the world at large. But besides the ability to reach a wider audience and fast, social media tools foster innovative ways of interacting with others.

Several months ago, while investigating the impact of social media on health care, I run into a threaded conversation about technology and health care or e-health. The contributors used hash tags at the start of an acronym or word in every entry. An intriguing hash tag was #hcsm. Soon, I discovered that "health care and social media" is an ongoing discussion occurring every Sunday 8-9 PM Central Time. The discussion participants are interdisciplinary: researchers and academics, social scientists, clinicians, marketing and health care business specialists, and patients or epatients . The weekly discussions provide an informal but powerful forum "strangers" to engage in dialogue about a specific and emergent subject with questions submitted by participants earlier. The power and tools to set up these virtual meeting places are not necessarily connected to an academic degree or authority, geographical location, or financial influence, but pure acumen. In my example, the convener, @danamlewis, is an undergraduate senior at the University of Alabama whose @HealthSocMed avatar serves as the hub for the #hcsm community.

As a result, an open interdisciplinary self-regulated community is born and sustained. This is the kind of reflexive engagement that our overspecialized professional guilds or academic worlds would make very difficult or highly expensive to create. For those of us attempting to construct a collaborative health care movement, a reflective practice that values the inclusion of several disciplines, patients and their families, and the community at large makes a lot of sense.

What do you think is the impact of social media on the collaborative health enterprise?

What are your thoughts and ideas as you think about the power of social media to enhance and shape the collaborative family health enterprise?

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Three Articles

Posted By Randall Reitz, Tuesday, November 24, 2009
Updated: Thursday, May 26, 2011

Imagine, if you will, that you were transformed into Sandy Blount for a day. You are to teach a one-day "intro to collaborative care" seminar to physicians. Before the workshop you email the participating physicians 3 articles or book chapters to give them an overview of collaborative care and to build enthusiasm for the seminar. Which 3 publications would you choose, and why? Out of the box answers are encouraged.

So as not to exert undue influence on our readership, I'll reveal my picks in a few days.

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Smoking Cessation in Primary Care

Posted By Peter Fifield, Thursday, November 19, 2009
Updated: Wednesday, June 1, 2011

The facts regarding the pernicious nature of smoking, second and third hand smoke (http://www.scientificamerican.com/article.cfm?id=what-is-third-hand-smoke) are abundant and clear. Tobacco use is the leading cause for preventable morbidity and mortality and quitting is the number one thing our patients can do to better their health. The problem: tobacco is extremely addictive. Back in the 80’s C. Everett Koop declared tobacco "as addictive as heroin and cocaine”. For many reasons an integrated primary care setting is an excellent place to help patients end their nicotine addiction.

Although there is no silver bullet for smoking cessation, there is a lot that can be done. The United States Public Health Service (USPHS) recommends the Five A’s approach. I added one of my own (Accept). The first thing (as I see it) is to accept that quitting smoking is very difficult and the relapse rates are very high; ranging from 60-98%. Acceptance of the difficult nature of smoking cession can retard potential cynicism and also allow for a level of empathy for that same patient who has failed time and time again. Acceptance also facilitates patience, knowing that relapse is to be expected.

Ask. This is the first of the USPHS’s Five A’s. Asking occurs, every time the patient presents in the primary care setting. Most professionals agree, that inquiring about tobacco use should be done every visit. Kreuter et al. (1997) state that only 55% of smokers are encouraged to quit smoking by their providers. This is the beginning of an obvious problem—If we do not know who is smoking, how can we help them quit.

Advise: This one is not so simple. Although a firm and clear statement regarding the reasons to quit is advised during every visit, some research has shown that repeated advice to quit can damage the patient/provider relationship http://www.bmj.com/cgi/content/abstract/316/7148/1878 . So there is a fine line we must walk here—ask enough but not too much. The Behavioral Health Specialist (BHS) or other integrated practitioner can take a patient centered approach to facilitate this interface. This interaction should focus on the patient’s ambivalence regarding smoking. Providers possess the skill base to perform this task but the major reasons providers report not addressing patient smoking habits in the primary care setting is due to lack of time.

Assess: Simply asking if the patient smokes, has ever smoked, or is currently smoking is just the beginning. If the patient is ready to quit then skip to the next step--Assist. If the patient tells you that they have no intention to quit, then educate them of the dangers of smoking and move on with the visit. We want to build alliances here, not half hearted quitting attempts begun to appease the PCP. If a patient is contemplating quitting then involve the BHS to use MI to evaluate the patient’s stage of change. This is the perfect time to build on discrepancy if the patient is ambivalent. For those smokers who have already quit, find out how long it has been and continue to support them. Data shows that 44% of all relapses with tobacco occur before the two week mark.

Assist: If a patient is ready to quit they will typically state their readiness, conversely, the patient that is not will most likely tell you "No I like smoking”. Some patients however are literally afraid to disappoint and will go to the extent of taking a medicating such as Chantix or Zyban and still continue smoking. I’ve had interviews w/ patients mid-way through a Chantix treatment tell me "Oh yah I still smoke, I just take these things [pills] so the provider will leave me alone but please don’t tell them”.

If the patient is ready to quit a few things should now occur. If appropriate, the PCP can discuss pharmaceutical interventions with the patient. The CDC reports that the chances of a person successfully quitting doubles (from 5% to 10%) if a pharmaceutical intervention is used. Medications such as Chantix and Zyban are often used as well as nicotine replacement therapy (NRT) such as the patch, gum and inhalers.

The second task is to set a quit date; preferably with in two weeks. This takes advantage of the patient’s current motivation level. If possible get the person to slowly cut down the number of cigarettes they smoke each day. I typically encouraged my clients to reduce by one cigarette each day for two weeks (storing them in a clear plastic bag so they know how many are left) while the Chantix takes effect. By the time they actually reach the quit date, they have reduced down to 5 or so cigarettes per day.

Thirdly, discuss your state or national quit line options. The states of Maine actually offers their residents four free telephone counseling sessions and free NRT. Many online sites exist as well. Some are: http://whyquit.com, http://www.way2quit.com, http://www.trytostop.org and http://www.quitnet.org.

Lastly, consult with the patient and PCP regarding comorbid mental health issues. This is where the integrated concept of BHS really shines. As with most comorbid diagnoses, the motivation to address them are significantly decreased by the presence of depression. Similarly, if people are suffering form anxiety, quitting smoking may be seen as impossible. The BHS can play a significant role in treating mental health related issues. Furthermore; tobacco abuse is highly correlated with other substance abuse issues. In our clinic we are fortunate enough to have two substance abuse counselors on site, integrated into our primary care services.

Arrange: Follow up sessions with a BHS can be scheduled at this time. Fiore et al. (2000) have shown that follow up interventions totaling 30-90 minutes, can increase over-all abstinence rates by approximately 31%. Brief 15 minute counseling sessions, ranging from 2-6 visits each, combined with medications or NRT work best in the primary care setting for the treatment of nicotine addiction.

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My Uncle Built Ford Cars, I Build Collaborative Models

Posted By Jennifer Hodgson, Monday, November 16, 2009
Updated: Wednesday, June 1, 2011

Now I have never honestly owned a Ford but my Uncle Ronnie worked for Ford for many years. He was devoted and loyal. He believed in his product and the fact that it was American made. He used to brag about how each car was touched by American hands prior to being shipped to its destination. That always stuck with me. The sense of pride and devotion he had to Ford despite the challenges of the job, the economy.

I recall one instance many years ago when honoring pride and devotion were central to initiating a collaborative care model into a cancer care unit. The nurses in the chemo bay were opposed to mental health being there. After all, their belief was that we would upset the patients and their job was to help keep them calm and receptive to treatment. Then one of my students approached me with an idea. She was a nurse and understood the gate keeping that was taking place. She spoke to the lead nurse and got permission to work with one patient who would cry during every chemo treatment. Once the nurse saw how the therapy happened, she started inviting that therapist into the chemo bay more. She knew my student understood the culture and was pleased with the results of the work done with patients there. My student understood the pride, devotion, and loyalty of that nurse to the patients. She was not being resistant to collaboration but resisted anything that would decrease the quality of the patient's outcome.

Since that student graduated, we have not had another student in that unit. Our relationship to that unit was tied to the unique credentials of that student and her ability to build a relationship with that nurse. Just like the production of a Ford product, it takes someone monitoring the fidelity of the process and product to ensure its safety. Rather than judge these quality assurance professionals, we need to learn how to respect their passion for protecting the patients and making sure they get the care they need.

I build models of collaboration for a living and my Uncle built cars. I used to think we could not be any further apart in our professional interests; today I appreciate how we could not be any more alike.

I am curious about the stories of those who are out there doing collaborative/integrated care. Do you have stories about your attempts to manufacture a top quality collaborative product? Was it a bit shaky at times but your devotion and belief in the process outweighed the challenges from inception to production?

* Tribute to my Uncle Ronnie who passed away earlier this year

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Sometimes Change Hurts: The Politics of Policy

Posted By Ben Miller, Tuesday, November 10, 2009
Updated: Wednesday, June 1, 2011

I was in Kansas City this past week for a conference, and realized a travesty was occurring on Saturday, which I had no control over: My hotel did not carry CSPAN.

For those of you non-policy wonks, CSPAN stands for Cable-Satellite Public Affairs Network. What was an out of town guy to do? The only thing that made sense to me was to begin walking and convince a bartender to change the channel from World Series of Poker to CSPAN. To make a laborious story short, I eventually ended up at a swanky seafood and steak house in the new Power and Light District in downtown Kansas City. The bartender graciously agreed to change the channel off the horse races to allow me a few minutes with the glorious debate unfolding before my eyes. They even turned up the sound for me so I could hear the constant objections and rude interruptions by some of our elected officials. I was in heaven. This was politics at its finest. Positioning, grandstanding and strategizing - all for a vote which would not come for many hours later. I could tell you more about my experience at this restaurant, including the cardiac nurse who served me my drink, the uninsured bartender who was confused on how healthcare was paid for, the hostess who told me the story of her being denied coverage, but I will reserve those stories for another day (you could also check out one of my favorite books on the topic: Cohn's Sick).

Policy, as one mentor described to me, is movement in a direction. What we saw on Saturday (if you were able to stay awake) was historical movement. This was the first step in a significant policy that could possible change healthcare for years to come. Was this bill perfect? Absolutely not. Was this bill a step in a direction? Absolutely! Speaker of the House Nancy Pelosi had to make concessions to allow this bill to come to the floor for a vote that would pass. Interestingly, the House has done their job so it is the Senate now standing in the way for healthcare reform to take place. In some ways, this was politics as usual, in other ways, the introduction and passage of the bill was not. Therefore, we have movement in a direction - we have the beginnings of a new health policy. (And how cool was it that Dingell sounded the initial gavel? If you don't know the historical significance of this, read here).

Change is usually not easy; however, we make changes daily whether or not we recognize them. Imagine doing something for so long that you don't know that what you are doing may have a different way to be done. Maybe it's pronouncing a word or singing lyrics incorrectly. To you, this is all you know ergo correct, but maybe it's not. Someone corrects your language or you hear someone singing the correct lyrics and boom, you are made aware of a discrepancy in what you have always known as accurate. Sadly, this has not been true for healthcare. The current healthcare system has been working ineffectively for years, and knowingly doing so, but despite being made aware of the inaccuracy of this approach, nothing has been done. While it may not hurt too much to change the way you say a word or sing a song accurately, it may hurt to change an entire system, which is responsible for taking care of what is often most precious to us, our health.

Tying this all together, there remains an opportunity to continue the inertia behind healthcare while still advocating for change. Collaborative care, as a field, is not directly addressed in the House bill. Does this mean that we cannot still push for policies on better care through integration and defragmentation? No, it means that we still have our work cut out for us. Stay involved in the national policy discussion, but act locally. Talk about this with your friends, family and colleagues. Inform the misinformed. Call and email your representatives to tell them what you think about healthcare. Use your voice. Change may be hard and occasionally hurt, but it begins with the recognition that there needs to be a change. There is no better place this is true than within healthcare.

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My Fantasy Football Healthcare Team

Posted By Jennifer Hodgson, Wednesday, October 14, 2009
Updated: Wednesday, June 1, 2011

Disclaimer- I am a Medical Family Therapist. My training is in systems theory and my lens is biopsychosocial-spiritual. My advanced degrees are in marriage and family therapy but my postdoctoral training is in medical family therapy.

Perhaps my husband's push to have me join his fantasy football league has impacted my use of metaphors these days. However, I offer up a challenge, that we create a fantasy healthcare team comprised of the "best" providers for the setting rather than what we believe are the "best" professions.

Working in healthcare has always been a strong passion of mine and is evident throughout my clinical, research, teaching, and program development interests. Ever since I chose my profession, I have felt more like a line backer than a mental health professional. Blocking aggressive maneuvers by other mental health professional groups to create space for my existence is a continuous battle. The culture of healthcare has bred this competitive state of being where we profess that we can do what another discipline does and even do it better. Our fragmented system has led us all to scramble for as much yardage as we can capture, building large pots of money to use when we need to lobby and secure our place in the industry. From lobbyists to insurance panels, money seems to determine what kinds of care people have access to and not necessarily the most well trained professional for their presenting concerns.

Many of my closest friends are from mental health professions that are not of my own. We all sit around confused as to why so many mental health professionals are intimidated by the presence of other disciplines. Sure we have crossover, but the added skills that we all bring are unique and necessary. Research has yet to catch up to this issue but that is another blog. Before we cast doubt on someone's credibility we need to make sure that we review the available literature on our own. For example, it makes me want to "call an audible" to hear that some people think my profession is an intervention that can be done by anyone with a mental health or medical degree. I hear this same thing about my colleagues in other mental health fields who specialize working in healthcare and medical settings. Anyone who knows what it is like to enter into a medical setting for the first time knows that you cannot do so without a clinical and/or research skill set and specialized training in healthcare practice.

Mental health professionals should not be judged by their license only, but by the skills and expertise they bring to the medical home. I want us to be about quality and not job security. We need each mental health discipline just like we need every medical specialization. Our consumers should have the right to choose which professional has the best training and skill set for their presenting concern. I believe this is called parity. Thoughts?

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Psychiatric Consultation

Posted By Peter Fifield, Monday, October 12, 2009
Updated: Wednesday, June 1, 2011

I have been fortunate enough to be part of the nascent stages of two integrated primary care programs. In both programs efforts to create a useful psychiatric consultation program were made. The goal: To provide psychiatric consultation to the primary care providers regarding the care of patients presenting with co-occurring medical and mental health issues. An expected result of this process was a reduced level of provider apprehension regarding the prescription of psychopharmaceuticals.

In our current practice, we meet one time a month for psychiatric consultation. The people at the table include a psychiatrist from a local community mental health facility, our primary care providers (PCP's) and behavioral health specialists. Typically the meetings combine an "In-Service” type educational component with actual patient case reviews. The hope is to gain insight into how certain psychopharmaceuticals can be used to affect the overall health management of these patients.

For the most part, this process has been quite successful. Anecdotally, in our facility, the nurse practitioners spend more clinical time addressing the psychosocial needs of our patients. Furthermore, they appear more likely to explore the world of psychopharmaceuticals. For them, the psychiatric consultation model is very appropriate.

For the doctors at our practice, however, this service appears not to be as useful. Their efforts are best spent trying to get their patients into psychiatry "where they need to be”. More often than not however, psychiatry is not a viable option. The reasons why vary but most of our patients simply cannot afford psychiatry. Exacerbating this fact, state mental health budgets are being trimmed and providers of mental health services expected to ration the care.

Although not explicitly stated in most articles, such budgetary cuts could result in an increase of patients presenting in the primary care setting with anxiety and depressive symptoms. PCP’s commonly address some mental health needs with medications. Often, certain psychotropic medications (i.e. fluoxitine, Wellbutrin, amytriptaline, hydroxyzine, Buspar etc.) are used as front line treatments of depression and anxiety in the primary care setting. Due to our clinic’s unique population, pain medications and benzodiazepines are typically steered away from due to their high propensity for habit formation. Mood stabilizers and typical and atypical antipsychotics are generally not resourced either. The concerns around these medications are warranted: These medications come with a significant increase in complexity for the provider and the patient. Among other things, frequent blood draws are required to monitor lipid and glucose levels, to assure therapeutic dosage and to prevent toxicity. This is not to mention the possible life threatening complications related to improper titration off of these medications; for example Steven Johnson’s Syndrome can be more severe and life threatening.

I recently had a conversation with our medical director regarding our involvement with the existing psychiatric consultation services. Although he was in favor of continuing the service, he stated "We are having a difficult enough time just treating patients with primary care issues like diabetes and hypertension…and I might add, we do a pretty good job. I have no interest in becoming a psychiatrist. That is not my specialty”. I’m sure his perspective is shared by many primary care providers—we are doing all we can here to manage the physical ailments of our primary care patients and we do not have the resources to treat their complex mental health related issues as well.

Our current intent is to continue with the psychiatric consultation services for it has proven to be insightful for all. Even though it has not completely ameliorated the anxieties around prescribing some types of medications, it has, in my opinion allowed our PCP’s to feel more comfortable addressing the patient’s mental health needs in general; including the use of select psychopharmaceuticals. After all that was the goal.

All in all this is a very successful program that I would encourage any integrated primary care practice to institute if resources allowed. In a perfect world, all patients could have their psychiatric needs met at a specialty mental health clinic. Another alternative could be to employ a psychiatrist or psych ARNP as part of the integrated team in a primary care setting. If both of these options are not accessible, psychiatric consultation could prove to be a viable alternative.

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Promoting Community Collaboration through the Creation of a White Paper

Posted By Randall Reitz, Friday, October 9, 2009
Updated: Thursday, May 26, 2011

Mesa County, Colorado is a unique healthcare community. We benefit from an investment of $1 million donated from the local physician's group with $1.5 million offered by the local health insurance company that self-started a regional health information organization (RHIO). This technical collaboration unites the health records of our entire community.

Similarly, the primary care physicians and mental health providers in our community have a long history of collaborating for quality patient outcomes. This is most striking in the collaboration between for-profit and non-profit offices. These efforts were originated and maintained through the coordination of the Integrated Care Council of Mesa County.

The Integrated Care Council's successes have gained some recognition on a state and national level, but they remain largely unknown among the inhabitants of our own community. This is to our detriment because it hampers our ability to grow our model. So, earlier this year the Council set a goal of publishing a white paper that would be endorsed by all the major healthcare players in our community. This was a daunting task because many of these stakeholders are competitors and some of them would be hearing of the council for the first time when we approached them for a signature.

Undaunted, we facilitated several brainstorming and writing sessions to craft the text of our document. Our aim was to convey the stats and stories of collaborative care in Mesa County, to celebrate success, to increase buy-in from the community, and to launch a next round of initiatives. From the outset, we set a goal of limiting the document to a one-pager (front and back) that could be easily distributed and digested.

Once we had edited it to the council's liking we began distributing it to community leaders. Everyone we spoke with signed the document and requested very few changes to the wording. This includes the heads of:

  • The largest for-profit primary care offices,
  • The local independent physicians association,
  • The safety-net clinics,
  • The community mental health center,
  • The largest for-profit behavioral health office,
  • The RHIO,
  • The predominant insurance company,
  • The predominant hospitals from the 2 largest cities,
  • The local NAMI affiliate, and
  • The largest human services non-profit.

The Council paid a nominal amount to have the content and digital signatures formatted by a graphic designer. Just this week, the dissemination-ready draft was given final approval by the signatories and the Council and this blog post is the official launch of our white paper. See the final document by clicking here.

Our next challenge is to capitalize on this momentum by going back to the signatories and partnering with them to advance the initiatives proposed in the white paper.

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What We Do

CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.