New Hampshire Integrated Care Learning Community
by William Gunn
Mission: To provide a forum for discussion of the development and sustainability of integrated care projects in primary care in New Hampshire. This includes both provision of behavioral health services in primary care health settings as well as providing health services in mental health specialty settings. The term "behavioral health” is currently used in these projects instead of "mental health” to reflect a broader array of services provided.
Definition: Integrated care is defined as team based care where medical professionals and behavioral professionals work together to address population based needs. This includes prevention projects in health promotion and disease prevention, managing chronic illness, assisting patients to make healthy lifestyle choices and providing acute care. Care management, consultation, and ongoing counseling and therapy provide a continuum of services.
Background: In 2005, the governor and legislature in New Hampshire formed a commission to study the provision of mental health care in the state. There were several areas studied including quality of care, access to services, use of technology, addressing stigma, and integrating medical and behavioral health care. The result of two years of work by over a hundred consumers and professionals produced a paper describing the current reality and making recommendations for change. The governor was presented with the results and attention to the issue by media and legislature.
A practical outgrowth of this work was the formation of the Mental Health Council (MHC) in 2008. The mission of the MHC was to select specific recommendations from the commission report on which to focus. Two were selected, ensuring adequate housing for consumers of mental health services and furthering the development of integrated care in New Hampshire. Dr. Bill Gunn, a psychologist teaching the NH/Dartmouth Family Medicine Residency along with Nancy Rollins, the Deputy Commissioner of Health and Human Services in New Hampshire co-chaired this initiative. Dr. Gunn, who had been co-chair of the integrated care sub-group, developed a mailing list of all those interested in being part of an ongoing learning community which would meet on a regular basis.
At the initial meeting 42 professionals met together to present what they were doing in their home settings. These professionals represented clinical, financial, and operational areas as well as the state government. The first two years this group met on a bi-monthly basis to discuss common barriers and tell success stories. In the last two years the group has had a fall and spring meeting where there have been presentations from regional efforts to promote integrated care. These have included Dr. Sandy Blount from UMASS, Mary Jane Mork, LCSW and Cynthia Cartwright, RN, MSN, innovators with Maine Health, and Craig Jones, medical director of the Vermont State Blueprint.
Future Directions: The next meeting of the learning community is on April 13th, 2012. We are hoping to include representatives from Martins Point, Health Care, a private health care organization operating in both Maine and New Hampshire, and Julie Schirmer LCSW, a behavioral health consult, who will present the initial results of a needs assessment, recommendations, and next steps for integrated care at Martins Point Health Care. This will provide a platform for discussion about methods to evaluate outcomes in integrated care.
There has been strong interest in having CFHA and a regional organization, The Family Medicine Education Consortium (FMEC, www.fmec.net), develop a stronger regional network including New Hampshire, Maine and Vermont. This partnership was recently approved by CFHA's board of directors.