The takeaway from data reviewed by Centerstone, a not-for-profit, community-based behavioral healthcare provider, was clear: Achieving better outcomes required covering a broader scope of care.
“Our research has shown individuals with behavioral health illness are dying 25 years younger than the general population, and it’s not related to their behavioral health condition,” says Mandi Ryan, MSN, RN, Centerstone director of healthcare innovation. “It’s related to undiagnosed and untreated medical conditions. Our population is at risk for cardiovascular disease, hypertension and diabetes.”
To overcome missed diagnoses and miscommunication between providers, Centerstone in 2012 set out to integrate its behavioral health services with primary care. The organization received a four-year Substance Abuse and Mental Health Services Administration (SAMHSA) grant to fund the integration of primary care with behavioral health. From there, Centerstone earned full health home agency accreditation from CARF for its Nashville outpatient treatment center, later expanding its integration efforts to four outpatient clinics, and, eventually, all 19 outpatient clinics.
The health home model brought a team approach to care coordination, ensuring all treatment concerns for patients would be met in harmony and that treatment (or lack thereof) for one condition wouldn’t jeopardize another, Ryan tells Behavioral Healthcare Executive. Comprehensive screenings upon intake helped Centerstone get a more detailed picture of clients’ health and identify conditions that previously went undetected.
“We had about 35% of our clients say, ‘A doctor has told me I have diabetes’ or, ‘My blood sugar is high.’ When we were actually testing individuals, 77% came back with high blood sugar and either were diabetic or were considered pre-diabetic,” Ryan says. “The majority of those individuals had a primary care physician, but they hadn’t ever requested the testing, so they had no idea.”
Returns have been promising for Centerstone since adopting the health home model:
- 84% of patients with high blood pressure reported lower readings after one year
- 56% reported lower anxiety levels
- 53% saw an improvement in their general health compared to their initial screening
In 2016, the state of Tennessee announced it would begin working with providers to offer health home services to its Medicaid population through its new Health Link initiative. Recognizing an opportunity to operate on a larger scale than it had done previously through its grants, Centerstone applied for and was approved as a Health Link provider. It began offering Health Link services in December.
For behavioral health providers looking to adopt the health home model, Ryan offers the following advice:
Engage the client. For behavioral healthcare providers, simply putting in a primary care office and expecting clients to do everything their doctor recommends to improve their outcomes isn’t a realistic expectation.
“You really have to focus on engaging the clients and working with them and truly utilizing all the aspects of a health home model, focusing on care coordination, health promotion, transitional care when they go to another facility and working with them when they’re discharged,” Ryan says.
Set realistic goals. One of the mistakes Centerstone made early on was creating goals with clients that were too far-reaching. It left clients feeling overwhelmed and more likely to disengage and not be motivated to change.
“We’ve learned to show clients that small changes can make a difference,” Ryan says. “Even improving someone’s blood pressure by six points can make a huge impact on their life and reduce their risk of cardiovascular disease, stroke or heart attack. Let’s start to make small goals, like losing five pounds instead of the hundred you have. As the clients start to make those small changes, they start to feel rewarded and see their accomplishments and make another change afterwards.”
Get everyone on board. Successful health home models incorporate therapists, psychiatrists, care coordinators and even wellness coaches who are willing to meet clients where they are to help them set goals—behavioral or physical.
“The team approach,” Ryan says, “is what makes the difference in individuals.”