PORTLAND, Ore. —
Physical health issues often have a mental health component. Diabetes, for example, heart disease or any number of conditions may make a patient stressed and depressed. And because providing appropriate behavioral health is one of the biggest challenges Oregon’s health care system faces, CareOregon is committing $5.5 million and technical support to helping 19 primary care clinics in the Portland Metro area expand or initiate behavioral health within their practices.
An additional $1.5 million is going to support behavioral health integration in Jackson, Tillamook, Columbia and Clatsop county primary care practices.
Coordinating mental, dental and physical health is one of the foundational principals of the Oregon Health Plan Coordinated Care Organizations (CCOs). CareOregon provides health plan services to about 250,000 OHP members through its relationships with four CCOs, including Health Share of Oregon in the Portland metro area.
“There is a lot of evidence to say that integrating behavioral health into primary care helps patient outcomes and helps improve provider satisfaction,” says Mindy Stadtlander, CareOregon’s director of network and clinical support.
“The problem has been historically that health plans don’t pay for behavioral health services because mental health funding is segregated. Because it’s important to CareOregon and our providers, we took big steps to figure out how to pay for those services in primary care.”
The practices across the Tri-County region funded this year are working on behavioral health integration projects ranging from hiring a behavioral health professional—clinical psychologist or licensed clinical social worker—for the first time to expanding existing integration projects.
Multnomah County Health Department is hiring staff to expand the county’s 3-year-old behavioral health integration program.
Primary care physician Lisa Sprague and psychologist Deborah Pack-Patton have been working together at Multnomah County’s Northeast Health Center for two years.
Mental health professionals can help with the emotional or behavioral issues related to their chronic health conditions such as diabetes, heart disease or COPD, Dr. Sprague says. But it didn’t happen often in the old model of care.
“There’s a pretty huge disconnect between community mental health and primary care,” she says. “Patients would frequently get lost before they got over there, or they just didn’t feel comfortable making that jump over to community mental health.”
The old stigma of mental illness and visiting a “shrink” kept many from using the services of a mental health professional even when referred.
Now, Dr. Sprague can visit with Dr. Pack-Patton during a patient’s office visit, or even call her in for a brief doctor-doctor-patient consultation. That has gotten more services to those who need help. For example, it’s helped patients depressed by their chronic illness to get past the depression and make the behavioral changes—diet, exercise, tobacco use—they need to improve their health.
Having the behavioral health provider in the clinic has improved acceptance.
“I find, as we begin to have that conversation with patients, they view behavioral health consultation not as something that’s wrong with them. Rather, it is a chance to do something positive to take care of themselves,” Dr. Pack-Patton says.
“There may be a little resistance at the beginning, but I find that once people have a little bit of information, they’re more willing to engage. I don’t find that people walk away because they think this is going to be mental health treatment or something that they are biased against.”
Dr. Sprague is particularly interested in having behavioral health services for pregnant women.
“A lot of them have had pretty significant adverse childhood experiences and are worried about whether they can do it themselves,” she says. “They are spending a lot of their pregnancy with a lot of anxiety, some depression at times. I really try to see if I can get my pregnant moms in to see Dr. Pack-Patton with the thought that not only is she going to help them with the anxiety, but she’s really going to work with them so they have good tools to parent, and we end up with another generation of healthy individuals.”
Funding from CareOregon is going to allow Multnomah County to increase the number of behavioral health professionals available to help the primary care teams.
For all the practices receiving the funding from CareOregon, CareOregon also will monitor outcomes the clinics set, provide technical support, and establish a collaborative so that the practices can share what they’ve learned with each other, Stadtlander says.
Technical support and collaboration have become consistent elements of CareOregon’s health care improvement practices. CareOregon pledges to stick with the providers who are embarking on improvement efforts to improve the chances for success, she says.
Additionally, this year CareOregon has committed to study how to address a critical component of care innovation that has been missing: how to pay for it.
“The way that Medicaid typically reimburses makes it really hard to figure out funding, but we’re going to put that aside because clinically it’s the right thing to do,” Stadtlander says. “We believe it will benefit our members and our provider community and we’re just going to pay for it.
“So as part of our commitment through this year of funding, we’re going to be figuring out how to transition to a sustainable payment model.”
For information, contact Jeanie Lunsford, 503-416-3626, [email protected].
About CareOregon
CareOregon is a nonprofit community benefits company that’s been involved in health plan services, reforms and innovations since 1994, serving Oregon Health Plan (Medicaid) and Medicare members and their communities. Our mission is cultivating individual well-being and community health through shared learning and innovation. Our vision is healthy communities for all individuals, regardless of income or social circumstances. We focus on the total health of our members, not just traditional health care. In teaming up with members, their families and their communities, we help Oregonians live better lives, prevent illness and respond effectively to health issues.
