Cherryl Ramirez Believes in Integrating Physical and Mental Healthcare

The new executive director of the Association of Oregon Community Mental Health Programs thinks the coordinated care organizations show great promise

December 6, 2011—Cherryl Ramirez gets the importance of integrating physical and mental health care.

The new executive director of the Association of Oregon Community Mental Health Programs began her career in Texas’ public health department, where she managed a diabetes prevention and control program.

“I noticed our clients with diabetes more often than not always had a serious issue with depression,” she said. “Diabetes goes hand and hand with a lot of our major killers—heart disease, diabetes, cancer.”

And she saw that patient’s physical health improved when they made lifestyle changes to their diet, exercise, and found treatment for their depression. “Integrated care makes a whole lot of sense to me.”

That knowledge is going to come in handy as the state begins coordinating physical, mental and dental healthcare for Oregon Health Plan patients.

Ramirez, who’s been in her new position for one month—three weeks of which was spent traveling around the state to learn about their mental health programs—views her role as providing support to counties as health reform moves forward. She’s focused a lot of time and energy on coordinated care organizations (CCOs), the health insurance exchange and efforts to improve health information technology in the state.

“Those are the three big pieces, in my mind, in making sure that health reform gets implemented in the way it was intended,” she said.

Ramirez believes it’s crucial for mental health care to be adequately represented in the new coordinated care model. “People with chronic diseases will not do better unless their behavioral health issues are met.”

And she thinks CCOs show great promise to create more robust community mental health services.

“The coordinated care organizations are being built at the regional or county level,” Ramirez said. “You can customize it according to what the needs are in the community. That’s a community based model. That will help people, because all health care is local.”

Community-based care is the key to providing effective and compassionate mental health, said Ramirez, who earlier was executive director of Illinois’ state association of community health programs.

“People can get the care they need. They have their families and friends around. They can stay in their homes,” she said. “That is just better for a person’s recovery, that they have a high quality of life.”

Compared to Illinois, Oregon has a more robust infrastructure of community-based care because Illinois is more “top-down” in terms of the number of state-run institutions it has for mental health treatment.

Funding is the biggest challenge faced by Oregon’s mental health system, she said. “It’s a problem in all states, and some worse than others. It’s going to take a little while to get out of this economic crisis, but we can’t just wait until it gets better. We need to move on and do what we can with the resources we have.”

She points to a new grant source available through the Centers for Medicaid and Medicare Services (CMS), called the CMS Healthcare Innovation Challenge that has $1 billion available. “It’s a substantial amount of money. There’s money out there.”

Ramirez is not as concerned about how the safety net programs, serving uninsured and indigent clients, will be impacted once Medicaid funding starts streaming into the CCOs. “Every state needs to make pretty big changes in the way they deliver and fund health care,” she said. “Whenever you go through big changes like this, there are always concerns and worries about what the system will look like.”

Ramirez wasn’t prepared to comment on recent reforms to the Psychiatric Security Review Board, and its policies for admitting and releasing people from the Oregon State Hospital. “The learning curve is pretty steep, and I’m still learning,” she said.

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