When primary care and mental healthcare delivery are both paramount, innovation needs to happen at every place the patient arrives—especially at the physician practice level. This mantra, born out of a statewide telehealth initiative, is transforming the way Colorado primary care physicians and mental health professionals interact, share data and serve their patients.
Colorado is a state with two realities where healthcare is concerned: Clusters of robust, high-tech cities are packed with healthcare resources, but delivery is challenging in the rest of the vast state. The state census includes large Medicaid populations, high volumes of military veterans and one of the highest suicide rates in the country. Abuses of methamphetamines, heroin and prescription opiates are all on the rise. Faced with high needs for behavioral healthcare and huge expanses of unconnected rural regions, Colorado’s Transforming Clinical Practice Initiative (TCPI) was a project begging to happen.
The initiative to connect primary care practices with mental health specialists began in 2015 as part of a $65 million federally funded statewide innovation project. Today, about 350 physician and specialist practices and four community mental health centers are part of the program, totaling nearly 2,000 clinicians.
The project has been a major culture shift, since few programs outside of Medicaid and the Veterans Administration have made any attempts to combine primary care and behavioral healthcare, explains Barbara Martin, R.N., the director of the clinical practice transformation initiative. “We're reaching a threshold of primary care providers who understand the value of integrating behavioral health and connecting with behavioral health providers,” she says. “Right now, we’re impacting about 25 percent of our primary care, and we have a variety of behavioral health providers from mental health centers to independent practitioners that work with our physician practices. We encourage them to develop different integration models that fit their patient population’s needs and the kind of business support they need. We make sure they have the systems in place to manage their populations and provide access to that behavioral health service.”
Health IT implementation is a cornerstone of the program, providing connectivity and business support to help clinicians work smarter. Making sure specialists and physician practices have the IT assistance they need spawned the launch of a new IT troubleshooting squad called the Clinical Health Information Technology Advisors (CHITAs). CHITA members work onsite to help practices implement technology and turn their data into actionable changes, including electronic health records (EHRs), quality care reporting, workflows and data validation. For example, practices often have an EHR, but may not understand how to assess the reports for accuracy or to mine them for deeper intelligence on population health or reimbursement issues, explains CHITA member Andrew Bienstock in a recent podcast. “A big part of the CHITA role is to make sure those numbers are correct before they’re reported to Medicare or others.”
The initiative also employs 21 “health connectors” who liaison with physician practices and public health agencies, says Heather Grimshaw, communications manager for the state’s innovation model initiative. “It’s part of ensuring that practices have access to the community-based resources that can help their patients with the different issues they're dealing with, including mental health.”
Transforming the way clinicians do their work and the way patients can access resources is also population health at its prime. To that goal, the team launched a web-based app and a targeted outreach campaign to engage at-risk patient populations. “We fund 31 of 64 counties in the state to support initiatives that are focused on reducing mental health stigma and improving mental health wellness,” Martin explains. “One outcome of that is web-based app called Let’s Talk that helps people start a conversation about health and wellness, including how to discuss issues with family and friends, and that it’s okay to reach out for help. It’s very much a stigma-reducing campaign. Another focus is an outreach campaign for men in depression because we have really high depression and suicide rates in men in Colorado.”
In May, the TCPI released its first call-to-action, a 41-page report that explored the state’s gap analyses in behavioral healthcare services and the heightened need for including social determinants in primary care data-gathering. Among its findings, the report identified men and boys as the populations in most urgent need for behavioral services yet are among the least served. The call to action emphasizes the need to focus on these populations within the primary care setting, asking questions about mental health, depression and drug abuse at each primary care visit, while clearing the obstacles to access for behavioral health services.
As the TCPI project matures, the state will be improving physician workflow, patient access to health services and population health efforts all at the same time. Providing easy access to health resources is a boon for both providers and patients, especially for Medicaid beneficiaries and other high-risk populations, Martin says.
And, since Colorado happens to be one of the few states in the country with a publicly available all-payer claims database, that wealth of claims data isn’t just for payers anymore. “It’s about engaging the patients as well as insurers and employers, since it's been hard to connect some of those dots and show that people can use the available data to make more informed health choices.”
To learn more about the CHITA workforce and its roles in getting physician practices engaged with their technology, listen to this TCPI podcast (April 2018)
Pamela Tabar is a healthcare writer in Medina, Ohio.