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• Describe how integrated care increases the capacity of primary care providers to provide appropriate, evidence-based behavioral health services to their patients.
• Describe how AHEC can help foster collaboration and communication between primary care and mental health providers that improve patient outcomes.
• Identify ways to create access to the mental health services by providing primary care providers with the knowledge to diagnose and treat, when appropriate, mental health and substance abuse disorders.
ANNUAL MEDICAL COSTS FOR ADULTS Without MH With MH• All adults $1,913 $3,545• Heart Condition $4,697 $6,919• High BP $3,481 $5,492• Asthma $2,908 $4,028• Diabetes $4,172 $5,559
Robert Graham Center for Policy Studies in Family Medicine and Primary Care, March, 2008. Information from US DHHS 2002 and 2003 MEPS AHRQ
ICARE: A Brief History• 2005- Group of state leaders ( DMA, Office of Rural
Health, AHEC, NC Foundation for Advanced Health Programs) identify the need:– Decreased public mental health services– Increased patients arriving at Primary Care with
behavioral health issues– Primary Care Providers limited capacity to treat
An NC SolutionIn 2006, led by the NC Foundation for Advanced Health Programs, a group of state wide organizations dedicated to integrating medical and mental health care of North Carolinians initiated a program called ICARE.
The Vision • The ICARE Partnership seeks to increase access to
quality, evidence-based behavioral health care services for North Carolinians
The Goals1. Increase collaboration and communication between
primary care and MH/DD/SAS providers.
2. Increase the capacity of primary care providers to provide appropriate, evidence-based behavioral health services to their patients and the capacity of MH/DD/SAS providers to screen and refer for physical illness
• ARC of North Carolina• Duke Department of Psychiatry• ECU Dept Child Dev and Family Medicine• NC Area Health Education Centers• NC Council of Community Programs• NC Department of Health and Human Services: DMA, Div of
MH/DD/SAS, DPH• NC Community Care Networks• NC Medical Society• NC Psychological Association• Wake Forest University Health Sciences Department of Pediatrics
Advisory Committee• NC NASW• NC Hospital Association• National Alliance On Mental Illness- NC ( NAMI)• NC Nurses Association ( NCNA)• Governor’s Institute on Alcohol and Substance Abuse• Carolinas Health Care System• Mental Health Association of NC• NC Community Health Care Association• NC School Community Health Alliance
Local Model Development• Four areas of the state• Different approaches• 19 practices• One pilot site coordinator • Two years• Evaluation• Second round of funding for 3 Eastern sites began
January 2009- designed for SA screening, treatment, referral
www.icarenc.org• Partnership contacts• Practice models across the state• Practice tools - screening tools/algorithms• Training calendar/online courses• News/job postings• Research – ADL and bibliography• User forums• Links• Resource Directory
Clinical Consultation Use of Psychiatry• On site and telephone consultation
• Telepsychiatry
• Psychiatrists in PCP’s
• PCP’s in mental health setting
• Rapid Evaluation and Stabilization- Psychiatrist available for urgent referrals from PCP for diagnostic work up and care until return to PCP or referred psychiatrist
The Results - 3 years later….• Strong branding of ICARE name-nationally seen as a leader• Popular website • Successful pilots• Identification and work towards removing process and policy
barriers through policy brief submitted to governor of North Carolina
• Solid relationships with CCNC and Division of MH/DD/SAS and most professional associations
• Early evaluation info shows increased provider and patient
• “My background in health care tells me it makes no sense to separate mental from physical care. The best research confirms that many patients have mixed mental and physical health issues.”
• Further, North Carolina can “establish the national model for an integrated approach to behavioral and primary health services for patients with mental health, developmental disability and substance abuse problems.”