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8/ accessHealthnews.net Summer 2013 ER to Medical Homes A village approach to treating mental illness By Tonia Wright Behavioral health Integrating a behavior health consultant (BHC) with primary care, Braucher said, helps to jumpstart care following a positive depression screen. He said the care can be handled within the primary care setting or, if necessary, referred to a specialist for high-intensity, chronic, psychiatric conditions. "A behavior health consultant can see a patient in the primary care exam room, with minimal interruption to the primacy care provider's schedule, and provide feedback and recommendations as well as immediate interventions with the patient," Braucher said. If you've ever watched primetime TV dramas like ER, Grey's Anatomy or HOUSE, emergency room scenes usually depict trauma victims or morbid, hard-to-diagnose ailments that come on suddenly and bewilder both the doctor and ER staff. describes a health care home as a coordinated system of health care delivery that brings together doctors, nurses, pharmacists, mental health providers and in some cases social workers to ensure patient care is met. However, Box says the onus is still on the patient to be an active player in his or her The reality is, ERs across both health and wellness. urban and rural America are packed with patients who need "While the patient is at the treatment for things like kidney center of the care, it is my belief infections, infected wounds, that ultimately the patient has diabetes complications, dental to become more actively problems, mental health involved in their care," he said. disorders and other ailments "The patient must be aware of that could be treated with what is leading to their current routine preventive care. health status. It could be a failure to exercise, tobacco use, To be fair, many individuals and a lack of self-maintenance without health insurance use the like not monitoring blood sugar, ER for that reason. However, blood pressure, or any number wait times for physician visits is of factors." another frequently cited reason for ER misuse. According to Pathway Community Health's John Other top reasons patients visit Braucher, director of the ER, according to industry collaborative care, health care data, is a lack of primary care home environments coalesce providers, inability to access treatment with improving the care, substance abuse and patient's health IQ. This is done mental illness. through prevention activities, self-management skills and Health care home follow-through with the Primary care providers, mental provider's recommendations. health providers and ER doctors Braucher adds that the expected are keenly aware of the issues. outcome is an improved patient In West Central Missouri, health health status and reduced ER care providers like Pathways utilization. Community Health, Lafayette Regional Health Center (LRHC), "This is important to the patient I-70 Community Hospital and because their quality of life is Live Well Health & Wellness linked to many of the health Center of Waverly are status indicators," Braucher collaborating to create health said. "The collaborative manner care homes to reduce avoidable in which care is provided ER visits. encourages self-efficacy, which can cause a ripple effect towards LRHC CEO Darrel Box a sense of happiness." There was a time when hospitals could contact an "oncall" therapist from a community mental health center for ER patients suffering from a mental health condition. However, stronger regulations on patient care require mental health providers to be on the hospital staff or to be contracted by the facility in order to provide service. "To have collaboration between the ER doctor, primacy care provider and mental health provider is extremely helpful," Braucher said. "It helps with follow-up visits, coordination of care and establishing patterns of patient behaviors as they emerge. It also increases trust between participants – especially when they all benefit from the overall cost reduction." Reducing costs Electronic health records is one example of cost reduction. Braucher said after an ER visit, a patient's discharge records can be sent from a hospital ER to a local clinic within a 24-hour period that enables the patient to receive an immediate, priority, follow-up visit with a primary care provider. With that, he also stresses the need for more funding to increase access to mental health care at Federally Qualified Health Centers (FQHCs) and look-alike rural health clinics, where many people go initially to have their mental health care needs met. Conversely, community mental health centers should also be equipped to head off crisis situations in the ER, whether the situation includes behavioral health, dental or primary care. "We also need to normalize the behavioral health consultants' role in clinics that are not Medicaid-laden," he said. Telehealth has the capacity to reduce costs, too. Mental health care providers, like Pathways, are using telehealth as a means to treat more patients and to reduce or eliminate wait times to see therapists. In the case of mental health care in the ER, on-call, telehealth-equipped mental health professionals can be accessed in minutes to provide immediate care. Box said, with technologies working in tandem, the ER visit may be avoidable for certain patients. The Health Care Collaborative (HCC) of Rural Missouri has been working for several years to integrate telehealth into rural health care. With plans underway to equip its rural health clinic in Waverly with telehealth capabilities, the nonprofit is also working to establish daily clinics that provide "ER diversion" services for both primary care and mental health patients. HCC plans to have these services available in 2014. Removing the mental health stigma is another strategy to reduce ER use and cut costs. According to the National Institute of Mental Health, about 26 percent of American adults have a diagnosable mental health disorder. "That's slightly more than one in four people who experience some kind of episode in a given year," Box said. In January 2014, the Affordable Care Act mandates that insurance companies will no longer be able to deny coverage for anyone with a pre-existing mental health condition. "We have to help people understand that a mental health disorder is not a weakness and it's okay to acknowledge a need for help," Box said. "Seeking mental health care does not mean you are 'crazy'. It's just another disorder like diabetes or heart disease." accessHealthNews.net accessHealthNews.net

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