Integrated Care in the Real World

presented at the

NIDA CTN Steering Committee MeetingWashington, D.C., September 21, 2010, by

John G. Gardin II, Ph.D.Director of Behavioral Health & Research, ADAPT, Inc.Administrator, SouthRiver Community Health Center

Clinical Assistant Professor, Oregon Health Sciences University Medical School

This project was funded by HRSA/DHHS Rural Health Outreach Grant #1D04RH06903-01.00

ADAPT, Inc.Incorporated in 1971Serving 3 countiesSUD: OPT, Res (adult/adolescent)MH: OPT (adult/adolescent)GamblingCorrections/Drug CourtPreventionPrimary Care +

HRSA RHO Grant

To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon

Barriers to Integrated Care in the Primary Care Setting

Lack of time

Lack of skills

Beliefs and attitudes about SUD/MH

Lack of confidence in SUD/MH treatment

HIPAA/42CFR Part 2

Billing, records

Sustainability

Overcoming Barriers

Staffed by LCSW and establishment of FQHC LA

Full-time co-location in clinic

Adaptation to medical clinic schedule/routine

“Open” cases; brief sessions; available

Modified SBIrT model

Behavioral Medicine billing codes (96150-96155)

Use of EBPs

Results

Screened approximately 2,000 patients/year (20% of total patients per year)

Providing treatment to about 15%; 50% of these are Medicaid patients

30% of Medicaid patients provided 70% of utilization (“frequent flyers”)

64% showed significant improvement (HADS)

Overall medical utilization by Medicaid patients decreased by 13%

For “frequent flyer” Medicaid patients, decreased medical utilization by 33%*

“Frequent flyers” had significantly less (p<.01) medical utilization after BHC sessions for both OPT and ER visits

Low utilizers had more visits after BHC contact (not significant)

Dr. John Gardin(541) 672-2691

drjohngardin2@mac.com