Citizens Medical Center Renews Focus on Behavioral Health

by HCE Exchange on March 15, 2014

CMC-thumbStephen Thames, Chief Executive Officer, Citizens Medical Center and David Way, Associate Executive Director & Corporate Integrity Officer, Gulf Bend Center

Improving behavioral healthcare is a vital part of treating the whole patient and is an area with which many hospitals struggle, especially when it involves integrating behavioral health with the rest of their service line.

One Texas hospital is partnering with a mental health provider to coordinate care and better serve its patient population.

Recognizing the gap in behavioral health care

Citizens Medical Center is a 344-bed not-for-profit acute-care hospital in Victoria County, Texas. It has a referral area of approximately 140,000 people in Victoria and the surrounding counties. Like many hospitals, its ability to provide adequate mental healthcare to patients was limited to mostly those patients with severe issues.

“There has been a gap between patients that meet the criteria for inpatient psychiatric services at a long-term psychiatric institution and patients that don’t qualify for inpatient services, but may not be safely discharged from the emergency department or acute-care setting,” said Stephen Thames, chief executive officer of Citizens Medical Center.

The emergency department has been the default location for patients with a behavioral-health crisis that often leads to a medical crisis. In fact, many patients have been brought to the emergency department before being taken to jail.

Ultimately, the hospital treated the patient’s medical condition, but not the underlying mental-health condition.

Thames said situations were also presented to the hospital in which the physician didn’t feel comfortable discharging the patient, but the patient wasn’t sick enough for inpatient care. Very few patients would seek mental healthcare on their own after discharge.

Conversely, the Gulf Bend Center, a mental health and intellectual and developmental disabilities facility, found that many of its patients had comorbid conditions such as diabetes, congestive heart failure, or obesity and needed medical care.

Creating a partnership across multiple organizations

The two facilities began working together after Texas implemented a Medicaid 1115 waiver. This transformational waiver encourages facilities to begin integrating services in an effort to provide patients with higher-quality, more efficient care. In turn, healthcare organizations would receive financial incentives.

Since one of the areas of emphasis in the waiver is behavioral health, Citizens Medical Center and Gulf Bend Center began discussing how to best utilize waiver funds in order to improve patient care overall.

The Gulf Bend Center is one of 39 mental health centers covering the state, and one of only a handful that has built projects for patients with comorbid conditions rather than remaining siloed into providing only mental health services. This placed it in an ideal position to develop a cooperative relationship with the hospital.

“Once a dialogue began, we realized we had a great opportunity to work together to provide a valuable service to the patients and the community, and in the process, both organizations would spend less money and better utilize the waiver funds,” Thames said.

“The hospital needs to prevent readmissions, unnecessary admissions, and reduce the burden on the emergency room; the Gulf Bend Center needs to get patients in for treatment,” David Way, associate executive director and corporate integrity officer at Gulf Bend Center, said. “We are serving the same person, and coming together to treat the whole patient in the end rewards the patient, the agencies involved, and our organizations, which have more funds to reinvest into services.”

To help bridge the gap Thames mentioned, Gulf Bend Center was awarded a grant from the Texas Department of State Health Services and a matching local in-kind grant from Citizens Medical Center that allowed it to create an outpatient extended observation unit at Citizens for patients who fail to qualify for inpatient care, yet need evaluation, intense counseling, or medication review.

Patients can be referred from the emergency department, acute care, or a mental health clinic and can stay 12 to 48 hours. Citizens Medical Center’s matching funds cover lease space and nursing services. The hospital’s on-site behavioral health consultation group provides discharge planning and assists Gulf Bend’s qualified professionals with evaluation.

“The patient wins because they now receive the appropriate level of care in the least restrictive setting,” Way said. “Being in the hospital also helps us reach patients at the moment they need us most. If they leave the hospital without an evaluation, we are more likely to lose them.”

Although the hospital and Gulf Bend are the primary parties involved, this venture has helped local law enforcement, EMTs, and hospital providers and staff to successfully treat those in a mental health crisis. Law enforcement officers can now bring these patients directly to the extended observation unit, which alleviates the burden on the emergency department. Gulf Bend may also send a professional to the officer’s location to triage the patient.

Developing systems to function in a changing healthcare industry

The advancements made in behavioral healthcare are just one of the ways in which Citizens Medical Center is changing the way care is delivered even as it embraces the true meaning of healthcare reform.

Citizens is developing an accountable care organization model and moving toward becoming a patient-centered medical home. The organization has pulled together the resources of 12 nursing homes, home health providers, a retail pharmacy, durable medical equipment, Gulf Bend, and others to coordinate care, manage dollars, and avoid waste in redundant administrative fees. These alliances will help the organization improve operations in a pay-for-performance world.

Thames and Way strongly believe that integrating services and streamlining the continuum of care is implementing the true intent of the Affordable Care Act and represents the best practice going forward.

“You cannot bring about change by reworking what we’ve been doing,” Way said. “There has to be a paradigm shift.”

by Patricia Chaney

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