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Bridging the Gap in Healthcare
April 2, 2012 @ 4:11pm | Rodika Tollefson
Individuals with severe or chronic mental illness live 20 to 25 years less, on average, for a variety of reasons including poverty and lack of medical care. Kitsap Mental Health Services and Harrison Health Partners are trying to bridge the gap in health care access for these individuals by partnering up to offer primary care.
As part of the collaborative effort, a Harrison primary care physician offers weekly appointments at the KMHS outpatient offices. KMHS staff coordinate and facilitate the appointments, and the care is integrated into the patients’ case management.
“These people have difficulty accessing care. They feel comfortable here and with the people working with them here who can help them accomplish what they need,” said Dr. David Beck, KMHS medical director. “The access to care criteria is fairly restrictive (for them) and they have difficulty functioning in the community. They usually have medical needs that haven’t been addressed.”
He said in addition to the patients having difficulty being in a regular medical setting, the system itself is under pressure, especially to serve low-income and uninsured individuals. “That system — including the community health centers — is under stress. It’s stretched so far that it’s difficult to address the depth of their needs,” he said.
A conference room has been converted into two exam rooms and outfitted by Harrison Health Partners (which is part of Harrison Medical Center) with the same equipment used at a regular clinic. The patients’ medical records are also integrated into Harrison’s electronic health records.
“By bringing the care on site, it enables the KMHS care team to participate in the primary care and support of the patients,” Beck said. “The system is no different from the care they’d get somewhere else, including after hours and urgent care and other services.”
Dr. Hector Reyes, who practices at the Harrison Port Orchard Clinic, began seeing patients at KHMS at the beginning of this year. The first appointments for new patients last as long as an hour and a half, and subsequent appointments are also longer than in a general setting. When Reyes is on site, it’s common for KMHS medical staff to walk to his office in between appointments to discuss a patient’s case, and KMHS case managers also follow up on the physician’s instructions. Clients may choose to make appointments with Reyes off-site as well.
“We see this as a really important opportunity to collaborate with Kitsap Mental Health and provide a service to these clients that they wouldn’t get otherwise,” said Gary Kriedberg, director of operations for Harrison Health Partners. “We were especially excited about this program because it’s so unique and not happening in many communities.”
The collaborative effort has been in the planning stages for a year, as the two organizations coordinated everything from electronic records to billing aspects. Beck, who is a board-certified internist, said he has worked in the community health system for many years and knew they would need a community partner to be able to address the medical needs.
“The community partner that stepped up was Harrison,” he said. He gave an example of how this partnership can impact the patients: When a KMHS client was hospitalized recently, Dr. Reyes worked with the in-patient team to make decisions.
“It’s never happened before where we could phone the patient’s doctor and have him respond so knowledgeably,” he said.
On a typical day at the Port Orchard clinic, Reyes would see as many as 20 patients. At KMHS, he wouldn’t see more than eight new patients. The environment, however, is the same — including his medical assistant and the setup of the exam rooms.
“You have a population of people with difficulty accessing care so you bring the care to them,” Beck said. “The other important part is the degree of integration of the two systems.”
Reyes has been in primary care since 2004 and says his work with KMHS patients is a natural extension of what he does. He started his career in public health, and has also worked with rural and underserved populations.
“The health care delivery system needs to be improved and in some little way, I try to contribute to repair it,” he said.
Kriedberg said now that the partnership is working well, the model could be expanded. One idea would be to have a Kitsap Mental Health provider available at the new primary care clinic in Bremerton to serve patients who would not qualify for KMHS services otherwise because of the narrow clinical criteria they would have to meet.
Kitsap Mental Health Services serves about 3,500 adults through in — and out-patient programs as well as 1,500 children every year. The primary care program is available to adults, and the two organizations expect to serve about 100 patients per year.
“It’s been a very rewarding experience so far for me, as an administrator, to see the kind of impact we’ve had on these patients in a short period of time,” Kriedberg said.
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