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Regional Team Meets to Improve Behavioral, Physical Care in NH

Regional Team Meets to Improve Behavioral, Physical Care in NH
From left to right: Dr. Peter Mason, the IDN DSRIP Region I medical director; Dave Berry, superintendent of the Sullivan County Department of Corrections; and A.J. Horvath, D-H Community Health Improvement consultant.

Nearly 75 employees of community-based health organizations, along with Dartmouth-Hitchcock (D-H) and Cheshire Medical Center employees, gathered in Claremont, New Hampshire, on January 25 to discuss how they will integrate and improve behavioral and physical health care services statewide as part of a five-year, $150 million federally-funded initiative.

D-H and Cheshire Medical Center are playing key coordinating roles in the federal Demonstration Waiver, a Centers for Medicare and Medicaid Services (CMS) funded initiative and are overseeing the coordination of care in Region I, comprised of 40 western New Hampshire towns in Sullivan County, the Upper Valley and Greater Monadnock region. As part of the Delivery System Reform Incentive Program (DSRIP) Waiver 1115, D-H and Cheshire are partnering with nearly 50 community-based organizations to support more than 27,000 Medicaid patients, about 9,000 of who have behavioral health needs.

The IDN DSRIP Region I kickoff meeting in Claremont provided an opportunity for attendees to share data about the current state of care and services for persons with mental health and substance use disorders, participate in team exercises and discuss how they will collectively achieve the long-term objectives for Region I. “We applied for the funding and were approved in June and then wrote and got our project plan approved in December, which provided a high level set of plans for the work from now until December 30, 2020,” said D-H’s Vice President of Community Health Sally Kraft, MD, MPH. “Now we are working on detailed plans and focusing on what we can get done in the next weeks, months and then years.”

The community-based partners who are participating in the program include social service organizations, hospitals, county facilities, general health providers and behavioral health providers, including mental health and substance use disorders services. These partnerships are designed to improve and integrate delivery of behavioral and physical health care to vulnerable populations. The project is engaging the resources of D-H’s Department of Psychiatry and building from components of the highly successful Healthy Monadnock program at Cheshire. D-H clinics in Concord, Manchester and Nashua are also participating in the creation of Integrated Delivery Networks (IDNs) elsewhere in the state; overall, D-H is involved with thousands of patients who have behavioral health needs among the more than 180,000 Medicaid-designated patients throughout the state.

Dennis Calcutt, chair of the Region I Executive Committee, welcomed the IDN DSRIP Region I participants to the nearly daylong kickoff at Claremont’s Common Man Inn and Restaurant and introduced the speakers. Jeanne Ryer, MS, director of the Citizens Health Initiative in Concord, spoke about “Integrating Behavioral Health and Primary Care in New Hampshire: Results of the New Hampshire Behavioral Health Integration Learning Collaborative Year One.” Ryer asked, “Why integrate Primary Care and behavioral health care in New Hampshire?” She then cited the following reasons:

  • One in four New Hampshire residents (300,000) have a diagnosable behavioral health condition
  • One in six residents (200,000) have depression
  • One in 14 (87,000) residents have alcohol dependence
  • One in 30 (37,000) residents are dependent on illegal drugs (not including prescription drugs

How does this impact the health system? Ryer noted that about half of behavioral health care takes place in a Primary Care setting and that 27 percent of Primary Care visits are related to a behavioral health condition. Nearly 13 percent of Emergency Department visits are related to a mental health condition. Additionally, people with chronic medical conditions have high rates of co-occurring behavioral health conditions. Under age 65, 40 percent of persons suffering from depression or anxiety have co-occurring chronic illnesses and over age 65, the number jumps to 80 percent.

The Director of the New Hampshire Community Health Institute Jonathan Stewart, MA, MHA, regional director, U.S. Health Services, Northern New England, then spoke about the key findings of the Region I behavioral health needs assessment. The participants included 571 consumers, 172 providers and 79 caregivers. Of consumers surveyed, 51 percent responded that a health professional has expressed concern that they may have a mental health condition and nearly 20 percent said that concern has been expressed about a substance use problem. Many had received mental health care in the past 12 months, but for those who hadn’t, 28.5 percent said it was because they couldn’t get an appointment and 18 percent said it was because health insurance didn’t cover the service.

In discussion groups with nearly 50 consumers and 55 providers, participants pointed to a number of care areas that need improvement for those seeking behavioral health and substance use treatment. These include:

  • An increased workforce capacity to help reduce case management turnover
  • Expanded services and resources to reduce waits for treatment
  • Increased family involvement and caregiver support
  • Treating patients with trust and respect
  • Community and life skills support
  • More supportive recovery lifestyle housing
  • Improved service coordination and system integration of care

The afternoon session was highlighted by three team breakout sessions. Among the takeaways were:

  • There are already many successes in the community and information needs to be shared so that organizations can learn from each other about what is and isn’t working.
  • A strong emphasis needs to be placed on ensuring that care is person-centered and person-driven.
  • Some available resources are not being tapped; connecting patients and organizations to those resources is crucial.
  • Medication-assisted treatment for patients with opioid substance use disorder is not an “either/or” but a solution that can be offered.

By the end of the afternoon session, many attendees had volunteered for project teams, which will examine a number of topics as the initiative moves forward. Kraft said their goals include involving patients and families in the care process and using data to guide and measure the effectiveness of their work. “There was a lot of enthusiasm here today, and all of us are excited to be working together to improve care for this under-served population,” said Kraft, who is co-administrative leader of the initiative along with Dr. Don Caruso, CEO and president and chief medical officer of Cheshire Medical Center. “We have a lot of very smart, passionate people who are eager to share their knowledge, ideas and best practices as we move forward to address the needs of our communities.”

Caruso said he was pleased with the inaugural IDN DSRIP Region I meeting. “The commitment to changing how we provide care was self-evident throughout the day. There was a strong desire to move beyond the barriers that have kept us all from providing better outcomes.”


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