Integrated
Care
at
the
    Medical
Home

 September 25, 2009

 Steve.Hurd@stmarygj.org
      970.244.2235
Marillac
Clinic
Grand
Junction,
CO




                     2
Brief
History
of
Marillac


• Started in 1987 after United Way needs assessment

• Sponsored by Sisters of Charity Leavenw...
The Medical Home Motto:

  “The right care, at the right place,
          at the right time.”




                        ...
5
Guiding Philosophy:
Meeting several patient needs
 in one visit results in greater
efficiency for both patient and
       ...
Marillac’s
Model

Five Lines of Service - All Under One Roof
           •    Medical
           •    Mental Health
       ...
Clinic
Eligibility

• At or below 250% of federal
  poverty level
• Mesa County residents
• 20,000 Uninsured in Mesa Co

 ...

Patient
Panel
-
2008

• 7650 Unduplicated Patients

• 29,300 Visits

• 20,000 Uninsured in Mesa Co


                    ...

Staffing
Pattern

• Size: 72 FTE

• 150 Referral Specialists- Sliding Scale

• Lab & Radiology – Sliding Scale

• Annual ...
Marillac
Revenue
Sources

                FY
08
-
09

      20%             21%




                                  Pati...
Operations
• LEAN Principles
  - Use of Impact Grids
  - Reduce Variability / Eliminate Waste
• Process Improvement
  - Ho...
Integrated
Care
-
Defined


Medical and Behavioral Health providers
work side-by-side to improve clinical and
functional o...
Prevalence
    Comparisons
 Marillac Clinic vs.                PHQ 3000

Major Depression

         Anxiety

  Panic Disor...
Location,
Location,
Location

   B Health        FamilyHealth
                      B Therapist      Addictions
          ...
Outcomes
             Utilization of ER and Inpatient Services
             by Marillac’s Integrated Care Patients


30.0%...

Inpatient
Psychiatric
Costs

         Jan
–
Apr
2003
vs.
Jan
–
Apr
2004


400000
                 341366
318750
         ...

 
          Fiscal
Sustainability
























via

 
          Blended
Funding




                          ...

 
          Fiscal
Sustainability
























via

 
          Blended
Funding
  • Shared savings from St. Ma...
18
Advantages
of

       Blended
Funding
• Removes barriers to care
• Patients need to present at only one
  location
• Encou...
Service
Delivery


• Delivery model is spontaneous –
  introductions, hallway consults

• Both medical and mental health p...
Advantages
of
Integrating
     
Medical
&
Mental
Health
                for
Patients

• More convenience
• Less stigma, mo...
Advantages
of
Integrating
        
Medical
&
Mental
Health
                   for
Providers
• Better match between provide...
Advantages
of
Integrating
     
Medical
&
Mental
Health
            Healthcare
System

• Simplified record-keeping
• More ...
Marillac
 Clinic
Bridging the healthcare gap
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2009 06 09 Integrated Care At Medical Home

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“The right care, at the right place, at the right time.” This is a presentation of the Marillac Clinic (located in Grand Junction, Colorado) model of Integrated Medical Care. This clinic serves the uninsured and under-insured. It is an affordable health care model of a Medical Home. Marillac provide primary care.

Published in: Health & Medicine, Business
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2009 06 09 Integrated Care At Medical Home

  1. 1. Integrated
Care
at
the Medical
Home
 September 25, 2009 Steve.Hurd@stmarygj.org 970.244.2235
  2. 2. Marillac
Clinic Grand
Junction,
CO 2
  3. 3. Brief
History
of
Marillac • Started in 1987 after United Way needs assessment • Sponsored by Sisters of Charity Leavenworth • Shared mission and values with affiliate hospital (St. Mary’s) 3
  4. 4. The Medical Home Motto: “The right care, at the right place, at the right time.” 4
  5. 5. 5
  6. 6. Guiding Philosophy: Meeting several patient needs in one visit results in greater efficiency for both patient and provider. 5
  7. 7. Marillac’s
Model Five Lines of Service - All Under One Roof • Medical • Mental Health • Dental • Optical • Low Cost Pharmaceuticals No Wrong Door 6
  8. 8. Clinic
Eligibility • At or below 250% of federal poverty level • Mesa County residents • 20,000 Uninsured in Mesa Co 7
  9. 9. 
Patient
Panel
-
2008 • 7650 Unduplicated Patients • 29,300 Visits • 20,000 Uninsured in Mesa Co 8
  10. 10. 
Staffing
Pattern • Size: 72 FTE • 150 Referral Specialists- Sliding Scale • Lab & Radiology – Sliding Scale • Annual Budget = $7.5 million 9
  11. 11. Marillac
Revenue
Sources
 FY
08
-
09 20% 21% Patient Fees St. Mary's Hospital SCLHS Sponsorship Local Philanthropy Tobacco Tax Foundations 16% 18% 12% 13% 10
  12. 12. Operations • LEAN Principles - Use of Impact Grids - Reduce Variability / Eliminate Waste • Process Improvement - Horizontal teams meet weekly - Reduce variability/Eliminate waste • Incorporate Patient Feedback 11
  13. 13. Integrated
Care
-
Defined Medical and Behavioral Health providers work side-by-side to improve clinical and functional outcomes for patients with chronic medical and psychiatric conditions. Psychiatry consultation available. 12
  14. 14. Prevalence Comparisons Marillac Clinic vs. PHQ 3000 Major Depression Anxiety Panic Disorder Alcohol Binge Eating Any Diagnosis 0% 15% 30% 45% 60%
  15. 15. Location,
Location,
Location B Health FamilyHealth B Therapist Addictions B Health Case Care Psychologist Specialist & Specialist Psychiatrist Counselor Specialist Manager Medical Medical Exam Exam Rooms Room Rooms Room Medical Provider Medical Medical Exam Stations Exam Rooms Room Rooms Room Bathroom Bathroom Medical Medical Exam Medical Exam Rooms Room Assistant Rooms Room Stations Medical Medical Exam Exam Rooms Room Rooms Room Reception Front Office 14
  16. 16. Outcomes Utilization of ER and Inpatient Services by Marillac’s Integrated Care Patients 30.0% 22.5% 15.0% 9.00% 8.00% 8.00% 7.5% 6.00% 4.00% 0% Year 1 Year 2 Year 3 Year 4 Year 4.5 Hospitalization E.R. Visit 15
  17. 17. 
Inpatient
Psychiatric
Costs
 Jan
–
Apr
2003
vs.
Jan
–
Apr
2004 400000 341366 318750 Annualized savings: 237500 $685, 539 156250 112853 75000 2003 2004 16
  18. 18. 
 
 Fiscal
Sustainability 























via 
 
 Blended
Funding 17
  19. 19. 
 
 Fiscal
Sustainability 























via 
 
 Blended
Funding • Shared savings from St. Mary’s Hospital and Colorado West Mental Health • United Way • Foundations • Patient Fees 17
  20. 20. 18
  21. 21. Advantages
of
 Blended
Funding • Removes barriers to care • Patients need to present at only one location • Encourages development of one treatment plan • Billing through CPT coding is eliminated 18
  22. 22. Service
Delivery • Delivery model is spontaneous – introductions, hallway consults • Both medical and mental health providers expect to be interrupted to assist one another • All providers work from the same medical record 19
  23. 23. Advantages
of
Integrating 
Medical
&
Mental
Health for
Patients • More convenience • Less stigma, more patient follow-through • Team approach leads to more accurate diagnoses, higher quality, and more holistic care • Encourages self-management of illness • Greater satisfaction 20
  24. 24. Advantages
of
Integrating 
Medical
&
Mental
Health for
Providers • Better match between provider skills and patient needs • Allows development of common treatment plan and consistency between providers • Enhances knowledge and skills for providers • Better exchange of information between disciplines • Shared responsibility for patient care • Reduces professional isolation 21
  25. 25. Advantages
of
Integrating 
Medical
&
Mental
Health Healthcare
System • Simplified record-keeping • More opportunities for mid-level and mental health providers to leverage physician resources • Less likely to have duplicative or dangerous medication complications • Greater emphasis on prevention and early intervention 22
  26. 26. Marillac Clinic Bridging the healthcare gap

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