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Integrated Care in the Real World

Integrated Care in the Real World. presented at the NIDA CTN CTP Caucus Meeting Washington, D.C., March 15, 2011, by John G. Gardin II, Ph.D. Director of Behavioral Health & Research, ADAPT, Inc. Administrator, SouthRiver Community Health Center

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Integrated Care in the Real World

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  1. Integrated Care in the Real World • presented at the • NIDA CTN CTP Caucus Meeting • Washington, D.C., March 15, 2011, 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

  2. ADAPT, Inc. • Incorporated in 1971 • Serving 3 counties • SUD: OPT, Res (adult/adolescent) • MH: OPT (adult/adolescent) • Gambling • Corrections/Drug Court • Prevention • Primary Care +

  3. HRSA RHO GrantMay 2006-May 2009 • To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon

  4. Results • Screened approximately 2,000 patients/year (20% of total patients per year) • Providing treatment to about 15%; 50% of these were 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%

  5. Overcoming Barriers • Full-time co-location of BHC in clinic • Modified SBIrT model • Staffed by LCSW • Establishment of RHC FQHC-LA FQHC? • Adaptation to medical clinic schedule/routine • “Open” cases; brief sessions; available; M&G • Behavioral Medicine billing codes (96150-96155) • Use of EBPs

  6. What is Working • Medical Assistants • Overbooking - 50% no show rate • Increased appropriate use of psychotropics • 15-20 minutes session/brief therapy • Use of Behavioral Medicine Codes

  7. Continuing Challenges • Training issues with CMAs • Training issues with providers • Schedule challenges • Same-day appointments • Poor penetration of SUD involved patients • eMR and confidentiality

  8. Dr. John Gardin(541) 672-2691drjohngardin2@mac.com

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