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Integrated Care in the Real World

Integrated Care in the Real World. presented at the NIDA CTN Steering Committee Meeting Washington, D.C., September 21, 2010, 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 Steering Committee Meeting • Washington, D.C., September 21, 2010, 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 Grant • To develop an integrated care model situated in free-standing, primary care private practices in Roseburg, Oregon

  4. Barriers to Integrated Care in the Primary Care Setting • Lack of time • Lack of skills • Beliefs and attitudes about SUD/MH • Lack of confidence in SUD/MH treatment • HIPAA/42CFR Part 2 • Billing, records • Sustainability

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

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

  7. “Frequent flyers” had significantly less (p<.01) medical utilization after BHC sessions for both OPT and ER visits

  8. Low utilizers had more visits after BHC contact (not significant)

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

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