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Medical Home Port Teams enhanced by Behavioral Health Consultants at Naval Hospital Bremerton
Story Number: NNS130617-08
6/17/2013

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- Naval Hospital Bremerton (NHB), focused on the improved standardization of patient care, is proactive with the alignment of behavioral health consultants into medical home port teams.

Since January, the consensus from both patients and provider have been positive on this endeavor. The incorporation of the two has enabled real-time, direct on-site consultation, and the immediate application of precisely targeted mental health resources directly to beneficiary care.

"The integration has worked out really great," said Lt. Cmdr. Ryan McDonald, Psy.D. "We are seeing patients who wouldn't normally come to us. We're now seeing them in their comfort level and when it's convenient for them."

With Navy medicine primary care services transitioned from an individual patient/provider model to a standardized primary care team model, there is now better access, continuity, wellness, and disease management for patients. The standardizations have improved the partnership between the patient, primary care provider, primary care team, and, as appropriate, with the families of patients. The partnership is centered on sustaining and enhancing overall patient wellness.

Behavioral Health consultants join the medical home port team consisting of a primary care manager (PCM), a registered nurse (RN), and a hospital corpsman and/or medical assistant. The team also partners with the beneficiary to fulfill administrative requests and provide additional medical services.

"We're able to accomplish a lot by now being part of Med Home Port teams," said Lt. Lindsay H. Gleason, medical services licensed clinical psychologist. "Because we're intervening early, we can catch and prevent conditions becoming major issues. The priority is on short-term treatment. When we meet with a patient, we go over their condition, share information and knowledge. There might also be some homework they take with them to help bolster the therapy."

The medical staffs do everything to help each beneficiary stick to the treatment/recovery plan from their primary care manager.

Behavioral health consultant services support medical providers and improve the effectiveness of the health care by using a team approach and addressing the entire range of the patient's presenting problems.

At the physician's request, the behavioral health consultant will conduct assessments and brief, focused interventions, gearing services toward early identification, triage, quick resolution and long-term wellness in brief appointments approximately 30 minutes in length, and assist the physician with assessment and co-management of the target problems.

Examples of the services provided by the behavioral health consultant are providing feasible new strategies for managing physical, emotional and behavioral aspects of health; clarifying and/or correcting diagnostic/problem definition; either improving or altering or discontinuing treatment; adherence interventions; when and how to assess clinical response; and relapse prevention strategies.

Mental health support focuses on taking any referral from a beneficiary to help them through habit, behavioral or emotional change. The 30-minute session concentrates on recognizing and discussing the need for intervention.

"Because we intervene earlier, we can catch and prevent general mental health problems and clinical health problems from becoming major issues," said Gleason.

General mental health problems include stress, anxiety/fears, depression, anger, relationship problems and grief or bereavement. Clinical health problems include insomnia, chronic pain, headache, fibromyalgia, tempormandibular disorders; low back pain; chronic illness management; diabetes, gastrointestinal problems; high blood pressure; hyperlipidemia, medication adherence; tobacco use; weight/diet; exercise, alcohol use; and sexual problems.

"The biggest benefit is access to care," said McDonald. "Patients are seen sooner and in a time that is convenient to them. By being embedded in family practice clinic, we get to see patients sooner rather than later. By seeing them the same day as they are having their appointment for other medical needs, we are then really providing more all-around patient-centered care."

Out of the referrals for follow-up appointment, many do not follow through with those. However, the feedback comments have been encouraging.

"Patients enjoy us being incorporated into their Med Home Port team," said McDonald. "They think it's great. Some have said, 'wow, it's about time.' They realize how much they can benefit from our services, such as getting educated on stress management or explaining to them exactly what diabetes is. We have tons of handouts on everything from tobacco cessation to hypertension. It's all knowledge they can take with them."

During a medical home port appointment, a patient's provider will share to them that there is a NHB team member they would like them to see, explaining that they are a behavioral health consultant for the clinic. The goal is to help develop a plan to manage whatever the issue and concern might be for that time.

There is ample endorsement on the move, citing improved patient satisfaction, better health outcomes, and a lowering of the bottom-line in cost.

"Dedicating time to a patient's emotional health needs when they are also here for a physical complaint just makes sense," said McDonald. "Good health is both physical and mental and our patients have expressed their approval, and by implementing a plan that is doable, a patient gains confidence to continue for the needed results they want. Ultimately, our intervention hopefully means lower cost spent overall by addressing the problem at the start and not later on."

Statistical reasoning for integrating mental health with medical home port includes 80 percent of patients nation-wide with a behavioral health disorder visit their primary provider at least once a year. Of all behavioral health disorders, 50 percent are treated in primary care, with 48 percent of the appointment for all psychotropic agents with a non-psychiatric provider. The prevalence of mental health concerns can lead to unmet behavioral health needs.

Compiled figures in the Navy and at NHB showed that 67 percent of patients with a behavioral health disorder did not get timely behavioral health treatment, and 30 to 50 percent of patients who got a referral from their provider to follow-up with an outpatient appointment do not make the first appointment. By providing the service and need during the one visit, a patient's appointment becomes a 'one-stop shopping' for their entire health and wellness needs.

Navy medicine figures also show that the top five conditions that currently drive overall health cost (combining work-related productivity with medical and pharmacy costs) are depression, obesity, arthritis, back/neck pain and anxiety. Behavioral health disorders account for half as many disability days as all physical conditions. When treated, the medical cost went down approximately 17 percent for those receiving behavioral health treatments.

Cmdr. David Thomas, deputy director for medical services, supports the combined efforts of McDonald and Gleason with the mental health departments involvement with medical home port.

"They both are local heroes for this program," said Thomas. "I love their behind-the-scenes efforts to integrate and manage care. These two do it the best."

The primary objective of the entire mental health department team is to support the fleet and maintain access to care for all eligible populations, provide care with the diagnosis and treatment of psychiatric and substance abuses disorders, and provide expert consultation to medical colleagues on inpatient and emergency department cases. For 2012, they had 11,264 total patient contacts, a 42 percent increase over 2011 (7,910). More are expected this year with the integration with medical home port.

For more news from Naval Hospital Bremerton, visit www.navy.mil/local/nhb/ .