The trend toward population health was one of the factors that spurred Trinitas Regional Medical Center and St. Joseph’s Regional Medical Center to merge their behavioral health programs in July 2016 into the new Integrated Behavioral Health Network. The hospitals, 30 minutes apart in northern New Jersey and sponsored by the Sisters of Charity of St. Elizabeth, serve largely low-income and racially diverse patient populations.
Leaders hope the partnership will help them recruit much-needed psychiatrists and prepare the institutions for the future.
Behavioral health in the state’s Medicaid program still is paid on a fee-for-service basis, but James McCreath, Trinitas vice president of behavioral health, predicts that New Jersey will move toward managed care contracts for these services.
“Our belief is those managed care entities are going to be looking to contract with larger, regional entities to be able to manage a larger population and achieve one of the newer goals in behavioral health, which is integration with primary care,” says McCreath, the health network’s executive director. “Having two large regional medical centers sponsor this larger, regional behavioral program is ideal because of our depth in primary care as well as psychiatric care.”
The partnership involves standardizing treatment protocols to reduce clinical variation and to better understand the cost of cycles of care. “It puts you in stronger position to negotiate contracts in population management deals, which is what the Affordable Care Act was trying to bring,” says Carlos A. Rueda, M.D., the network’s regional chairman of psychiatry/behavioral health. “In value-based health care delivery and population health models, knowing your cycles of care and controlling your clinical variation will yield more effective and efficient contracts.”
The partners are beginning work to integrate behavioral health and primary care. Trinitas was awarded a four-year, $1.6 million federal grant to open a primary care clinic in its outpatient mental health center, which serves patients with severe psychiatric disorders.
“These are folks who can be homeless; they can be involved with substance abuse and often lack family support or any kind of social support,” McCreath says. “They’re unemployed, on Medicare, Medicaid, Supplemental Security Income or Social Security Disability [Insurance]. No one is really engaging them in any kind of primary care.”
At the new clinic, advanced-practice nurses screen patients for chronic illnesses and help patients to manage them; refer patients to specialists as needed; conduct labs; and work on such wellness issues as weight loss and smoking cessation.The program will track patients’ progress in controlling chronic illnesses over time. “We’re seeing people who at first lab have A1Cs of 9 or 10 [high blood sugar levels],” McCreath says. “We’re immediately working with them and monitoring those successive lab tests to see if we can bring that A1C down.”