Description

In northeast Mississippi, the number of patients per primary care provider far exceeded the national average. This was directly affecting patients at LIFECORE Health Group's mental health centers. Sixty-eight percent of LIFECORE patients had co-occurring physical illness. Patients' medical conditions were not improving at the rate necessary to gain full health.

In 2012, LIFECORE created the state's first integrated care delivery model. Patients around the 7-county designated Health Professionals Shortage Areas (HPSAs) now have full access to both primary and mental healthcare in one location.

LIFECORE primarily serves children and adolescents who suffer from severe emotional disturbances and adults who suffer from chronic behavioral health disorders or chemical dependency. Their goal is to help patients function independently while lowering the amount of psychiatric hospital admissions or placements in long-term institutions. With this integrated care delivery model, LIFECORE patients can connect with both behavioral health and primary care services services from one location.

As a regional community mental health center, LIFECORE is supervised by a regional commission under the Mississippi Department of Mental Health. LIFECORE partners with the University of Southern Mississippi to recruit nurses who gain dual certification as a psychiatric nurse and a nurse practitioner, a USM program funded by Health Resources and Services Administration (HRSA). This helps bridge the gap for the shortage of psychiatrists and has added to the LIFECORE workforce. The Mississippi Rural Health Association is also a LIFECORE partner and supports their work.

In addition to revenue generated from insurance reimbursements, LIFECORE has received grants through the Mississippi Department of Mental Health that support this integrated care delivery model.

Services offered

The 220 LIFECORE staff include health professionals who work together to meet both physical and behavioral health needs of patients. The following are licensed and clinical staff who cross-refer patients.

• Child/Adolescent Psychiatrists
• Adult Psychiatrists
• Family Practice Physicians
• Family Nurse Practitioners
• Psychiatric Nurse Practitioners
• RNs and LPNs
• Clinical Psychologists
• Master's Level Therapists
• Day Treatment Therapists
• Community Support Specialists

The following services are offered as a part of LIFECORE's integrated care delivery model:

• Behavioral health
• Addiction
• Outreach
• Recovery support
• Peer support
• Assessments
• DUI assessment
• Prevention
• Family
• Co-occurring illnesses
• Primary residential support
• Transitional residential support
• Assertive Community Treatment (ACT)
• A mobile crisis response team
• Outpatient services

Additional LIFECORE services:

• Onsite pharmacy – Allows patients the convenience of picking up their prescriptions after an appointment.
• Mental health pre-assessments – Patients can take online to evaluate their risk of anxiety, depression, borderline personality disorder, and attention-deficit disorder.
• Climb-Up – A LIFECORE transportation service that offers patients rides to and from appointments at low cost.

Results

LIFECORE Health Group's integrated care delivery model has seen significantly positive outcomes in their 6,000-person patient population. LIFECORE has been successful in their goal of becoming a "one-stop shop" for meeting behavioral health, primary care, and pharmaceutical needs. Integrated treatment plans and same-day referrals are helping patients gain full health, physically and mentally.

Reimbursement rates for these services are still limited, but the integrated approach has allowed the model to attain sustainability. Patient data is tracked and collected within an electronic medical record system that is shared between behavioral and primary care providers. Data from these records show the following positive results since the implementation of the integrated care delivery model:

• The number of primary care follow-up appointments has increased while the number of acute hospital stays has decreased at the region's psychiatric hospital (from 608 in 2012 to 574 in 2015)
• Patient compliance rates have improved.
• Health outcomes of patients with chronic diseases have improved.
• Patient numbers and the utilization of LIFECORE services have increased.
• More patients are taking advantage of care coordination service and educational opportunities.
• LIFECORE has experienced an increase in revenue due to the model's efficiency and an increase in patient numbers. Because of this, LIFECORE is planning on growth and expanding services and locations in the near future.

Challenges

• CMS reimbursements restrictions prevented Medicaid patients from getting primary care and behavioral health services on the same day. With the passing of the 21^st Century Cures Act, the restrictions are expected to soften. This will expedite reimbursement of all same-day services LIFECORE offers, provide additional resources for suicide prevention, and expand crisis intervention training for first responders.
• Because of the difference in medical terminology used by psychiatrists and primary care staff, getting everyone to use the "same language" has been a challenge. An effort is currently being made by both professions to learn the other's terminology and use it when appropriate, lessening the communication barriers.
• Other challenges include the EHR merge and maintaining HIPAA compliance, discussions surrounding "who owns the client," shifts in the economy, and workforce shortages.

Replication

LIFECORE Health Group was the first community mental health system in the state to adopt an integrated care delivery model. They regularly present about their methodology and serve as a resource for those who have replicated the model. Below are some of their key replication principles:

• In most cases, primary care staff are relieved to have behavioral health specialists readily available. Capitalize on this desire for primary care to lean on behavioral health staff and vice versa by pitching the integrated service delivery model.
• In many settings, services offered by behavioral health adjuncts (contracted professionals or students who are brought in from outside of the facility) are non-billable and can be promoted as a free service to patients. Even if you have your own behavioral health staff onsite, a working relationship with adjuncts can be helpful when there is an overflow of behavioral health needs within your facility.
• An integrated service delivery model like this one requires long-term commitment. In many cases, behavioral health services are hard to locate, too small, and not well promoted. True integration requires constant collaboration and communication, with behavioral health promoted alongside of primary care services.
• In regards to integration between electronic medical records, collaboration between providers, clinicians, and pharmacy is crucial in the accurate and useful synchronization of patient records.

Contact Information

Ricardo Fraga, Chief Executive Officer
LIFECORE Health Group
662.570.1218
rfraga@LIFECOREhealthgroup.com