Brightways Counseling Group and Rimrock Trails Treatment Services propose to partner with select primary care clinics, PacificSource CCO, and the Central Oregon IPA (COIPA) on an eighteen-month pilot project that will significantly increase specialty outpatient behavioral health (BH) access and capacity in Central Oregon. This new innovative project will focus on four components identified by primary care clinics as essential for better meeting patients’ behavioral health (BH) needs:
1. Timely access to specialty BH with closed-loop referrals
2. High rates of engagement in specialty BH treatment
3. Evidence-based and outcome-oriented treatment utilizing measurement-based care
4. Close coordination with primary care
The BH Navigator will be the single point of contact for patients, ensuring timely access to specialty BH, high rates of treatment engagement, and close coordination with primary care. Patients will no longer “fall through the cracks” when referred from primary care to specialty BH.
“It has been great to have more formalized conduits for communication and coordination of care with Brightways and Rimrock for our shared COPA patients. In particular, the willingness of both organizations to accept fax referrals from COPA has really streamlined the process and made it much easier for the BHC teams. With the pandemic, all our schedules became quite inundated and being able to triage to our referrals team to send over notes and demographics for the Brightways and Rimrock teams to call was helpful. Initially the direct scheduling with Brightways was a great tool but as their team exploded in size, it became near impossible to ever schedule anyone in ourselves, so we have essentially abandoned that aspect. That said, for both groups, it is helpful to know they have a waitlist going so we do not have to keep track of that from our end.” Grace Lee, LCSW - Central Oregon Pediatric Associates
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- The purpose of this project is to integrate an adequate specialty BH system for patients who need a higher level of care. Currently, when primary care providers (PCPs) identify patients who need specialty behavioral health, they are often handed a resource sheet with the names and phone numbers of local BH providers. Patients are on their own to call BH providers and see if they are accepting new patients and their insurance plan. Frequently, calls to go unanswered and messages not returned, or they have a message saying they are full and not accepting new clients. This often leaves patients feeling abandoned. Navigating the complicated BH system without assistance is daunting, especially for patients who struggle with depression, anxiety, or other behavioral health concerns.
- The project was implemented by Rimrock Trails and Brightways Counseling Group.
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The project attempted to:- Increase timely access to and engagement in specialty outpatient behavioral health care
- Increase communication and care coordination between primary care and specialty behavioral healthcare providers
64% of the 337 patients referred from the partner primary clinics had an appointment scheduled within two weeks of the referral date.
28% (79/281) of the people who completed at least one appointment had a note sent back to their primary care organization within 30 days of that appointment.
Out of the 160 people who successfully completed 4 encounters within 60 days, 56% were still engaged in services at the end of data collection. Of the remaining 71, 48% had documentation that a discharge summary was sent to the referring PCP.
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- A disagreement ensued at the beginning of the project leading to division among the BH providers therefore changing the project design. In the future, prior to the start of a project with multiple partners, all contributing partners will sign an agreement to participate throughout the agreed project.
- COVID-19 added more barriers with communication and paperwork due to telehealth and work-from-home orders. Our internal systems were not equipped to handle all these changes within the first year. Rimrock added an Outpatient manager who was able to organize and create better communication systems for the front office staff. Rimrock is now better situated to handle the increased client load.
- For Rimrock Trails the past two years has provided exponential growth in client numbers and the staff were normally overwhelmed. Within 2021, front office coordinators now sit at each location in a full-time capacity, and an Intake Coordinator was hired for all new client appointments. Adding these extra staff has assisted with improved client support, standard paperwork processes, and following up on no call/no show appointments.
- However, as our client numbers continue to grow, care coordination capacity is still a concern. The Intake Coordinator hired most recently has a background in psychology and is awaiting confirmation of getting their QMHA. Once Intake has received their licensure, certain job tasks are billable, creating a more sustainable position. As growth continues and counselors are hired, it is becoming obvious that understanding the numbers of counselors to front office staff ratios is important to prevent Front Office burnout and turnover.
There were 55% of clients who completed at least 4 visits within 60 days of referral.
The project highlighted communication barriers from the beginning between not just primary care but within the BH organizations.
New partnerships were created and continue to develop. Referrals from non-project primary care organizations are filling our Intake systems along with those from Weeks, COPA and Mosaic Medical.
There is less confusion regarding what criteria to include in a referral and the follow-up notes.