Small Health Care Provider Quality Improvement Program – ThedaCare
The Georgia Health Policy Center recently spoke to Tina Pelishek, project manager, and Heather Pagel, manager of integrated behavioral health, at ThedaCare about progress toward integrating collaborative mental health care into primary care.
To date, what has been the biggest accomplishment or win in your quality improvement program?
Heather: Generally, this funding has allowed us to put collaborative care and behavioral health services in rural areas where patients have historically had to travel more than an hour for any kind of care. For the patient, this is a big win.
Tina: The quality improvement grant helped us to gather metrics, starting with identifying those metrics that will be valuable for our collaborative care. The collaborative care, evidence-based model comes from University of Washington, so we were able to contract with them to help us identify which metrics would help us to identify any gaps, reduce disparities, and improve our services. Our information services data analytics team is helping us build a dashboard in two phases, starting with the six quality metrics required by the grant.
What is a tip or early learning that you would share with an organization launching a similar program?
Tina: Start small. Pick one target population, like adults, and a small set of diagnoses, like depression or anxiety, in a single or small group of clinics. Get your bearings before you expand to other clinics, or other populations, like pediatrics or maternal health. Also, don’t be afraid to ask questions or reach out to others. There are a lot of resources out there now on integrated behavioral health and a lot of people are doing great work that you can learn from, so there is no reason to recreate things.
Heather: Accepting that just about anything is going to take a little bit longer than you hope or anticipate — from building the dashboard to hiring in rural areas — things take time. So, be ready to be patient.
How do you see participation in FORHP’s Quality Program as impacting your broader health improvement efforts?
Heather: This funding has helped us start collaborative care in underserved rural areas. Things like the dashboard that we developed as part of this grant are part of our ongoing strategic growth plan that applies beyond the scope of this grant. The intention is that we have collaborative care available in all our primary care clinics within the next couple of years. Then, we would like to start to explore our pediatric population and specialty care, like pain management, cancer care, or maternal health. The metrics that we developed as a result of this funding, have opened the door for us to continue to grow and tell our story to decision makers and stakeholders that this is the right thing to be doing.
One other thing that that we noticed over the couple of years that we have been expanding our collaborative care is the effect that collaborative care has on provider wellness. Tina and our medical director conducted a survey of providers who have collaborative care in their clinics. The results were extremely positive. The providers love having a collaboration manager available, and it really helps them in terms of support and stress. And you know all the things that impact providers and primary care. Provider wellness is a piece that has not been well studied, but we should not underestimate the impact of collaborative care on it.
What’s next on the horizon for your grant-funded program?
Tina: In the future we are eager to see if improving mental health through collaborative care positively impacts other chronic illnesses, like cardiovascular disease and diabetes. The six quality measures in our grant reporting reflect the impact of collaborative care on these conditions. That could be really huge over time. At the end of the four-year grant, we should have two-plus years of data collection, so, I hope we will be able to see something in that timeframe. We already started to see a little bit of reduction of referrals to other specialty mental health, such as psychiatry or neuropsychology. Less referrals are needed when we can manage conditions with our primary care providers in the clinic, with the involvement of a consulting psychiatrist.