{MORE STORIES IN THIS SERIES}
- Social Workers Down the Hall: A Case Study of Integrated Care
- Project Gives Southern Miss Social Work Interns Real-World Experience
- Every Tuesday, the Homeless are the Priority at This Biloxi Clinic
- Moss Point Students Get Free Behavioral Care from Coastal Family Health
When Coastal Family Health Center partnered with the University of Southern Mississippi to introduce social workers into its clinics, it was a bit like an arranged marriage.
There was a lot to like, but the loving took a little longer.
“We have come a long way,” says Larry Knight, chief operating officer for Coastal, which has 13 facilities in 10 south Mississippi cities.
The integrated care model, in which social workers were located onsite regularly in seven clinics, primarily to provide more immediate behavioral and mental health services, was conceived through the Mississippi Integrated Health and Disaster Program. The Southern Miss School of Social Work managed the MIHDP with funds from the legal settlement of the Deepwater Horizon oil spill in 2010. The school and Coastal worked together under a Memorandum of Understanding from 2012-2018.
‘Starts and Stops’
“Well certainly, when the program first started, I think our first big challenge was getting buy-in from our staff,” Knight says. “Integrated behavioral health was a new concept in a primary care setting. I think it was a work in progress.”
Social workers were first placed in larger clinics and worked with a small group of Coastal providers in order to build rapport and smooth out a functional process, Knight says.
“There were a lot of starts and stops,” he says. “We were defining the duties and criteria for doing hand-offs with the clinic.”
As with any job, personalities and professional specializations played a role in the success.
“In my case, I think it has been very much dependent on how interested the social worker is in pediatrics,” Dr. Wendy Williams, a pediatrician in Biloxi, says. “Everyone has their preference. We have gone through a couple that were not as helpful … but then I have had some who have been tremendous. They were huge assets to the families.”
Proof is in the Patient Outcomes
Knight says the company worked proactively to break down barriers and avoid an us-and-them environment.
I will tell you, very rapidly our providers realized the benefits to take those complicated patients that were having those behavioral health challenges and doing warm handoffs. …”
“We integrated them in our leadership meetings,” he says. “They have representation there. We include them in all of our training, participation in our all staff days. We try – and I feel like we do a good job – in integration not only in a work setting, but also making them part of our family. They come to our functions, our meetings, and so that has made that transition very seamless.”
The ultimate buy-in was based on results.
“The providers had to see the benefit of what the behavior health specialist could bring to bear with our patients, the benefits it offered to our patients, and to the primary care providers,” Knight says. “Social workers are really tuned in to social determinants of health, so they understand and can address more specifically those social challenges that directly relate to poor health outcomes.
“I will tell you, very rapidly our providers realized the benefits to take those complicated patients that were having those behavioral health challenges and doing warm handoffs to get them over to a behavioral health specialist. They realized it was very important to them, and very beneficial.”
Williams recounts a case where a girl came in with her aunt to receive a routine physical for an adoption. The girl, who was dealing with the deaths of both her mother and father in the previous year, became overwhelmed.
“Tears just welled up in her eyes, in the aunt’s eyes,” says Williams, who turned to social worker Beth Lamey to help the family. “I say, ‘Here’s Beth! She is awesome!’ If I bring Beth in, just for two minutes, they kind of feel comfortable with each other. Then they are going to follow up. That has been huge.”
Better Results, Better Bottom Line
Angel Greer, Coastal’s chief executive officer, says that kind of patient outcome is one of three points of what the Institute for Healthcare Improvement refers to as the Triple Aim.
Operationally it has been very beneficial with us achieving a lot of our quality measures.”
“It is lower cost, better patient experiences and better health outcomes,” she says. “My view of the impact of integrated care is that it is the answer to address the Triple Aim. It’s the only way we’re going to achieve all of that.”
Knight points specifically to the impact of integrated care on federal reporting requirements such as Healthcare Effectiveness Data and Information Set (HEDIS) and Uniform Data System (UDS) Resources that can affect how the business is reimbursed.
“Well, certainly from a COO perspective, operationally it has been very beneficial with us achieving a lot of our quality measures,” Knight says. “Our HEDIS and UDS measures have improved significantly over the past five years.”
Healthier Patients, Greater Capacity
Social workers also have helped with chronic care management programs for patients covered by Medicare.
It is also better patient outcomes that drive health care these days.”
“So we are seeing, from an operational and business perspective, those are increased dollars from the Medicare program through the CCM (Chronic Care Management),” Knight says. “But it is also better patient outcomes that drive health care these days.”
Healthier patients require fewer return visits – or costly trips to the emergency room – and allow Coastal to accept new patients.
“I certainly think there are some direct and indirect favorables,” Knight says. “It frees up appointment slots for other patients, which has allowed us to grow our patient population because we have more available. It frees up the provider with more time.”
The Southern Miss School of Social Work 