Making the Case for Integrated Care and Physician Engagement With Addiction Patients

A back to back session and panel at this fall’s ACO & Emerging Healthcare Delivery Coalition focused on the importance of utilizing integrated healthcare to treat individuals with addiction and ensuring physicians are educated on understanding addiction.

Mark McGrail, MD, Director, Addiction Medicine Services, Cherokee Health Systems, discussed the benefits of using integrative care for the most minor to the most severe of illnesses.

“Integrated care is the care that results from a practice team of primary care and behavioral health clinicians working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care, for a defined population,” said McGrail.

In addition to addressing the medication aspect of addiction, integrative care addresses mental health and substance abuse conditions, health behaviors, life stressors and crises, stress related physical symptoms, and ineffective patterns of health care utilization.

Aspects of the integrative care model include: functions of care delivery shared across the team; shared patient panel, staff, space, treatment plan/goals; shared clinician documentation; access to behavioral health expertise “where and when behavioral problems show up”; improved communication and care coordination; and supported patient engagement.

At Cherokee Health Systems, McGrail and his staff provide addiction medicine, behavioral health services, primary care, psychiatry services, pharmaceutical access, nursing, and care management.

“When a patient who has been using for years decides they’re ready for treatment, there is a very narrow targeting opportunity,” said McGrail. “If you miss it, who knows when they’ll have that thought again.”

Keeping this in mind, Cherokee Health Systems has an open intake clinic where patients can walk in at any time and access help.

The biggest lesson learned for McGrail and his team was the group medical visit model. When Cherokee Health Systems started last fall, drug management and behavioral therapy were separate from each other. They found that patients would show up for management but not for the behavioral therapy, so they decided to link the 2 with an hour of drug management followed by 2 hours of behavioral therapy. Patients cannot receive their prescriptions until the behavioral therapy is over.

Marilyn Gaipa, Vice President, Clinical Operations, UnitedHealthcare Community & State; Jennifer Moore, PhD, RN, Executive Director, Institute for Medicaid Innovation; and Frank James, MD, JD, Medical Director, Primary Care Contact, Harvard Pilgrim Health Care, American Society of Addiction Medicine, followed up the session with a panel emphasizing the need for physicians to understand how to work with addiction patients.

“There are not enough addictionologists right now. This is an epidemic that took us by surprise, and the industry was not prepared to take care of patients with substance abuse, in particular with opioids,” said James. “It’s really about how do we engage physicians so that they understand the treatment formalities, things that work for patients, and engage other medical specialists.”

Patients aren’t likely to go and find treatment because of the stigma they face from physicians who don’t understand how to treat those with addiction, said James.

Agreeing with James, Moore mentioned the need for all healthcare professionals to get training, from the physicians to the people who pick up the phone to make appointments, saying it’s essential to provide sensitivity and understanding on all fronts.

Gaipa discussed a learn source model utilized at UnitedHealth Group that includes 3 webinars for addiction. Teams are asked to take them in order to learn how to engage in conversation, be able to ask patients the basic questions, and know where to send them based on their answers.

According to the panelists, there is a lack of standardization of treatment. When someone’s business is treating addiction, they are more than likely not following evidence-based care, and outcome measures are not being utilized. There is a need for studying patients after they finish a program to measure success and use that measure as the standard of care.