1. Integrating Primary Care: RBHA’s Journey to Whole Health Promotion
James C. May, Ph.D.
1/3/2019

2. Integrated Care…Early Days
Started with a state-funded, 16-bed Crisis Stabilization Unit in 2009, a regional program that included both psychiatric and primary medical services. That program has now been existence for 8 years.
Operated a small, grant-funded pilot from with a sub-regional award from the Virginia Health Care Foundation (VHCF) which included a mandatory partnership with a local FQHC health clinic to provide medical services on-site at RBHA:
Clinic operated one (1) day/week serving about 80 of our adult MH population; later expanded to 2 half-days/week.
1/3/2019

3. Then came RICH Recovery Initiative
Richmond Integrated Community Health
1/3/2019

4. RICH Recovery
July 2013: RBHA awarded a $1.6 million, 4-year PBHCI grant from SAMHSA to deliver integrated care
Expansion and enhancement of the on-site primary medical care clinic, including on-site pharmacy, both located next to psychiatry
Addition of medical practitioners, health educators and peer navigators
Use of multiple datasets to track outcomes, maintain health registries, and comply with grant reporting
1/3/2019

5. RICH Clinic Services
Initial referral can come from RBHA’s Rapid Access unit or anywhere else in the organization
On-site primary care:
Main Office (downtown location): Open 4 & ½ days per week, including one evening
Currently serving over 1,800 individuals
Also has on-site pharmacy
Residential (North Campus): Medical services and/or consultation available 24/7
Referrals to specialty providers

6. RICH Clinic Services
Health & Wellness programming (health education, nutrition, smoking cessation, walking groups)
Women’s Wellness
HIV/Hepatitis testing
Office-Based Opioid Treatment Services (OBOTs) for opioid addiction
Main Office (downtown location): Currently serving over individuals (on-site pharmacy is very helpful)
Residential (North Campus): Averaging about 30 people receiving Medication-Assisted Treatment on any day.

7. Snapshot of RBHA’s clinic consumers
# Medicaid/
Non-Medicaid:
32% Medicaid; 12% Medicare; % Uninsured/self-pay
Age:         
69% population between 35-64; no pediatrics, at this time
Race/Ethnicity:
75% African-American; 22% Caucasian; 1% Other
Gender: 
55% Male; 44% Female; 1% Transgender
Common Medical Diagnoses:
26% Hypertension; 18% Vitamin D deficiency; 13% High Cholesterol; 12% Obesity
Common BH Diagnoses:          
32% Opioid Dependence; 19% Psychotic Disorder; 18% Mood Disorder
1/3/2019

8. RBHA Screening Process
Screenings completed in Clinic by RN and LPNs (at least every 6 months):
Breath Carbon Monoxide (CO)
Fagerstrom (on North Campus)
Adult Body Mass Index (BMI)
Waist circumference
Comprehensive Metabolic Panel (includes glucose level)
Complete Blood Count (CBC)
Lipid panel (cholesterol, triglycerides, HDL and LDL)
Urine Drug Screening
TSH (test for underactive/ overactive thyroid gland)
LFT (liver function tests)
Hepatitis C, HIV and RPR (for syphilis)
Pregnancy
Vitamin D
1/3/2019

9. Why Do We Do It?
Mr. F began attending RICH in 2014 and was diagnosed with Type 2 Diabetes. He is a regular participant in our Healthy Living group where he has learned how to manage his diabetes with better nutrition. Since 2014, Mr. F has lowered his blood glucose levels from 117 to 90mg/DL.
Mr. P has been a patient of the RICH Clinic since 2014, at which time his BMI was a dangerous 34.4, falling within the “obese” category. He has attended his quarterly RICH appointments consistently and worked on getting to a healthier weight. As of his last visit, his BMI is down to 26.5.
Ms. F was first seen by the RICH Clinic in April At the time, her blood pressure was 144/101, falling within the Stage 2 Hypertension range. As of her last visit, Ms. F’s blood pressure has steadily dropped to 108/78.
1/3/2019

10. Challenges & Solutions
Organizational Planning to address culture change and the “fish out of water” syndrome:
Developed high-level, cross-divisional work teams appointed to address physical plant renovations, clinical workflow, evaluation and marketing issues
Backed by clear and unambiguous support from the CEO and the RBHA Board
Created multi-level and multi-modal internal and external marketing plans to build and retain buy-in from staff and stakeholders
1/3/2019

11. Challenges & Solutions
Related to Clinic Operations:
Developing and refining the hours of operation: seek input from all and follow the data
Creating schedule and personnel planning: develop a plan and tweak it along the way, based on experience.
Managing same-day appointments: go through the case managers
Managing no-shows: reminder calls
Ongoing monitoring of prescription costs: develop a formulary
Coordinating services between psychi psychiatry and medical: engage the front desk staff
1/3/2019

12. Future Directions
Maximize productivity; integrate with same-day access and just-in-time scheduling options;
Continued analysis of consumer outcomes to identify disparities, guide decision-making and clinical practice;
Continued expansion of the OBOTs program
Collaborative planning and data sharing with various partners and data sources (e.g., pharmacies, state Medicaid MCOs, possibly commercial insurers);
Track client hospital admissions and develop program cost- effectiveness model;
Expand into pediatrics
1/3/2019

13. Questions and Discussion
1/3/2019