Integrative Medical Clinics: Models of Collaborative Care. Holli Richey, RH(AHG), LCSW Chattanooga, TN

Transcription

1 Integrative Medical Clinics: Models of Collaborative Care Holli Richey, RH(AHG), LCSW Chattanooga, TN

2 What s in it for Me? 1. Apply how one s specific skill-set could work and benefit within a collaborative care model. 2. Gain perspective on how various collaborative care models work, and how shared care might be better than a silo approach for clients and providers. Funding, fee share, profit share, etc. 3. Tips for communication with providers of different modalities for the client s benefit.

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5 Levels of Collaborative Care Level 1 Minimal Collaboration: Providers work in separate facilities, have separate systems, and rarely communicate about cases. Level 2 Basic Collaboration at a Distance: Providers have separate systems at separate sites, but engage in periodic communication about shared clients, mostly through telephone and letters, viewing each other as a resource. Level 3 Basic Collaboration Onsite: Providers have separate systems, but share facilities (Co-located). Proximity supports at least occasional face-to-face meetings and communication improves and is more regular. Still siloed Level 4 Close Collaboration in a Partly Integrated System: Providers are co-located and share some systems in common such as scheduling and charting. There are regular face-to-face among providers, coordinated team plans for difficult patients, and a basic understanding of each other s roles and cultures. Level 5 Close Collaboration in a Fully Integrated System: Providers share the same site, vision and system. All providers are on the same team and have developed an in-depth understanding of each other s roles and areas of expertise. Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA), Center for Integrated Health Solutions.

6 What I do Where I do it With whom: providers & clients How we work together How managed care works & doesn t work Tips Why we do what we do

7 What I do Medical Herbal Model Extensive bio-psycho-social-spiritual intake form 50 min consult, self-pay, herbs compounded in-house Support the body, holistically with herbs, food, lifestyle, and stress reduction techniques

8 What I also do Psychotherapy, LCSW Same intake form 50 min consult, herbs might not be a part of treatment DSM diagnosis for insurance to pay Mindfulness-Based Cognitive Therapy (MBCT) Acceptance and Commitment Therapy (ACT) Motivational Interviewing (MI) Client-Centered Exposure therapy Nature therapy

9 What I also do Integrated Mind/Body Therapy Mindful Eating Weight Management Program: collaboration with nutritionist and primary care

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11 With whom: providers & clients Primary Care Providers: MD, DO, PAs Behavioral/Mental Health Providers Acupuncturist Nutritionist, RD Bioidentical Hormone Specialist Nurse Bodyworkers: Soft Tissue Manipulation, massage therapy Center Physical Therapy Center Medspa

12 How we work together Provider meetings Referrals Informal communication Same chart for Weight Management Program Collaboration on Wellness Programs Different chart for Herbs & Counseling; however I refer to medical chart as needed

13 Important Pieces to Collaboration Co-location Face-to-face interaction Multidisciplinary meetings on clients, idea-share Warm hand-offs Shared Electronic Health Records

14 Pros and Cons Working with pros pun intended! Collaboration for optimum client care Various skill-sets, expertise, view points No one person has to be expert on all things Built-in referral source Creativity for collaborative programs abound! Some cases need conventional medical attention, but can benefit from herbal support. Medical colleagues who support your recommendations for a shared client! Not all patients want or do well with pharma. Increase in medical knowledge & collegial discourse. Increased volume increases pattern recognition for conditions

15 Pros for Herbalists Increased legitimacy if you re looking for that. You get to see a great diversity of people Increased exposure among populations unaccustomed to herbal approaches Access to in-house labs. In a medical center, HSA and Flex plans can be applied toward consult fees. Provide formulas for acute conditions, for which people typically do not get an herbal consult.

16 Cons/Challenges for Herbalists Sometimes you get punted the most difficult cases the 1%ers. Being in an insurance-based model clinic can deter some of the population from self-pay modalities. Less autonomy and more mainstream, i.e., Possible limitations on methods/approach or how you keep your office, since you re not flying below the radar so much. The number of providers might dilute your referral base if clients need to choose between you and acupuncture or bodywork.

17 Tips Get to know what other providers do, how they describe what they do, what their skill-set is and how you can best utilize their talents. Explain, illustrate what you do as an herbalist: giving case examples and describing the herbal approach to healthcare (enhancement & compensation). Learn medical terminology and be able to be a bridge, converting it into herbal language. Follow-up with providers on client care, what is working and not working, discuss concerns and suggestions. Collaborate on programs, co-author articles Get Release of Information. Get to know the specialists in your area, too.

18 Case Study: Marion 59 yo female. Complains of fatigue, muscle weakness, pain in neck and feet. Excessive worry. Digestive issues. Dx with fibromyalgia, multiple chemical sensitivity. PA referred to Soft tissue manipulation Bodyworker referred to me for herbs for digestive complaints. Sugar-free diet. Ashwagandha. Rhodiola Flashback of sexual assault 40 yo occurred with bodyworker. Client able to process in a counseling session following day. Client reports she feels the best she s felt in years.

19 Why we do what we do Hippocratic Oath What in the best interest of the client? Wholism / Vitalism Being agents of change Being a Bridge for wholistic plant medicine

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