alluvion health & gateway
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Alluvion Health & GatewayI n t e g r a t e d M e d i c a l / S U D M o d e l
Health Center History
• Established in 1994• Cascade County and Cascade City
County Health Department saw a need for medical services in our community and worked with Health Center leaders to open Cascade Community Health Care Center under a co-applicant model
• Operated for 24 years out of a single location, most recently:
• 9 exam rooms• 3 dental operatories (dental
added in 2009)• 1 procedure room
• Expanded to add Behavioral Health in 2012
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Gateway History Founded in 1969• First Name was Providence
• State Set-up facility in response to enabling community treatment
• Non-Profit• Now known as Gateway Community Services • Has gone through several changes in scope and
direction of service, but providing addiction treatment to the residents of Cascade County has always been our mission
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Alluvion Scope of ServicesServices Providers
• 4 MD’s
• 1 Psychiatrist
• 3 Physician Assistants
• 8 Family Nurse Practitioners
• 1 Psychiatric Nurse Practitioner
• 19 Licensed Mental Health Professionals
• 3 Dentists
• 1 Dental Hygienist
• Medical Primary Care
• Dental Primary Care
• Behavioral Health Primary Care
• Outpatient Substance Use Disorder Treatment Services
• 3 School Based Clinics
• Mental Health in GFPS middle and high-schools
• Medication Assisted Treatment Services (MAT)
• Psychiatric Services
Gateway Scope of ServicesScope of Services Providers
• 10 LAC’s• 4 LCPC’s• 4 Peer Support• 1 Rehab Aid Tech
• Intensive Outpatient • Outpatient• Relapse Prevention• Family Therapy/Instruction• Prime For Life Program• Blue Thunder Lodge• Federal Treatment Contracts• Drop-In Center• Peer Support
Motivations to Transition
to Integrated
Model
• Create a fully integrated model that supports better outcomes
• Stabilize access to SUD services for current Alluvion patients
• Increase access to medical and dental services for Gateway patients
• Ensure access to SUD services remain intact in community
• Mutually beneficial model that plays to the strengths of both agencies while creating a better care model for the patients
• Innovation in service delivery
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Timeline of Project
• April 2018 ( B e g i n n i n g o f D i s c u s s i o n s )• Review of potential arrangements• Financial modeling for possible models
• May 2018• Applied for Change in Scope to HRSA for site and service
• July 2018• B e g i n n i n g o f S e r v i c e s
• Care Coordinator located at Gateway FT• Contracted services begin for SUD/MH services
• October 2018• Completion of build of medical clinic inside Gateway• Staffed FT with FNP and MA
• Identifying organization for patients seeking care
• Billing processes and workflows
• Impact on FQHC quality and UDS measures
• Sustainable business model
Solution• Dually branded intake paperwork, clear
communication process• Defined expectations, billers embedded
in both agencies• Care Coordinator collects all medical
records or patients referred to PCP in medical clinic
• Operate essentially breakeven on SUD services, look to build medical panel for revenue
C h a l l e n g e s t o S u c c e s s
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Overcoming Barriers
Concern
Accessing Care
Collaborative Partnership• Ability to respond rapidly to community
needs
• Leverage strengths of agencies involved without duplication of services
• Leverage benefits of reimbursement models to create long-term sustainable programs and services
• Partner with entities to create substantive and comprehensive whole person/whole life service models
• Impact all social determinants of health
• Truly design a creative and inspiring model of care that impacts the health of the community
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Shared Impact
UDS 2017 UDS 2018
• 4,618 Unique Patients• 22% increase
• 24,500 Encounters• 88% increase
• 56.30% < 200% of FPL
• 3,782 Unique Patients
• 13,000 Encounters
• 67.98% < 200% of FPL
Shared Patients
• 541 Unique Patients
• 9,444 Encounters
• 72.64% < 200% of
FPL
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Outcomes to Date• Clients who are comfortable receiving addiction treatment now are able to receive
physical care and medically assisted treatment without leaving the building • Clients are comfortable in the building and trust providers• MAT is a collective effort between the provider and the addiction counselors• Historical low follow-through if the client is sent somewhere else• Dental Care with little to no effort on the clients part
• Changes in Addiction Provider Manual forced Gateway to adjust how treatment was provided
• Resulted in a large drop in the successful graduation rate – 25%• New treatment collaboration with Alluvion increased the graduation rate to 50%• Client medical issues that have been ignored for years are now resolved• Powerful collaboration between Care Coordination and Peer Support• No-show rates now below 15% • Client satisfaction is at an all-time high
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Outcomes to Date
• Increased access to SUD services for FQHC patients• Beneficial impact on quality data metrics • Additional service site for patient population that needed access, but wasn’t
able to access at other locations• Improved model of care with focus on patient outcomes
Questions
Trista Besich, MBAChief Executive Officer
www.alluvionhealth.org
Bob WigdorskiExecutive Director
www.gatewayrecovery.org