August 21st, 2013

New Vermont collaboration integrates care management

It used to be that someone with a heart condition needed a different health care provider if they also struggled with clinical depression.

A new collaboration in Vermont has changed that situation. Last spring, Blue Cross and Blue Shield of Vermont (BCBSVT) teamed up with the Brattleboro Retreat to provide comprehensive care that went into effect July 1, 2013. The new organization – known as Vermont Collaborative Care (VCC) and jointly owned by both non-profits – integrates psychiatric and substance abuse services with those of traditional health care.

The move acknowledges the increasing data that links physical and mental health, according to Peter Albert, LICSW, senior vice president of government relations at The Brattleboro Retreat and president of VCC.

“Blue Cross Blue Shield of Vermont had been using an out of state, for profit vendor, for mental health care coverage,” says Albert. “They thought that to integrate care, they needed to bring it back into Vermont, create local care and conversations and team up with a partner like Brattleboro. We were excited to join them.”

A clinical social worker at the Brattleboro Retreat for more than 30 years, Albert sees the collaboration as a cultural change in total care for the whole person. He says his new role includes helping BCBSVT better understand the dynamics of each element of mental health care. VCC has hired 10 new mental health professionals to work in the BCBSVT office in Berlin, Vt., and created a system of training and supervision together.

“We’re talking about a different way of care so we have to be intentional about a system of services,” he says. “That means we’re looking at the total cost, focusing on providing the best care possible, not for making money for shareholders, but so that we can reinvest in the system.”

Albert says VCC will spend its first year listening to clinicians and clients to produce the most effective services. They have created a state-wide clinical advisory group to keep the process moving forward and to learn what makes sense in terms of outcomes and services.

“I have the sense that they (VCC) are genuinely interested in finding good solutions to providing mental health care given the pressures anticipated for the future such as the single payer system and cost containment,” says David Brown, Ph.D., of Southshire Behavioral Health in Bennington, Vt. “They seem to be quite open to input from the private practice community.”

Though the collaboration has the possibility to enhance intervention earlier by helping patients address all of their needs, Albert acknowledges it would take time to work out the system’s “hiccups.”

Even so, according to Kathy Parry, coordinator of external affairs for BCBSVT, an integrated claims data base, evidence-based guidance, and an individualized care review process will allow both staffs to better support providers while improving the quality and efficiency of care across all conditions.

“(This) integrated approach will be particularly valuable for members who have co-existing medical, mental or substance abuse conditions,” she said in a company statement.

While VCC will initially work only with Blue Cross, it is considering contracting with other health care organizations. Brown sees the effort as a natural progression for what many in Vermont have already been doing. “Networking with each other and our professional societies as well as with the people who make and implement policy in the state,” Brown says, “can open opportunities to influence healthcare reform as it evolves.”

Albert agreed. “This is our chance to transform a system from the bottom up. With health care reform front and center nationally and in Vermont, this is our opportunity to work together, to create a system that really demonstrates the importance of caring for the whole person.”

By Jo Kadlecek

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