A discussion with clinic leaders: Standing out in the world of whole-person care

00:00:00 Speaker 1

I'm excited to help facilitate a conversation today between our amazing panelists. But before we do so, I'll go ahead and introduce myself and provide some background information to our topic of discussion today. I wanted to let everyone on this call know that you can use the Q&A and chat function to ask questions, and at the very end, we'll have time for a Q&A.

00:00:20 Speaker 1

My name is Allison Wudo and I am director of business development for General Healthcare. I've been with Genoa for about 5 years now. Part of our growth and development team. I helped support general's growth into new clinics and I have a focus on expanding our services to impact as many lives as.

00:00:35 Speaker 1

Possible. Again, my role today is just to moderate the conversation between our amazing panelists, and I'll introduce them here shortly before we get going. I wanted to give a background of whole person care and kind of what it is and why we chose this as a topic of conversation. So starting from the very beginning to level set with everyone, what is whole person care so.

00:00:55 Speaker 1

Whole person care is an approach to healthcare that recognizes that people are complex. It is, you know, health is a product of economic conditions, social stressors, environmental exposures and behavioral factors. In addition to physical and mental health. So there's a lot all-encompassing to someone's healthcare and whole person care really.

00:01:14 Speaker 1

Is that rather than focusing on a single issue or diagnosis, whole person care acknowledges that health outcomes depend on so many different factors. It's a patient centered approach, which I think at least for all of us on this call, I think is why we're in healthcare, because we wanna care about the patient as a whole, not one.

00:01:30 Speaker 1

Individual.

00:01:30 Speaker 1

Condition. The positive effects will be shared today throughout the web and are really high.

00:01:34 Speaker 1

Right. The positive implications for the high risk population that we care for, so whole person care uses a comprehensive approach to help patients tackle all issues that they might be facing together.

00:01:46 Speaker 1

If you like statistics at all like me, I found this very interesting. So a recent survey found that nearly 60% of behavioral health, primary care and complex providers reported that their organization currently offered or had plans to begin offering integrated care to the patients that they serve, which is an increase of 7% from 2020.

00:02:05 Speaker 1

And I think we all know what happened in 2020 that might make a big difference in to why people are focused on whole person.

00:02:11 Speaker 1

Care.

00:02:11 Speaker 1

Now, so why is their focus on it now? Well, just like everything, COVID-19 really shined a light on whole person health by highlighting the correlation between behavioral health and overall Wellness as so many people who were living with behavioral health conditions.

00:02:26 Speaker 1

Experienced worse symptoms throughout the pandemic, while others struggled for the first time and didn't know where to turn.

00:02:32 Speaker 1

Social determinants of health are becoming more important factors in success for both Medicare and Medicaid health plans.

00:02:38 Speaker 1

And this means a lot for clinics. They're now thinking about different ways and forms to offer whole person care to their patients. One of my favorite ways to think about whole person care is talking to your doctor about your high blood pressure. Imagine you're having a conversation with your doctor, who then connects you to a behavioral health specialist in the building and shares his concerns about your health.

00:02:58 Speaker 1

With you and the behavioral health specialist, then imagine you work together to identify issues in your life that can be contributing to your high blood pressure, such as financial stress and anxiety.

00:03:07 Speaker 1

Whole person health looks at the factors that affect your well-being. Health and disease are not separate things. Instead, you can think of them as a path that's connected. So think about whole person health with health in One Direction and disease in another. Some things move towards health and some things lead you away from it.

00:03:25 Speaker 1

When I think about whole person care, I immediately think about sports. On any given team, let's use the Minnesota Timberwolves as an example. There are so many components that make a successful team, so you have the players, coaches, trainers, doctors, nutritionists, psychologists and more.

00:03:40 Speaker 1

You know no team would be as successful if they did not work together to take care of the players and the Minnesota Timberwolves certainly wouldn't have made it to the Western Conference finals this year without the approach of taking care of their players in their entirety. So before I let the experts on this topic jump in, I just wanted to give an overview of.

00:04:01 Speaker 1

I see go Celtics. In the chat. We can save that for another conversation.

00:04:04 Speaker 1

And.

00:04:07 Speaker 1

That just distracted me, but I I will let you guys know that there is a poll question in the chat and we just want to make this conversation as relevant as possible for everyone. So if you could just describe and all you have to do is select one in the function, answer the poll question, which of these best describes your clinic? Is it a CCHC?

00:04:27 Speaker 1

FQHC, CCHC and FQHC. Neither CCHC or FQHC.

00:04:34 Speaker 1

Look like if you could go ahead and take some time to answer in the poll what your clinic resembles most in the meantime, I am going to finally introduce our amazing panelists. I'll start with Doctor Vanna Campion. She is the chief medical officer at Tara's health in Phoenix, AZ. Doctor champion.

00:04:54 Speaker 1

Is a family medicine physician by training and a leader in providing integrated medical care to the community at Tara's health. She champions initiatives that blend primary care with specialized mental health and substance use treatment, and we're really excited to have her on this.

00:05:07 Speaker 1

Secondly, I'll introduce Vera Sansone. She is the president and CEO of CPC Integrated Health and is responsible for the overall strategic direction and operational performance of the agency dedicated to building healthier and more equitable communities and known for being on the forefront of the most recent advancements in mental health and substance use disorders.

00:05:27 Speaker 1

Treatment under Vera's leadership, CPC became the first certified community behavioral Health Clinic in the state of New Jersey and one of the first in the nation.

00:05:37 Speaker 1

Additionally, Vera LED CPC to become the pilot program to partner with Horizon Blue Cross Blue Shield of New Jersey for the integrated systems of Care program, which integrates behavioral health services through coordinated care, a program which is now being replicated all throughout New Jersey and last but certainly not least, we have Kelly Mckevitt here. Kelly is the executive vice president of CEO.

00:05:57 Speaker 1

And CEO of Southwestern Pennsylvania human.

00:06:00 Speaker 1

Passes SPHS helps people of all ages by providing an array of services to those in need, including childcare, aging programs, mental health, substance use, treatment, homelessness assistance, personal care, nutrition services and family support. So really a little bit of everything SPHS and its affiliates offer services to residents of Southwestern Pennsylvania.

00:06:21 Speaker 1

Kelly also helped design the Centers of Excellence for opioid use Disorder Treatment program, along with many other innovative programs. At SPHS, she has a reputation for innovation, agency growth and team development.

00:06:32 Speaker 1

Kelly's Passion is to help those in need and to be the driving force behind her success. In 2024, Kelly was recognized as woman of influence by the Pittsburgh Business Times for making strides in her career while giving back to the community. She was one of 26 influential businesswomen in the Pittsburgh region to be honored with this award, so to say the least. We have quite the qualified.

00:06:53 Speaker 1

Group of people here to talk about whole person care and I'm going to go ahead and kick it over to Doctor Vanna Campion to start us off by asking her a question.

00:07:02 Speaker 1

What are the benefits of offering whole person care programs or initiatives at your clinic and how have you seen an impact on your patients?

00:07:12 Speaker 2

Thanks, Allison. I appreciate being here today. So for the benefits of whole person, healthcare and initiatives in our clinic, I think that they're limitless, right, the whole person care really allows us to think of a person and all of their needs as a primary care physician.

00:07:33 Speaker 2

You know, in training you learn of like, here's a disease process. Here's a diagnosis. Here are the medications that treat it. And often you feel frustrated that your patients aren't following your recommendation plan. They're not making any progress.

00:07:46 Speaker 2

You don't know? Like, did they not understand or what's happening? Right. That's keeping them from being able to meet their health goals and whole person healthcare as a primary care physician, like allowed me to feel more connected to my patients. It allows us to have a better understanding of.

00:08:07 Speaker 2

What is it that they are going through? Because we know with hypertension or diabetes there are so many factors that play into that.

00:08:16 Speaker 2

Or ability to get food where you live, right? The environment that you are living in if you have housing, can you afford your medications? All of those things. And for our patients, I see that patients are a lot more engaged, they're more successful. They're able to actually achieve those health outcomes.

00:08:37 Speaker 2

That, you know, we all want them to achieve with more support, so it has been.

00:08:44 Speaker 2

Really fun to be the CMO at Tara's health, where I don't know. I also get to do primary care, but we also get to look at people's mental.

00:08:53

Health.

00:08:54 Speaker 2

We address their substance, use disorders and really have a network of of people that are taking care of.

00:09:01 Speaker 2

The patient so.

00:09:07 Speaker 3

I can add to that I from, yeah, I'll be glad to add to that. So here in southwestern.

00:09:13 Speaker 3

Tanya, we we've been providing this array of services that grew over the years and this is our 60th year and I've been involved for a little over 30. So historically when you want to think about how did we see our patients benefit, I've seen that in real time. So I could remember a time where.

00:09:34 Speaker 3

Individuals were coming out of state institutions on the mental health side and working as a caseworker and seeing that struggle and not maybe even be able to get in to talk to the physician when they want.

00:09:45 Speaker 3

And seeing those gaps, to seeing people now, maybe later on in their journey that they're living independently and they have an array of services, that or you know or more coordinated. So for us it's, I mean some people look at us as a large organization and say well you, you know, you have all these pieces to the puzzle, but that doesn't mean necessarily that everyone that we serve.

00:10:07 Speaker 3

Is limited to just our services. Many times they touch a bunch of different pieces.

00:10:12 Speaker 3

They might get mental health and substance abuse from us, but maybe their primary care suffer, or maybe some other housing piece is suffer. So it's really making a commitment to that individual for the best outcome that we're going to work with all the people, and we are going to be that brokerage in those old time like I call them old social work.

00:10:33 Speaker 3

You know, skills to get that done and just to wrap that up, I think the biggest thing is hearing the feedback from the individuals cause, that's the most.

00:10:43 Speaker 3

Just frustrating, right? Whether you're a family member or you're the individual and care if you feel like the people that are trying to help you aren't on the same same page and working together.

00:10:54 Speaker 4

You guys make such great points. I couldn't agree more. I can add that I know for us, we were always integrated with substance use and mental health. We've been doing that for many, many years, but it was extremely frustrating not to be able to help people who were in the emergency room all the time with chronic medical conditions.

00:11:16 Speaker 4

That either they felt they were, they were.

00:11:19 Speaker 4

They there was a lot of stigma when they went to either primary care or, you know, other medical practices, or they just did not focus on that because they, they had so many other issues that they were and hearing that people with serious and mental serious and persistent mental illness.

00:11:39 Speaker 4

We're dying.

00:11:41 Speaker 4

20 years earlier than the general population really made us feel like how can we not do this? So I would just add that.

00:11:49 Speaker 1

Yeah, that's a really good point. And you all three make great points. Vera, I'm gonna kick it back to you and ask then what was the first whole person care initiative that you offered at your clinic? And would you recommend it as a starting place for other folks that are interested in incorporating this to their facility?

00:12:04 Speaker 4

Sure. Yeah, great question. So for us, again, you know we we were doing mental health and substances. We've always done case management, social determinants of health, you know, food insecurity, housing and that kind of thing. So in New Jersey, there was a program that was offered as a a potential.

00:12:24 Speaker 4

Grant behavioral health home and that brought in medical case management. So we had applied for that and we got it and.

00:12:32 Speaker 4

It it what it did for us was to help us start to change the culture with our staff so.

00:12:38 Speaker 4

That we were all.

00:12:39 Speaker 4

Looking at all the components because in the past even our medical staff would say things like this guy's got a really serious chronical medical illness. He should see a doctor. You know, as though, like, you know, there was a separate kind of group that should be addressing those.

00:12:48

Yes.

00:12:52 Speaker 4

So I think the behavioral health home really started us focusing on ourselves as a whole health operation. But what really made us feel?

00:13:03 Speaker 4

That this was for us was when the whole idea of the CBHC's came out. So we it we we thanked National Council for being the leaders in that and when they started talking about it at their meetings who were like this sounds amazing. Let's try and convince New Jersey to be one of the States and.

00:13:23 Speaker 4

From.

00:13:23 Speaker 4

There, you know, we we have never turned back and we we really do. You know, we're we call ourselves true believers when it comes to CDHC because we really feel like there's so many different types of of formats to to use for integrated care. But we really believe that CBHC is a great model. And so I think for us that was.

00:13:43 Speaker 4

Really a turning point.

00:13:45 Speaker 1

Umm yeah, Kelly, would you say that's similar for you guys at SPHS or what was the first kind of initiative that you guys offered with regards to whole person care?

00:13:55 Speaker 3

Since our homework has always been that I think for us when I think about, you know, your question, I hear, you know, if you're talking, I'm sure her and Dan, they've all experienced this is that.

00:14:07 Speaker 3

You know, sometimes these initiatives come upon you because of funding or an opportunity that comes up and that's great. But even if you don't have that opportunity now, you can start working as an organization about like a cultural shift.

00:14:20 Speaker 3

Because that starts all the way from the beginning when you're screening people from high, you're and you're onboarding and you're training and your board and your leadership, strategic planning, mission vision statements, all that is about that because then it's ingrained in the everyday work. The example I use is I can remember a time where in mental health.

00:14:41 Speaker 3

Vera might remember this like that. They say you have to coordinate. The insurance companies were saying, like you have to coordinate with the an individuals primary care and a lot of clinics.

00:14:52 Speaker 3

Create a form and said you have to make a check box and then they got the HR and they build that into their HR. Well I use that as an example and say don't make.

00:15:00 Speaker 3

This a check.

00:15:01 Speaker 3

Box because then the staff and the physicians just become overwhelmed or this is another thing that I have to check off and I'm just trying to help people. It needs to really start with.

00:15:12 Speaker 3

With the basis, but this is our culture. This is our mindset. So I love when Vera said like true believers, because they mean that means that that organization really believes this is what's best for the individuals. And if we get everyone on the same.

00:15:26 Speaker 3

Page, the actual initiatives will be so much easier. They'll just be like a rollout.

00:15:32 Speaker 1

Yeah, and I love that. And I I know prior to this, we had a conversation about that and I would just ask, you know, how do you encourage your team to buy into the idea of whole person care and the extra work that might come along with it when you talk about building a culture, could you expand more on how you guys were able to do that?

00:15:48 Speaker 3

I think sharing the benefits, you know having the information and we can, you know having information from FQHC, CBHC's other models and showing them appropriate outcomes and actually having individuals, we have a lot of peers and a lot of individuals and long term recovery and mental health.

00:16:08 Speaker 3

Lot of individuals by.

00:16:09 Speaker 3

That or have been through our services and having them talk to the staff and becoming part of that onboarding and ongoing training to keep mentioning that and build it in, you know, to the supervision. So it has to be both bottom up you know and and talk to them because everyone kind of gets on the.

00:16:29 Speaker 3

Same page and I think it goes back to what we said. If someone really doesn't believe in that it's big and deeper in understanding why do you want to compartmentalize. And sometimes it's really not that an individual's not on board with it. As far as a staff person, sometimes it's they've got the wrong message. They think you're just trying to put more work on them and have more.

00:16:48 Speaker 1

Yeah.

00:16:49 Speaker 3

Things to do and they don't really understand, you know what the the initiative is.

00:16:56 Speaker 4

That's a great point and I would just add to that, I know for our staff, we started sharing stories of success that we were starting to see with some of our clients who had, I mean very serious medical issues, hepatitis B, we're starting to identify things and seeing them.

00:17:17 Speaker 4

Treated and then seeing them be able to focus on their substance use and mental health challenges, and in some cases go on to become peers. Go for the training and come back to work with us. And I think there was something about that making it real.

00:17:33 Speaker 4

That even those of our staff who were, you know, a little more old school and felt like it was going to dilute what we do and we're not the experts in this and you know, a lot of the stuff that I'm savanna has heard so like, OK, let's try it. And so and and being in the same way that we with our.

00:17:53 Speaker 4

Our clients, we meet them where they're at and try and work with them so that they can accept and maybe find some common ground. We did the same thing with our staff around that kind of thing.

00:18:04 Speaker 1

I love that point and culture. It reminds me just a lot of Genoa too, because I I think I mentioned this to you guys, but one of the things that we offered a few years ago was free mental health first aid training to our entire organization, even people who work from home like I do and not actually patient facing. So buying into culture and starting from the top and really integrating that through everyone's.

00:18:27 Speaker 1

Day-to-day and workflow is definitely a game changer, so I can relate to that in some ways, not necessarily the same exact ways, but there are certain.

00:18:34 Speaker 1

Things that I can totally see how it just starts from the bottom and then you expand from there. And Doctor, Vanna, what about you at Tara's health? How do you encourage your team to kind of buy into whole person care and and the extra work that might come along with that?

00:18:51 Speaker 2

Yeah. So I think you know, at Terrasol Terrace started as a substance abuse and treatment company, but.

00:18:57 Speaker 2

Again, the late 1960s and the the teams here have always looked for ways that they can do more and help their patient help patients and and be more involved in the community. And so really early on back in the late 1980s, we started doing HIV testing, which made sense.

00:19:17 Speaker 2

For our patient population at the time, but we did those things in two very separate buildings and it's kind.

00:19:26 Speaker 2

Of a way.

00:19:27 Speaker 2

From.

00:19:28 Speaker 2

Each other, right? And that continued and that continued for several well until 2024. So this year we're finally bringing our HIV testing sites into our actual clinics, right. And and kind of having more.

00:19:46 Speaker 2

Focus on how we do all of those.

00:19:49 Speaker 2

But I think having someone who is excited at your site and about this who's benefited from whole person care, who has had a medical illness or a family member with a medical illness that's affected their mental health or their substance use and really sharing those.

00:20:09 Speaker 2

Worries and a lot of times our providers who so I'm the first primary care CMO at tariffs, right. So they've always had a psychiatrist in this role. We've always done mental health and substance abuse treatment and about 10 years ago is when they really, truly added on primary care. But it wasn't given a ton of focus.

00:20:30 Speaker 2

Until when I came on two years ago and.

00:20:35 Speaker 2

I think everybody was terrified when I got here, right. She's going to come in. She's going to change everything we do. Primary care has no idea what mental health does. It's just so separate and different. You treat people different, you know, all of the things. And in a traditional primary care clinic, you get 1015 minutes with the patient.

00:20:42 Speaker 4

Hmm.

00:20:55 Speaker 2

Down to the next one, right. And so it doesn't really lend.

00:20:59 Speaker 2

For a lot of a lot of that.

00:21:02 Speaker 2

Whole person care and that.

00:21:04 Speaker 2

Understanding that we see with our mental health patients, however, is not like I got here very early on I realized. Ohh OK, they're all terrified of me.

00:21:16 Speaker 2

I need to I need to understand what our mental health providers do, right? I need to truly understand what happens in our clinics and how we're taking care of these patients so I can effectively show our primary care providers how we can help them meet their need.

00:21:34 Speaker 2

And so whole person care really isn't about adding additional work. It's about everybody working together and collaborating. So everybody's work, work, workload gets a little bit lighter. It's a little bit easier to do the hard work that all of our mental health providers are doing.

00:21:53 Speaker 2

Every day, because your patients not in the ER every day, right? Like you're not constantly having to to figure out where they are. We're able to take better care of them. And our primary tier care teams.

00:22:08 Speaker 2

The patients don't hear.

00:22:10 Speaker 1

You know, I got.

00:22:11 Speaker 2

This really bad diagnosis for my primary care doctor, and they didn't spend any time.

00:22:14 Speaker 2

With me to talk.

00:22:15

Mm-hmm.

00:22:15 Speaker 2

To me about it, right, because our primary care team knows there's someone right there that can help our patient kind of process this new information and work through it. So it's really just showing everybody that when we work together.

00:22:30 Speaker 2

Everybody's job gets easier and our patients just feel more supported. So that's what we've been doing and I think we're, we're making a lot of progress from when I got.

00:22:39 Speaker 1

Here. So that's awesome. That's awesome. And I love the self-awareness. You're like, they didn't like me at first. I I find that.

00:22:45 Speaker 1

Hard to believe.

00:22:45 Speaker 2

Ohh no, they were terrified.

00:22:47 Speaker 1

Find that hard to believe.

00:22:50 Speaker 1

I'm going to go ahead and kick it back to Kelly. Just explain to me what role an integrated pharmacy partner can play when operating or offering in person, whole person care, having a pharmacy partner such as Genoa on site.

00:23:04 Speaker 3

So, to be honest with you, 8 years ago that was new new to me. We expanded some operations in a county north of Pittsburgh, PA and that setup was already there. And I thought well, this is interesting. You know how you know, how's this all?

00:23:20 Speaker 3

Work Fast forward to now. We operate around 10 outpatient clinics and three or three largest have the integrated pharmacies, but they also support numerous other you know locations and.

00:23:39 Speaker 3

I think it's so helpful and I think it's a good example of how you don't necessarily cause. I think sometimes there's different.

00:23:48 Speaker 3

People out there in the community and they, they have a role there and they're doing good work, but it's not in the cards for them to be behavioral, health, substance abuse, they might not. It's not easy to run a primary care so that that's the one, right. So I really give Doctor Vanna all the credit because going in and out.

00:24:09 Speaker 3

Not is very, very. You know that's a, you know, a heavy lift and they were able to do, but that's not in the cards for everybody. But this is a perfect example. You don't have to own everything. We used to own our own pharmacies and we walked away from them it what it became too.

00:24:24 Speaker 3

To labor intensive for us to resource demanding, but we have a partnership. So you could establish those same partnerships. I mean it's nice when.

00:24:33 Speaker 3

You're all all.

00:24:34 Speaker 3

Employed by the same and you're in the same building, but you can build those same bridges you know with other partners and really.

00:24:45 Speaker 3

The feedback that we get from the individuals that use the pharmacy and they're there on site and I just, there's something special at least for the the ones that we have and I and it's only fair to say you know all three of ours are Genoa. I mean this isn't a commercial, but I mean the credit is due where the credit is due and.

00:25:04 Speaker 3

They really treat our individuals just spectacularly and also we have a lot of physicians and psychiatrists that work for us and they're very good about getting them.

00:25:16 Speaker 3

And physicians have a really hard job. There's a lot and there's a lot of moving parts and they're able to get good accurate information and they're able to collaborate and make sure things are right. If they're adding a medication, if there's an issue where maybe someone says, you know, I didn't take this medication all the time or I'm having some sort of difficulty.

00:25:36 Speaker 3

And I think the staff feel supported as well and they feel part of that same community of the clinic and the pharmacy because a.

00:25:45 Speaker 3

Lot of the stuff.

00:25:47

Mm-hmm.

00:25:47 Speaker 3

The pharmacy to meet their own needs, and they know they can walk over and they could get something taken care of and that the pharmacies there and I think the pharmacies are just more receptive when they're on site. It's much easier if you're a commercial pharmacy someone called and said, oh, I don't have that on stock. Ohh I can't help you. Ohh it's not working with the insurance call someone else.

00:26:08 Speaker 3

All the doctor's office. The script's not right. It's just easier to pass you off. But when you know the integrated pharmacy is right there, you get a much more collaborative.

00:26:18 Speaker 3

Committed effort and it's just been the everything for us has been really been a benefit in those locations. I'm trying to convince everyone to have one at our administrative offices. We have very little treatment here, but we have very large administrative headquarters and everyone here wants a pharmacy.

00:26:38 Speaker 3

On site, but the the more employees that than otherwise. So yeah, it's been great.

00:26:39 Speaker 1

I love it.

00:26:42 Speaker 1

Dress.

00:26:43 Speaker 1

I love it and I think I know you can talk to for that one, so I'll have to make sure you're in contact with the right person later. But I like what you mentioned. Right, you've got 3 on site, but the ten other clinics you guys have also utilized that and dedicated pharmacy partner as well and that's that's great to hear. So, Vera, what about you?

00:26:47

OK.

00:27:04 Speaker 4

That kind of sums it up. We're much smaller, but we feel the same way about having Genoa involved again.

00:27:12 Speaker 4

Not not an ad, but although I'm more than willing to put a banner out because I can't believe how great it is, especially with like reconciliation, you know, Med reconciliation and assorted other things, some of our clients who are really, you know, not happy about dealing with pharmacies and the respect that they get and and the fact that they do coordinate and.

00:27:33 Speaker 4

Share information, but just to give you an example like a real life one that I'm sure a lot of you can identify with. You know in 2020.

00:27:42 Speaker 4

I think we had a living, breathing example of what integrated care can do. We had, you know, nothing was open. Primary care doctors weren't answering their phone. Everyone's telling you not to go to the emergency room. People didn't have food. And and we, you know, we decided. All right, let's see what we can do. So we had our partial.

00:28:01 Speaker 4

Have folks making bats of spaghetti and putting things together to bring out into the community, along with our family practice APN who was riding bridge meds because.

00:28:13 Speaker 4

We didn't know when people would be able to get any medications, and our pharmacist who was delivering meds herself, much less with her, you know, the tech folks that were with her and and our case managers. And if that's not integrated here, I don't.

00:28:27 Speaker 4

Know what it is so.

00:28:29 Speaker 4

Shots they gave you know we we never stopped giving shutting up. There were agencies that were putting people.

00:28:33 Speaker 4

Understandably, back on oral meds because they didn't have, everybody was helping out with everything and and to me, that's like a living, breathing example of what integrated care can do.

00:28:44

Yeah.

00:28:47 Speaker 2

I would agree that is an amazing story actually. But you know our our integrated pharmacies at Tara's.

00:28:55 Speaker 2

They have been extremely helpful partners, our pharmacists and the pharmacy techs. They know our patients, right, they they understand what their needs are, they communicate with our team like hey, this person didn't pick up their medication. Is somebody going out to see them later today? Like how do we?

00:29:15 Speaker 2

How do we make sure that they're adherent to their medications and don't have challenges because of that? They also.

00:29:21 Speaker 2

Been really helpful in you know, administering influenza vaccines every year, right? I don't have to have those at the clinic and and provide the oversight for that. Our pharmacy partner is able to manage that for us and that's been really helpful, COVID-19 vaccines and other preventative vaccines for all of our patients.

00:29:43 Speaker 2

They, you know, our pharmacists.

00:29:46 Speaker 2

Definitely help with medication management. I remember a time was working in one of our when I first got here to understand mental health better, I decided to go one day a week and practice primary care at one of our recovery centers serving our patients with serious mental illness. And it was really interesting.

00:30:06 Speaker 2

I remember a patient came in and she had all of these symptoms and I.

00:30:09 Speaker 2

Was like please.

00:30:10 Speaker 2

Show me what meds you're taking. Right, like dizziness. And she was feeling awful. Like, show me she was taking duplicates of so many of her hypertension medication.

00:30:24 Speaker 2

I remember just being like.

00:30:26 Speaker 2

OK, so I don't know how to get through this, but you should not be taking all these meds, right? And I remember walking over to the pharmacist. I mean, like, he's. So I'm new here, see MO. And can you help me figure out what's going on here?

00:30:44 Speaker 2

And he spent a large amount of time helping me coordinate with other pharmacies and and figure out. Does she still have active prescriptions there? What do we need to do to cancel them and get them all transferred? So she's getting all of her medications here. He was like, we should be doing a bubble pack for her to make this easier for her. And I was like, what is a bubble?

00:31:04 Speaker 2

Yeah, I'm not familiar, but yes, let's do that. And it really just made my job a lot easier in in helping to navigate that patients care.

00:31:16 Speaker 2

And and helping her get what she needed, which was phenomenal. I didn't have to call a bunch of pharmacies myself, and I had that support. So I would say that truly they are a member of our care team regardless of what organization they work for, right. And we've just been really, really lucky.

00:31:37 Speaker 2

To see the benefits of that for our patients and our providers.

00:31:42 Speaker 2

So.

00:31:43 Speaker 1

That's amazing and I love the love fest for all of the site managers. It's like I don't know who has the best, but we can.

00:31:49 Speaker 1

Fight about that later.

00:31:51 Speaker 2

They're all phenomenal. We'll just go with that.

00:31:53 Speaker 1

Yes, all 700 and however many we have now. Well, thank you all for sharing that experience with the pharmacy partner for the listeners. I'd be curious on your three perspective of what advice you might have for a clinic that is interested in incorporating whole person care into their practices. Just kind of where to start or what advice you might have or things that you.

00:32:13 Speaker 1

We weren't expecting.

00:32:18 Speaker 3

I should start because I just have probably the smallest thing to say about that. I would just say I have a lot of patience and realize it's a continuous evolution and and not to be intimidated and not be afraid. You know to to start taking steps in a direction because it's really.

00:32:38 Speaker 3

Us, you know, incorporating, you know that holistic perspective and it's in your your core most people that work they wanna they wanna do that they want it's good for the person. So it feels natural to yourself. Imagine it feels you know natural to those you serve. So I think that would be you know my advice just to start making incremental steps.

00:32:59 Speaker 3

And realize like it's a journey and you don't have to feel like you have this big initiative and and you, you know, did it. And because it's not going to be done even when it's done, there's always going to be you know more to do.

00:33:12 Speaker 4

I would add to that that if you're a smaller agency and it feels overwhelming, like the whole CBHC and all of the things you have to do to be 1, maybe approach to CBHC about being a DCO, which is kind of a subcontract. But in doing that you are part of that team and so.

00:33:33 Speaker 4

Not only do you get the benefits of, you know.

00:33:37 Speaker 4

Payment. But you also get to understand the larger context of how to provide whole health, what your role is, and and then you can kind of figure from there what you want to do or you could start by hiring someone case manager in. In our case, the first person that we hired, we just locked out because we were.

00:33:57 Speaker 4

CDHC and we had to do what we were doing at MAT, but we had to do ambulatory D.

00:34:03 Speaker 4

We found a physician who had decided that she didn't want to be an anesthesiologist any longer. She had been doing primary care. She wanted to do addiction work, so she brought the whole 9 yards in because she was doing substance use. But she also now was advising us on some of the primary care stuff. And then from there.

00:34:23 Speaker 4

They brought in an APN who was a family practice as opposed to, you know, psychiatry. But you if if you're not into the medical stuff, you know, if you. If that's like too big.

00:34:34 Speaker 4

Hire a case manager who's worked in medical settings. You can get somebody who worked in an FQHC or in a hospital, and so they have some expertise so you know, yeah. Like Kelly said, he sports well, don't get overwhelmed by it. And then it's just something that you feel good about and you want to continue it.

00:34:54 Speaker 4

Then apply for you know to be a CBHC when that opens up, you know in in your state or something along those those lines.

00:35:04 Speaker 1

Some.

00:35:05 Speaker 2

I would definitely echo what both of you said. I think do something that feels natural for your organization and your patience. Right? Don't force something just because it sounds like a good idea or there's a funding opportunity. We've definitely made those mistakes in the past, but do something that helps your patients.

00:35:26 Speaker 2

And you'll start the benefit, right. I think for tariffs, we started doing HIV testing.

00:35:33 Speaker 2

Definitely was something our patients needed at the time, right. And now as we're looking at our primary care, I think.

00:35:41 Speaker 2

When our primary care providers have started to look at how they can better meet the needs of our mental health patients, right, our patients are also having substance use disorder issues. They also have diagnosis of hepatitis C So we've branched into looking at how do we provide treatment right for hepatitis C.

00:35:59 Speaker 2

How do we help?

00:36:00 Speaker 2

Prevent HIV and do HIV prevention. How do we help with those things that we know our patients are already dealing with? It became a lot easier.

00:36:11 Speaker 2

And so I think for me, it's do what feels natural and what makes sense. But if you say you know, your behavioral Health Organization and tomorrow and you see mainly adults and tomorrow you decide that you're going to serve kids, it's going to be a lot more challenging. Right. But if you say.

00:36:30 Speaker 2

Let's look into how do we serve the justice population? Maybe that's a good place to start, right? Or something that your patients need. So.

00:36:41 Speaker 1

All very good perspectives, and it sounds like you are all aligned with doing something that feels natural to you, which sounds about right to me. So last question I have for you and then we will go over to any Q&A questions. Just reminder to anyone listening if you have questions for these three wonderful ladies, go ahead and put them either into the chat or.

00:36:59 Speaker 1

Into the Q&A section.

00:37:01 Speaker 1

But the last question I have for you all is, is there anything you wish you knew before offering full person care initiatives at your clinic? So anything that you wish you could go back in time and and know beforehand?

00:37:17 Speaker 3

Yeah, I'll go first. That's easy for me. I wasn't. I mean, that's just been the history. So for me to say, you know, we would undo it.

00:37:27 Speaker 3

And I'm a social worker by trade, like it's just like the natural, you know, I mean, the natural thing. So.

00:37:34 Speaker 3

I I really can't, you know, I mean, I think that you could always know more. We have had experience. We had an FQHC look alike and we let that, you know, go and want a different direction with our primary care mixed with MAT. So maybe I could just say.

00:37:53 Speaker 3

Like, have you know, knowing that you can always, you know, change gears, there's more than one pathway. Maybe that's what I would say and not, you know, feel pressured, you know that, you know, cause you see another entity and you feel like you're doing good work and then you see an entity get, you know, some designation or some funding and.

00:38:13 Speaker 3

That's OK. You look like Vera said you could partner. You could work together. But other than that, I can't really think of anything, Allison.

00:38:21 Speaker 1

OK.

00:38:25 Speaker 2

I think Terrence has been doing, you know, some of these initiatives before I was born. And so, you know, I, I I don't know that I would tell them to do anything differently. I think the one thing that I maybe wish that I knew when I took this job right as primary care is that.

00:38:44 Speaker 2

UM.

00:38:46 Speaker 2

As a primary care CMO and kind of went into this role, was really that it's just about understanding each other and understanding how each person can contribute to the team.

00:39:01 Speaker 2

But communicating that so when you're making the decisions at an executive level at a director level, right, and you're really driving the mission of your organization?

00:39:11 Speaker 2

And making sure you communicate that early, often and in a way people understand is is really important and you prioritize whatever that initiative is, right. It's something that you talk about regularly. It's in your strategic plan. It's something that the whole.

00:39:31 Speaker 2

Organization sees as a priority and understands the value of because you've told them you've helped them see it themselves rather than just say we're gonna do this new thing and and hire a director for it and let it kind of be on its own would be something that I would recommend.

00:39:46

Stuff.

00:39:51 Speaker 4

That makes a lot of sense and I would just add for us really small steps. You know it don't get ahead of yourself and keep going back to make sure that you didn't miss your staff.

00:40:03 Speaker 4

While you were.

00:40:03 Speaker 4

Moving forward, because we, you know, we there were plenty of times where, you know the executive level staff, we're all having these conversations and we're sure that we're doing the right thing.

00:40:12 Speaker 4

And then we, you know, go back and the staff were kind of like, you know, they had kind of caught up with that. So going back and checking in, making sure that and also.

00:40:22 Speaker 4

In in getting to know our partners, you know, in in those folks in the community like the primary care practices and stuff, getting to know them and and also helping them understand cause they're really busy and it's not that they don't want it. And like one guy told me, if I ask all these questions to, you know, to in my 15 minutes, if I ask about.

00:40:44 Speaker 4

Domestic violence and they say that they have these problems. What exactly am I supposed to do then?

00:40:51 Speaker 4

And So what we decided we would do is find a way to partner with them so that we could say you're going to call us and we're going to help you. And so establishing those those relationships early on where people see the value and what you can do to help them be able to do what they do better or you know more efficiently or whatever.

00:41:11 Speaker 4

So I think had I known that like we had all these big picture goals, but when it it, it was like, oh, let's get to know the family.

00:41:18 Speaker 4

Receptionist because she's the person who knows more about what's going on and will communicate with us in a different way than trying to bother this poor guy who's got back-to-back people, you know, so it's those kinds of things, I think.

00:41:29 Speaker 1

Yeah.

00:41:32 Speaker 1

Yeah.

00:41:34 Speaker 1

Well, I certainly appreciate and value all of your insights. Again, you 3 are just experts in this area and it's been an honor to have a conversation with you 3. I hope the listeners were able to take something away. I'm not seeing any questions specifically yet in the Q&A section, but please reach.

00:41:51 Speaker 1

Up to anyone on our marketing team or myself for additional questions and we can expand or maybe connect you with these leaders one-on-one. So OK, it looks like there is one question before we jump off. I was just about to let everyone go and now we have one question.

00:42:08 Speaker 1

Can you speak to the use of telehealth and its appropriateness as a treatment modality in whole person care? It's very interesting.

00:42:20 Speaker 3

Yeah, we all want to champion. It's like that. It's it's. I mean, for us it's a mix. We have some protocols that we try to determine what's the best path pathway for the for the the individual.

00:42:21 Speaker 4

Jump, yeah.

00:42:38 Speaker 3

But I'm going to be honest with you. We do believe in that. We still need some, you know, personal interactions that are not virtual. So we still are out that and a big piece of our business is community based work. We have people that are navigators and a lot of the best outcomes we've had is holding.

00:42:58 Speaker 3

Hands with people in the community and helping them navigate difficult situations and.

00:43:03 Speaker 3

Systems, and I'm sometimes it's literal hand holding. Like we're right there next to them. So I would just say if you have a good telehealth platform and you have the right people on both ends that it's a good fit for that, it makes sense. But we've seen on both sides where you have practitioners who maybe.

00:43:23 Speaker 3

It isn't the best thing for them, but they're feeling of what they want to do and what is a good fit for them doesn't match. But it's other places. It is a match and it's the same way with the individual and their presentation, whether it it's good and that's I'll leave it at that.

00:43:38 Speaker 4

Yeah, I I would just add to that it we've seen it as an evolution. It went from an emergency kind of service to a treatment modality that really should be specific to the person that you're treating. So what we'll do is like during the intake, we'll ask a lot of questions about any kind of barriers to coming in in person.

00:43:59 Speaker 4

Which is usually our default is. We try to get people to.

00:44:02 Speaker 4

And if it's transportation, then we can help out with that. Is that the only reason that you you, you know want telehealth or if there are other reasons and then we would decide if we think that this is the appropriate modality for this individual person. Sometimes we'll come up with a kind of a hybrid approach to even to telehealth. OK, fine.

00:44:22 Speaker 4

They'll do telehealth with you for, you know.

00:44:26 Speaker 4

Brief sessions out of the month and you come in for one or you know.

00:44:31 Speaker 4

To come in quarterly or something if it's the prescribers who are, you know, seeing the person, but we we I I think it's in about evolution, I don't think it's stopped yet. The other thing is we did a survey of our consumers in 2021 asking them what they preferred and it was overwhelming. Nobody wanted to come.

00:44:51 Speaker 4

In in person.

00:44:52 Speaker 4

Was like we just want telehealth today. We're we're having to ask our staff to come in more into the office more hours because the overwhelming majority now want to.

00:45:02 Speaker 4

Be seen in.

00:45:02 Speaker 4

Person. So it's got to be part of an evolution and also based on the treatment needs of the individual person. So and are you going to say something I think.

00:45:11 Speaker 2

Yeah. So, yes, I would agree. I think it's very individualized and it's how do we best serve the patient in their current setting and how do we provide that care, right. But one of the ways that I think telehealth has helped us very significantly is it has been a way to connect our community.

00:45:32 Speaker 2

Base teams who are in who are in person, teams that are in the clinic, right. So we'll have teams that are out in the community. We have a portable care pilot that's actually staffed with a behavioral health technician and nurse.

00:45:45 Speaker 2

And a behavioral health professional. And they go out into encampments into the community, do outreach to patients, and then get them connected if they need something via telehealth platform to or primary care provider. That's at one of our clinics or our behavioral health provider.

00:46:07 Speaker 2

Or a clinician for an intake for residential treatment and that has been a really successful approach for us and a good use of telehealth because oftentimes the patients that we're.

00:46:20 Speaker 2

Being aren't interested in coming into the clinic, they've had negative experiences. They've, you know, they don't know how they're going to get there. They're all of the things, right. And it allows us to get people connected to care at the point of service. When we're right there with them. And so that's been a really fun.

00:46:41 Speaker 2

And great opportunity for us and I think we're going to continue to.

00:46:45 Speaker 2

See that evolve so.

00:46:48 Speaker 1

Very interesting perspectives and it does feel like at at a point in 2020, this pendulum swung very far one way, and now it's kind of swinging back the other way. So I appreciate those different perspectives, and that was a great question that came through last minute. So if there are no other questions, we'll go ahead and wrap it up and give everyone a couple more minutes of the.

00:47:08 Speaker 1

Lunch break? I assume so. Thank you all for being here. I really appreciate your time. And thank you again to our wonderful panelists for joining us today.