“The right care, at the right place, at the right time.” This is a presentation of the Marillac Clinic (located in Grand Junction, Colorado) model of Integrated Medical Care. This clinic serves the uninsured and under-insured. It is an affordable health care model of a Medical Home. Marillac provide primary care.

1. Integrated Care at the
Medical Home
September 25, 2009
Steve.Hurd@stmarygj.org
970.244.2235

2. Marillac Clinic
Grand Junction, CO
2

3. Brief History of Marillac
• Started in 1987 after United Way needs assessment
• Sponsored by Sisters of Charity Leavenworth
• Shared mission and values with affiliate hospital (St.
Mary’s)
3

4. The Medical Home Motto:
“The right care, at the right place,
at the right time.”
4

5. 5

6. Guiding Philosophy:
Meeting several patient needs
in one visit results in greater
efficiency for both patient and
provider.
5

7. Marillac’s Model
Five Lines of Service - All Under One Roof
• Medical
• Mental Health
• Dental
• Optical
• Low Cost Pharmaceuticals
No Wrong Door
6

8. Clinic Eligibility
• At or below 250% of federal
poverty level
• Mesa County residents
• 20,000 Uninsured in Mesa Co
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9. Patient Panel - 2008
• 7650 Unduplicated Patients
• 29,300 Visits
• 20,000 Uninsured in Mesa Co
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10. Staffing Pattern
• Size: 72 FTE
• 150 Referral Specialists- Sliding Scale
• Lab & Radiology – Sliding Scale
• Annual Budget = $7.5 million
9

11. Marillac Revenue Sources
FY 08 - 09
20% 21%
Patient Fees
St. Mary's Hospital
SCLHS Sponsorship
Local Philanthropy
Tobacco Tax
Foundations
16%
18%
12%
13%
10

12. Operations
• LEAN Principles
- Use of Impact Grids
- Reduce Variability / Eliminate Waste
• Process Improvement
- Horizontal teams meet weekly
- Reduce variability/Eliminate waste
• Incorporate Patient Feedback
11

13. Integrated Care - Defined
Medical and Behavioral Health providers
work side-by-side to improve clinical and
functional outcomes for patients with chronic
medical and psychiatric conditions.
Psychiatry consultation available.
12

14. Prevalence
Comparisons
Marillac Clinic vs. PHQ 3000
Major Depression
Anxiety
Panic Disorder
Alcohol
Binge Eating
Any Diagnosis
0% 15% 30% 45% 60%

15. Location, Location, Location
B Health FamilyHealth
B Therapist Addictions
B Health Case
Care
Psychologist
Specialist & Specialist
Psychiatrist Counselor
Specialist Manager
Medical Medical
Exam Exam
Rooms
Room Rooms
Room
Medical
Provider
Medical Medical
Exam Stations Exam
Rooms
Room Rooms
Room
Bathroom
Bathroom
Medical Medical
Exam Medical Exam
Rooms
Room Assistant Rooms
Room
Stations
Medical Medical
Exam Exam
Rooms
Room Rooms
Room
Reception Front Office
14

16. Outcomes
Utilization of ER and Inpatient Services
by Marillac’s Integrated Care Patients
30.0%
22.5%
15.0%
9.00% 8.00% 8.00%
7.5%
6.00%
4.00%
0%
Year 1 Year 2 Year 3 Year 4 Year 4.5
Hospitalization E.R. Visit
15

17. Inpatient Psychiatric Costs
Jan – Apr 2003 vs. Jan – Apr 2004
400000
341366
318750
Annualized savings:
237500 $685, 539
156250
112853
75000
2003 2004
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18. Fiscal Sustainability
via
Blended Funding
17

19. Fiscal Sustainability
via
Blended Funding
• Shared savings from St. Mary’s Hospital
and Colorado West Mental Health
• United Way
• Foundations
• Patient Fees
17

20. 18

21. Advantages of
Blended Funding
• Removes barriers to care
• Patients need to present at only one
location
• Encourages development of one
treatment plan
• Billing through CPT coding is
eliminated 18

22. Service Delivery
• Delivery model is spontaneous –
introductions, hallway consults
• Both medical and mental health providers
expect to be interrupted to assist one
another
• All providers work from the same medical
record
19

23. Advantages of Integrating
Medical & Mental Health
for Patients
• More convenience
• Less stigma, more patient follow-through
• Team approach leads to more accurate
diagnoses, higher quality, and more holistic
care
• Encourages self-management of illness
• Greater satisfaction
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24. Advantages of Integrating
Medical & Mental Health
for Providers
• Better match between provider skills and
patient needs
• Allows development of common treatment
plan and consistency between providers
• Enhances knowledge and skills for providers
• Better exchange of information between
disciplines
• Shared responsibility for patient care
• Reduces professional isolation 21

25. Advantages of Integrating
Medical & Mental Health
Healthcare System
• Simplified record-keeping
• More opportunities for mid-level and mental
health providers to leverage physician
resources
• Less likely to have duplicative or dangerous
medication complications
• Greater emphasis on prevention and early
intervention 22

26. Marillac
Clinic
Bridging the healthcare gap