Regional initiative to improve behavioral, physical care in NH begins

Under the federal Demonstration Waiver, D-H and Cheshire will partner with nearly 50 community-based organizations to support more than 21,000 Medicaid patients in 40 towns in western New Hampshire, about 9,000 of whom have behavioral health needs. The Demonstration Waiver, from the Centers for Medicare and Medicaid Services to the state of New Hampshire as part of the Delivery System Reform Incentive Program (DSRIP) Waiver 1115, was approved by CMS in January 2016; the contracts to provide services under the program were awarded in August.

“Our overarching goal – an audacious one – is to focus on improving behavioral and physical health for a large segment of people in our region who struggle with challenges to their health,” says Sally Kraft, Dartmouth-Hitchcock’s Vice President of Community Health and co-administrative leader of the initiative with Dr. Don Caruso, CEO/President and Chief Medical Officer of Cheshire Medical Center/Dartmouth-Hitchcock Keene. “This program brings community organizations together to improve care for a population in great need. Funding will support workforce expansion, use of technology to improve information exchange, and integration of mental health, substance use disorder treatment, clinical care and social services.  This work will go a long way to addressing the needs of our communities,” Kraft says.

Community based partners will include social service organizations, hospitals, county facilities, general health providers, and behavioral health providers including mental health and substance use disorders services, all to improve and integrate delivery of behavioral and physical health care to vulnerable populations. The project will engage the resources of D-H’s Department of Psychiatry and build from components of the highly successful Healthy Monadnock program at Cheshire. D-H clinics in Concord, Manchester and Nashua also will participate in the creation of Integrated Delivery Networks (IDNs) elsewhere in the state; overall, D-H will be involved with thousands of patients who have behavioral health needs among the more than 90,000 Medicaid-designated patients throughout the state.

 “This funding, and the collaborations it creates, is at the crux of our commitment to improve the lives of the people and communities we serve, for generations to come,” said Dr. James N. Weinstein, CEO and President of Dartmouth-Hitchcock. “It comes at a critical time, as we work to address the substance use and mental health crises here in New Hampshire and across New England. Health care providers, social service agencies, emergency responders, police, and courts – individually overwhelmed by these crises – can now join forces to find the best paths to a healthier population.”

Integrated care has long been a key component of the concept of population health. “We need to tie together our resources to help the neediest members of our communities, providing holistic, consistent and comprehensive support,” says Ruth Bleyler, a longtime Upper Valley behavioral health advocate associated with West Central Behavioral Health. A former three-term state legislator and retired EPA toxicologist, Bleyler adds, “We hope to do that now, and Dartmouth-Hitchcock is uniquely situated in the community for providing those kinds of connections. The best outcome would be that someone, who has any of these needs from Primary Care through other health and behavioral care providers, will be able to make those service links, so that they’re not on their own, navigating very complicated and confusing systems. It’s all about making those connections for people.”

Agencies involved in the IDNs are now proposing ways to coordinate their efforts in four main areas:

• Deliver integrated physical and behavioral health care that better addresses the full range of individuals' needs
• Expand capacity to address emerging and ongoing behavioral health needs in an appropriate setting
• Reduce gaps in care during transitions across care settings by improving coordination across providers and linking patients to community supports.
• Move fifty percent of Medicaid reimbursement to alternative payment models that reward high quality care delivered at lowest cost.

D-H and Cheshire Medical Center will be the lead administrative partners for the IDN in Region 1, which encompasses the areas defined as Greater Monadnock, Greater Sullivan County and the Upper Valley. Other regions include Region 2: Capital, where D-H Concord will partner with Concord Hospital; Region 3: Nashua, where D-H Nashua will partner with Southern New Hampshire Health Services; Region 4: Derry & Manchester, where D-H Manchester will partner with Catholic Medical Center. Other regions in New Hampshire are Region 5: Central & Winnipesaukee; Region 6: Seacoast and Strafford; and Region 7: North Country and Carroll County.

 “This funding offers us the opportunity to redesign the behavioral and physical health models of care inside our health system as well as designing the models with our Integrated Delivery Network partners. Those changes will benefit all patients and our communities, not just Medicaid patients with behavioral health needs,” noted Caruso. “By participating in four of the seven regions in the state, D-H has an opportunity to advocate for standardized, evidence-based practices across the state. This is an opportunity for D-H, Cheshire, and other organizations to make an important contribution to this statewide project, showing leadership, providing expert advice and learning together with our partners and communities.”

“This program illustrates the power of partnerships,” notes Dr. Peter Mason, a long-time family medicine physician at Alice Peck Day Memorial Hospital in Lebanon, who will be part of the program in the Upper Valley. “Now, more than ever, we have an opportunity to get together to empower people to get healthy and stay healthy.”