Enhanced Care Program: A Collaborative Multi-Disciplinary Model for Complex Care Management Across the Medical-Psychiatric Spectrum

Friday, November 11, 2022

2:15 PM – 3:45 PM

Location: Room 206-207

Presenting Author(s)

Chritopher Plescia, MD

Assistant Professor of Psychiatry
University of Pittsburgh Medical Center; Western Psychiatric Hospital
Pittsburgh, Pennsylvania

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Co-Author(s)

JB

Jodie Bryk, MD

Medical Director, UPMC Enhanced Care Program
UPMC
Pittsburgh, Pennsylvania
AL

Anita Leon-Jhong, MD

Clinical Assistant Professor of Medicine
UPMC
Pittsburgh, Pennsylvania

Abstract: Background: Individuals with untreated mental health (MH) and multiple physical comorbidities have poorer quality of care and overutilization of unplanned care. The Enhanced Care Program (ECP) was created in July 2014 as part of our institution’s Internal Medicine clinic in collaboration with our health plan to address medical, psychiatric, and psychosocial needs of high utilization patients. The ECP team consists of 1.1 FTE internal medicine physicians, 3.0 FTE nurse case managers, 1 FTE administrative assistant, 1.0 FTE licensed clinical social worker (LCSW), 1.0 FTE consulting LCSW therapist, and a consulting integrated care/CL psychiatrist. Utilizing a primary care behavioral health integrated care model, patients are directly triaged weekly to MH services with the ECP therapist/psychiatrist for long-term management, for one-time consultation by the psychiatrist and co-management by the internist, or for referral to appropriate psychiatric/dual diagnosis program. We present an analysis of pre- and post-enrollment data on key health benchmarks of this innovative model of health care delivery.

Methods: Pre-/post- enrollment quality data was collected for patients enrolled July 2014 -March 2021. Metrics for patients accessing ECP for ≥ 6 months were continuously collected from electronic health records including: linkage to mental health services; diabetes management (A1C, foot, retinal exams); blood pressure screens; and cancer screening. Utilization data was collected and analyzed by our health plan using propensity-matched comparison populations of all ECP members enrolled as of March 2021.

Results: Rolling enrollment data showed that of 183 patients enrolled in ECP, 154 had MH diagnoses. 54% were connected to behavioral health services at time of enrollment compared to 99% within 6 months of ECP enrollment. Data showed a significant reduction in average HbA1c, BP, increased adherence to preventative health screenings, and utilization of unplanned care of patients pre-enrollment as compared to 6 months post enrollment.

Discussion: We found improvements in linkage to MH care, diabetes quality metrics, BP control, and cancer screening compared to pre-ECP enrollment and national benchmarks. Success in connecting patients to MH care is hypothesized to be due to “warm hand-offs” to referral bases and in-office MH services. Our results showed that a health plan funded integrated care model, and multidisciplinary team targeting patients with high utilization of health care services can affect meaningful change in quality metrics.

Conclusions: Management of co-morbid mental illness in primary care with multiple physical comorbidities allows for better procurement of routine health maintenance and contributes to improvements in health care utilization. ECP is another model of integrated health care that optimizes psychiatric resources using unique care delivery.

References: Hayes SL, Salzberg CA, McCarthy D, et al; The Commonwealth Fund. High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care—A Population-Based Comparison of Demographics, Health Care Use, and Expenditures.