Unity Physician Partners and Centerstone Health Partners share the belief that a person’s mind and body are not separate. What affects one, affects the other.
This philosophy led them to create a partnership focused on providing care for medically underserved patients with physical and behavioral needs. To do this they established integrated care clinics that address a patient’s whole health to achieve better outcomes, improve care coordination and develop a collaborative environment between the two groups that often see the same patients.
Unity operates as a primary care facility overseeing patients’ physical health while Centerstone is one of the nation’s largest providers of community-based behavioral healthcare. Both have clinical locations in Tennessee and Indiana, states served by atom Alliance.
According to Wellness Coordinator Valerie Klein, patients with behavioral health issues have significantly higher rates of diabetes, hypertension, obesity and hyperlipidemia. Many times the patients go untreated, further complicating their well-being.
“People with mental illness tend to have a shorter life expectancy, because physical health and mental health go so hand in hand, that if they’ve got chronic behavioral health issues, they’re typically going to have physical chronic health issues as well,” she said. “So if we can help them with some of those physical health issues and understanding them and working on them, knowing how to prevent them, then we can hopefully extend their life expectancy.”
Medication providers, therapists, and case managers from Centerstone meet weekly with the doctors and nurses of Unity to discuss potential participants who would benefit from being paired with a Wellness Coordinator and determine how to best integrate care.
This is where Klein comes into play. She acts as a go-between for patients. She matches Unity patients who meet certain clinical criteria with Centerstone’s services and follows through with the services offered. Participation is voluntary and, for the most part, those contacted to participate have agreed to the assistance.
“I’m actually pretty surprised at how receptive so many people have been,” she said.
Patients are contacted about the program and offered the opportunity to participate. If they agree, an enrollment appointment is scheduled to meet with a coordinator to complete a survey to determine the patient’s perception of both their physical and mental health status. The patient then undergoes a physical exam to establish a clinical baseline. Measurements such as carbon monoxide levels, waist circumference, blood pressure, height and weight are taken and then a health screening is conducted by Unity. This usually includes verifying a patient’s glucose and cholesterol levels.
The entire initial process takes about a month. That may sound like a long time, but the program’s pace is designed to meet the needs of a patient as many have transportation or financial issues that complicate care. The focus is on the patients’ needs. And if that means more time, then there is no rush to begin the program.
“I think that overall that healthcare, in general, is really going in that direction,” she said. “Treatment should be patient centered and better outcomes. And in order to get those better outcomes, you really have to focus on the clients and patients and make sure that they understand their treatment, they understand what is going on and they understand how to improve it. That’s where we come in as Wellness Coordinators to bridge that gap.”
When a patient first starts the program, the Wellness Coordinator discusses the patient’s medical conditions and what can be done for improvement. Goals are set – no matter how large, small, short-term or long-term – all are identified and supported.
“So, once we know what they want to work on, that is what we focus on and we give them as many evidence-based practices and information we can give them or work with them on,” Klein said. “Most of the time when somebody comes in and starts that initial wellness coaching, its a matter of sitting down and talking to them about how many times a day are you eating and what does that consist of. People don’t realize that what they’re eating and how many times a day they’re eating is affecting their mood and behavior throughout the day. We really just start with the basics.”
For some patients, the basics literally means a lesson in eating right and exercise. Participants are invited to attend group learning sessions where food selection, preparation and nutrition is taught along with exercise and health tips that address their chronic conditions.
However, while most of the coaching is done face-to-face with a Wellness Coordinator, the coaching is not limited to in-office visits. Some patients need motivation by having coaches step out of the clinical setting and into the real world where they share their knowledge of exercise, nutrition and coping in a setting the patient can relate to.
Klein shares a story about one of her patients who had a hard time understanding the importance of nutrition when it came to grocery shopping. Her behavioral health issues caused her to become agitated, nervous and uncertain while at a grocery store. She didn’t spend time looking at and examining fruits and vegetables as the options were too overwhelming.
Klein stepped in and met her client at a local Kroger where the two of them walked the aisles and discussed the types of foods needed to maintain a healthy lifestyle. She provided the patient with a shopping list cheat sheet that eased the patient’s anxiety. Klein taught her the basics of how to pick out fruits and vegetables and encouraged her to explore the store for other nutrition options.
“We’re not limited to handing out information and now go do it,” she said. “We can go to the grocery store. We can get them enrolled into the gym. We can do exercises with them here in the office when they are here. We approach it in so many different ways — we work from where they are coming from and where they want to be. I don’t limit success to reaching any certain number.”
Klein emphasizes that success can’t be determined solely by clinical terms. Centerstone’s research staff monitors patients’ data and results, then provides reports to determine reassessments every six months.
Monitoring of weight loss and lab results may show improvement, but the real improvement is determined by a person’s quality of life being improved by the simple changes and achieving their goals, no matter how small or how long it takes. The pace of progress is determined by the patient’s participation level. Klein said they don’t want the patients to feel that this is just “another thing we have to do”.
“At each Wellness Coaching session, we ask for them to set a short-term goal and a long-term goal. Those short-term goals are sometimes very, very small steps. But if they’ve accomplished them by the next time they come in, that’s success. That’s leading them into the right direction. That’s making change they maybe would not have made otherwise,” she said. “There’s nothing that says they’re not successful until they hit this point. Every single person – if they’ve made any progress at all – that’s success.”
While patients are cheered on for the changes they make, they are still reminded and held accountable for health outcomes that may not be so positive. When a participant doesn’t progress, Klein says it’s a Wellness Coordinator’s job to take a closer look at what factors may be playing a role in a patient’s health.
Those who don’t make progress get special attention and discussions about why progress is not happening. For many people with behavioral health issues, focusing on change can be overwhelming. Because the program assists patients with behavioral health issues such as depression, bipolar disorder, substance use, schizophrenia and borderline personality disorder, Klein stressed that being aware of these conditions is essential to moving treatment forward.
“Sometimes you run into a client that just isn’t having a good week or month and you’re not going to make any progress because of the symptoms they’re experiencing at that time,” Klien said. “You can kinda tell when somebody isn’t getting anything out of it. If that’s the case, you change it up. You do something else and make sure the client is engaged. Because if they’re not engaged, they’re not going to be willing to make those changes.”
At this point, immediate needs are examined and care coordination between the various clinical needs is done to make sure participants are getting the services they need, connecting with the specialists they need and making sure medications are provided. Flexibility in treatment is key.
“Physical health and behavioral health are connected. The symptoms of your behavioral health are going to increase if your symptoms of your physical health increases and vice versa because that is just how it works,” she said. “We have to be there to help them understand that they have to take control of one of those. A lot of times the physical health is a lot easier to take control of. So if they can take control of that physical health, then they can improve their mental health as well.”
The “move at your own pace in your wellness journey, we’re here to help you along the way at any time” tactic appears to be working, Klein said, as participants have shown improvement on both clinical and behavioral health conditions. Once a patient shows they are able to maintain the changes they’ve made without a lot of involvement from the Wellness Coach, they are encouraged to become independent and continue to make improvements.
“It seems that the biggest motivating factor so far has just been seeing them see their progress. Seeing weight loss. Seeing their blood pressure go down. Seeing those numbers – their cholesterol, their A1C drop – after three months of making small changes gets them even more excited and gets them to want to make changes,” she said. “We don’t ever just say you’re done. We continue with care coordination after and make sure they understand and are comfortable with it and they are continuing to make the progress they want to make with it.”
An old proverb states that a person is born with three things — a mind, a body and a lifetime. How the first two are used determines the third. This statement rings true for Klein and her patients who continue to make improvement and stop becoming another negative statistic.