Health Care Home Connects Mind and Body for TCMHS Consumers

Tri-County’s new Health Care Home program has quickly succeeded in connecting and coordinating health and mental health care for clients of Tri-County Mental Health Services.

Launched in January as part of an initiative to improve care while containing Medicaid costs, the program is working with almost 500 Tri-County clients to reduce duplication and improve client health by linking previously separate services within Tri-County and the community. The program supports a recognition that mental and physical health are connected, and that traditionally separate services often cost more and accomplish less.

“It’s one of those epiphany moments,” Director Robbie-Joe Hughes said. “The health care field should have been doing this 30 years ago.”

Along with Robbie-Joe, the effort at Tri-County includes two nurse care managers, an administrative assistant and a physician who serves as the primary care consultant. Those involved also include scores of agency case workers, area physicians, nurse practitioners and hospital staff within the Northland. Equally important are members of Tri-County’s unique community care provider network, independent mental health professionals who provide much of Tri-County’s services in local communities.

Linking all of these largely independent professionals is the biggest job faced by Health Care Home. It’s also why, in her first few months on the job and focusing on communications, Robbie-Joe was grateful for a snow-free winter.

“I was talking to people in Richmond, and I was talking to people in Platte City,” she laughed. “I was so grateful we had an easy winter.”

Such communication is a key to the new effort. With recognition of the connections between physical and mental health comes the need to ensure that the different types of health care are connected. For example, medication for an ailment can affect the client in other ways, and a physical ailment can have emotional impact. Creating a formal way for health care professionals to communicate this type of information is a goal of Health Care Home.

“Many medical professionals have been calling for this for a long time,” noted Robbie-Jo, an RN. “It’s really exciting.”

One example involved a consumer who could eliminate the need for oral diabetes medicine by losing five percent of his body mass, an achievable goal of 8-12 pounds. “That isn’t that much, but it can have a major impact, especially if there is asthma and other issues,” Robbie-Joe noted.

Communication with Tri-County clients has also been important. Robbie-Joe noted that, in hindsight, she might have suggested a name other than Health Care Home. “Initially, some consumers were thinking they were being sent somewhere,” she recalled. “Looking back, it might have been better to call it Care Coordination Services or something like that.”

Although it took time to communicate with almost 500 people, the program was embraced when it was explained. “Everyone was on board once we started doing our face-to-face meetings, and we explained that it’s coordination of care, including health wellness and prevention.”

Consumer involvement is also important because success is dependent on their efforts in many ways. “The idea of person-centered care stresses the idea that they set their own health goals,” she explained. “And, personal involvement to help the “whole person” is the core of what Health Care Home is about.”

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