‘Health Homes’ Bring Broader Coverage

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The Health Improvement Partnership of SC County (HIP) received a $200,000 grant from the Blue Shield of California Foundation on Dec. 3, 2013. The grant will expand the services available at four Santa Cruz safety net clinics and allow them to take advantage of changes made by the 2014 Affordable Care Act.

A safety net clinic typically serves uninsured or poorly insured patients who cannot afford private healthcare providers and specialists. The grant will primarily help HIP’s Patient Centered Medical Home Initiative (PCMH) further integrate mental healthcare and substance abuse services — which are now covered by Medi-Cal — into Santa Cruz’s safety net clinics, according to a HIP press release.

“Recently, there has been a big push to have these clinics become what we call ‘health homes,’ meaning they can be a one-stop shop for patients to take care of all of their needs,” said HIP program coordinator Jordan Turetsky.

By adding mental health and substance abuse services, the PCMH initiative hopes to provide better and more well-rounded care at the safety net clinics serving Santa Cruz’s low-income residents.

HIP runs the Safety Net Coalition, which is composed of healthcare clinics providing primary care services to Santa Cruz residents who are uninsured or receive healthcare from publicly funded programs like Medi-Cal. The Safety Net Coalition includes Salud Para La Gente, Santa Cruz Women’s Health Center, Santa Cruz County Clinics and another temporarily confidential clinic.

HIP was launched in 2004 as a nonprofit collaboration between public and private healthcare providers with the goal of increasing access to and improving Santa Cruz healthcare centers. It is entirely funded by public and private foundation grants, such as the recent grant from Blue Shield.

“The HIP project was funded as part of our support for safety net clinic consortia throughout the state,” said Blue Shield of California Foundation program officer Crispin Delgado. “However, HIP was the only consortia funded to do behavioral health integration work.”

Turetsky said HIP plans to integrate mental health and substance abuse services into primary care for years, but it was limited due to the relative scarcity of patients covered by Medi-Cal and Medicare.

This year, the Affordable Care Act designated behavioral health services as a reimbursable service at clinics. With this, and the ACA’s expansion of Medi-Cal, more residents can receive mental and behavioral healthcare at safety net clinics.

“Historically, you have gone to these clinics just for primary care appointments, so for your annual exam, because your throat hurts, or because you sprained your ankle or something like that,” Turetsky said.

The extended clinic services and Medi-Cal coverage may further facilitate healthcare because more services will be available to patients at clinics they’re already familiar with.

“If people have to take steps beyond visiting their primary care provider, such as getting a referral, having to go to another office or researching their coverage, they are less likely to access those services,” Delgado said.

Medi-Cal’s newly expanded coverage allows HIP to use the Blue Shield grant to increase regular behavioral health service and substance abuse service coverage, but the severely mentally ill will be referred to the county’s mental health system.

Regular mental health and substance abuse services generally include counseling, screening, brief intervention, treatments and potentially psychotherapy, Turetsky said.

Additionally, the PCMH initiative organized clinics to assign a set of patients to one particular provider “so the patient sees the provider every time they’re in the clinic.” Close relationships between healthcare providers and patients creates a more comfortable environment.

“Over the past three years these safety net clinics have been working together to learn things like team-based care,” Turetsky said. “They’re working with a medical assistant and a provider to really be a team providing care to a specific population.”

According to the HIP website, team-based care encourages communication among doctors, nurses and specialists. Cohesive healthcare clinics united by their common purpose of providing care for their patient use scarce healthcare funding more efficiently.

Blue Shield of California Foundation granted HIP $200,000 to support safety net clinics in 2012 as well.

“Santa Cruz safety net providers are long time partners of Blue Shield of California Foundation,” Delgado said. “Their contributions to supporting low-income patients and the uninsured are immeasurable.”

Blue Shield of California Foundation is entirely funded by the Blue Shield of California corporation, a not-for-profit health plan founded in 1939. According to Blue Shield of California Foundation’s website, their grants are meant to improve California healthcare and domestic violence services as well as increase their accessibility. In 2013, the foundation donated 41 statewide grants for a total of $15.8 million dollars.

“Our mission is to provide access to quality healthcare for the most vulnerable Californians,” Delgado said. “We funded this project because it is a unique partnership among a broad set of stakeholders serving the neediest people in the area.”