Supporting Whole Person Care at Nebraska CCBHC, CenterPointe Inc., with One EHR

Now into its second round of grants to support Certified Community Behavioral Health Clinic (CCBHC) services, CenterPointe Inc. of Lincoln, Nebraska, has added primary care services to its longstanding range of 40 mental health and substance use disorder care programs. In doing so, CenterPointe can address an individual’s overall wellbeing and provide the best quality care to the high poverty, high need communities throughout Lancaster County.

“When someone walks through our front door, whether we’ve seen them before or not, we can get them the care they need,” said Isaac French, CenterPointe Vice President and Director of Continuous Quality Improvement and Data Managment. “There is no wrong door here.”

Adding primary care services to the mix, along with same-day access to behavioral healthcare and 24/7 crisis intervention services were the biggest changes that came with winning CCBHC grants. Either under a CCBHCs own roof, or in partnership with a Designated Collaborating Organization (DCO), screening and monitoring for primary care conditions is one of the nine required CCBHC services. Leadership deciding to actually provide primary care services beyond screening and monitoring is CenterPointe going beyond the CCBHC criteria.

“We chose to go beyond the CCBHC requirements and provide primary care services ourselves, because we wanted the people already coming to us to keep coming, and to bring in people who needed care and weren’t getting it,” French said. “On average, individuals are seen by our PCP within 12 days of expressing interest in receiving PCP services, though the median is 4.5 days, due to a few large outliers. 71.8% of individuals are seen within one week. At the start of our first CCBHC grant, 27.2% of individuals served had an established Primary Care Provider (PCP) in the community. That has since increased to 44.8%, largely due to having primary care available to 1,100 more people now who have an established PCP,” French said. That level of access is a benefit to the community of CenterPointe’s CCBHC services.

The physical proximity of having primary care and behavioral health services under one roof facilitates integrated care: “The provider’s offices are right next to each other. We evaluate at intake what services people need. When they come to us for one thing, they can say they also want to see another provider. If they are here for behavioral health and they want to address primary care concerns, we take them straight over to the doctor,” French said.

CenterPointe’s first CCBHC grant award happened in an expedited timeframe in 2020. Managing CCBHC growth and expansion through the COVID pandemic gave CenterPointe’s commitment to primary care sharp urgency. “Enhanced coordination was one of our immediate priorities, and that strengthened our commitment to providing primary care. During FY 22-23, we saw 34% more individuals than we did the year prior to becoming a CCBHC. During the last year, we saw 42% more brand new individuals compared to the year prior to becoming a CCBHC,” French said.

Part of the organizational change CenterPointe executed on becoming a CCBHC was reimagining the workflows, data gathering, reporting, metrics and analytics existing within the Credible EHR from Qualifacts when the grant awards were announced. That included building new forms for primary care when that service line was created.

“Credible made it possible for us to add new documentation, forms, and workflows ourselves for our inhouse primary care services, leveraging the primary care module to map out our own workflows,” French said.

CenterPointe went live with the Credible EHR in 2017, and French joined soon after as a key CenterPointe team member. Barely four years later, he led the CCBHC adaptation effort. “Building forms to support the provider’s workflow for CCBHCs was easy and customizable. The right form can save the providers minutes at the point of care, which is critical. We are doing more and more primary care services in-house now, including immunizations and labs.”

“CenterPointe has developed trusting relationships with its communities over decades, and adding primary care services has broadened its reach,” said Mary Givens, Qualifacts CCBHC Program Manager. “CCBHC funding awards made it possible for CenterPointe to offer people primary care services where they already receive their ongoing behavioral health and substance abuse disorder care, and to bring people in for primary care first and extend other services to them, as needed, including parents and their children. CenterPointe’s mix of services continues to add true value to the communities served, and opportunities for a better quality of life, for today’s clients and for future generations.”

“Working with CenterPointe and our CCBHC customers across the country, who go through tremendous organizational change when they win grants that allow them to add services and programs, we often hear that leaders like Isaac French are able to work independently with their teams to configure the Credible EHR for their changing needs,” Givens said. “Adding primary care workflows to Credible and tracking the data and for reporting with Credible Business Intelligence (BI) tools is typically an ongoing self-managed process for Qualifacts CCBHC customers. CenterPointe’s team led and managed these efforts to get the results they need, with support from the peer leadership of the nation-wide Qualifacts CCBHC cohort group, and from our staff subject matter experts as needed.”

Today, CenterPointe’s primary care offerings include services for adults, and children; women’s health care, management of chronic conditions such as high blood pressure, high cholesterol, obesity, and diabetes; tobacco cessation counseling; adult immunizations; sick visits for common cough and cold symptoms; minor injuries; STD screening; HIV and Hepatitis screening, and care coordination between physical health and behavioral health care providers.

“Our most common chronic condition is obesity. Of those with a BMI of 30 or greater, 46.5% have lost weight since their first primary care visit, for an average of 15.9 pounds among that group. 11.1% no longer meet criteria for obesity,” French said. “Our second most common chronic condition is hypertension. 55% of those who have met criteria for hypertension had their most recent blood pressure check below hypertensive levels.”

CenterPointe’s CCBHC success is tracked and managed with the advanced business intelligence tools Credible offers. “Credible has given us the flexibility and the data management to fully enact the define, measure, analyze, improve, control quality improvement method of learning and moving forward,” French said.

As a CCBHC, CenterPointe also offers referrals to complex care and social services, depending on a person’s needs. Successfully offering referrals and tracking them is part of the CCBHC mission. “We don’t turn somebody away, whether they need to figure out where they will sleep tonight or they need a meal or they are in crisis,” French said. CenterPointe has built a robust referral workflow through the Credible EHR, which includes following up to ensure clients attended the referral appointment and that CenterPointe receives the reason for referral report back.

CenterPointe’s CCBHC success with Credible puts it in a leadership role within Nebraska, where the EHR has a large and collaborative user group. The flexibility of Credible, combined with the enthusiasm of its users, promotes engaging conversations where participants share their approaches and solutions for enhancing day-to-day operations. “I will share workflows and form structures with anyone who asks, and I am glad to do it,” French said.

Qualifacts also offers formal, regularly scheduled work groups and informal peer-led discussion groups, nationally, state by state, and by topic, with input from staff subject matter experts as needed.

“Having one EHR to manage programs and services for behavioral health, mental health, substance use disorder, and primary care allows for better coordination of services, and enhances outcomes for the communities served,” Givens said. “Having these types of providers in one setting allows for greater communication and coordination of care across teams, within the organization and beyond, including the tracking of emergency department visits, hospitalizations and discharges for a full understanding of where clients have been and where they are going.”

 

About CenterPointe, Inc.

CenterPointe helps the people we serve get better, sooner, for longer. Over the past 50 years, CenterPointe has grown to include over forty programs including mental health and substance use treatment, primary care services, rehabilitation, medication management, 24-hour crisis response, and housing.

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