Partnering with an FQHC to integrate care: Update from Spectrum Systems

Spectrum Health Systems, Inc., based in Worcester, Massachusetts, is a private, nonprofit substance abuse and mental health treatment provider. Spectrum currently treats 48,000 individuals each year through more than 130 programs in community-based settings and correctional institutions throughout Massachusetts, Rhode Island, Georgia, Tennessee, Iowa, Maine, and Washington State.

Lisa Blanchard, MA, LMHC, Executive Director of Outpatient Operations, is responsible for operations at the agency’s seven outpatient programs. Lisa has been a manager and director at several Spectrum Health Systems programs since 1999, and is also a NIATx coach and presenter.

The Lincoln Street Clinic is Spectrum’s largest outpatient clinic, treating more than 1300 clients in the opiate treatment program daily. The program admits 25 clients daily through three walk-in admission days. It also offers 100 groups each week.

In 2011, Spectrum began negotiations to offer primary care services at the Lincoln St. Clinic through a partnership with the neighboring Edward M. Kennedy Community Health Center (EMK) clinic.

The primary care clinic opened in spring 2012 with the capacity to serve 6-8 primary care clients weekly. Today, the clinic offers 14-16 primary care appointments weekly, serving 12 clients. 

The NIATx E-news featured this partnership in the 2013 story, Partnering with an FQHC to deliver primary care: Lincoln St. Clinic.

We recently caught up with Lisa to get an update on the integrated care program.

“Our Lincoln St. program offers a full range or primary care services on site, starting with basic primary care,” says Lisa. Clients also have access to all other the services offered by EMK, which include dental, pharmacy, vision services, as well as social services.

Lisa cites great communication and a willingness to work together as two of the strengths of the affiliation with EMK. “Regular meetings with EMK leadership have been key to this coordination and collaboration,” she says.

NIATx tools and techniques have provided a mechanism to support and strengthen ongoing communication between the two agencies. 

“We have formed a cross-agency change team to focus on increasing referrals and decreasing no-shows,” says Lisa, who trained the EMK staff on NIATx. “Training the primary care team on what NIATx is and how it works has been very exciting,” she adds.

The cross-agency NIATx projects have focused on making small, manageable changes. “We’ve done PDSA Cycles on reaching out to clients and working with counselors on addressing the importance of physical health as part of recovery,” says Lisa. “As a result, the no-show rate for primary care appointments dropped from 42% to approximately 25%.

One lesson about no-shows that emerged very quickly from the early stages of the partnership was related to making assumptions about how OTP clients view primary care.  

“We thought we had a captive audience and that we’d have no trouble filling all of our primary care spots,” says Lisa. She explains, “We started out using the same process in primary care that we use in OTP, where clients receive their methadone after their counseling sessions, as a way to reinforce the counseling. We thought that we could use the same approach and dispense methadone after the primary care appointment.”

What they found, however, a strong negative reaction from clients and an increase in no-shows to primary care appointments, as well as a reluctance to commit to primary care treatment.

The Lincoln St./EMK team then went back to their clients to ask how they felt about having their medication delayed until after seeing a primary care doctor.

“They told us that seeking primary care was their choice, not mandated,” says Lisa. “When we adjusted our procedures and simply reminded clients as they presented for medication dispensing about their scheduled appointment, there was an increase in show rates and connection to primary care.”

Lisa’s advice to other organizations working to integrate primary care with substance use disorder services? “Keep client needs, input, and the NIATx principle to understand and involve the customer at the forefront of your integration plan.”