As the New York State Delivery System Reform Incentive Payment (DSRIP) program enters its final phase, the Nassau-Queens Performing Provider System (NQP) is working to leave a legacy of new models of care that rely on a new healthcare workforce.
Bob Hettenbach, the Executive Director of NQP stated, “The manner in which health, behavioral health and concrete services are delivered has needed to change for quite some time. Services need to be accessible, welcoming and provided in such a way that the stigma of seeking help is eliminated. This has caused traditional services to change the way they operate, and had spurred innovation in regards to the healthcare workforce”. He added, “the DSRIP funding has allowed NQP and its partners the flexibility to experiment and try out new approaches to see what is most effective”.
One new service model and new career path involves “integrated care” sites where a mental health professional is embedded into a primary care practice. This model provides “one stop shopping” where the patient can receive treatment for both physical health and mental health conditions during the same visit, thus eliminating the need for a separate appointment at a different facility.
In terms of staffing needs, the integrated care model requires a “new breed” of mental health professional. Instead of providing 45 minute therapy sessions by appointment in mental health clinics, clinicians in integrated care settings do not have a set schedule. They may be called upon to provide an immediate evaluation for a patient who appears depressed, or they may be asked to provide case management and referral services to a patient who is in need of food. They must also be very aware of chronic medical issues and their biological impact on the patient’s mental health and mental status.
To date, NQP and its hospital and community partners have established over 30 integrated care sites. Looking ahead, these sites are also considering a greater use of telehealth to maximize coverage when the mental health worker is not physically present at the primary care office.
Another new approach and career path is the increased use of Behavioral Health Peer Specialists and Community Health Workers (CHW’s). Peers and CHWs are individuals that have a personal or family history of mental illness, substance abuse, or chronic health conditions. They often come from the same communities in which they work, and they openly share their personal life experiences with those they serve encourage them to be open to receiving needed services.
To date, NQP and its partners have funded Peer and CHW positions in over 15 sites in Nassau and Eastern Queens including hospitals, behavioral health agencies and local non-profits. The main role of a Peer or CHW is to engage with the patient on a very personal level and to help get them connected to a wide range of health, mental health and concrete services such as housing or food resources. Peers and CHWs work closely with mental health professionals and medical staff in order to coordinate efforts on behalf of the patient.
The NQP funded Peers and CHW’s are deployed in unique ways including: providing transition care to patients being discharged from hospital inpatient psychiatric or substance use units, staffing a mental health peer respite for crisis de-escalation and providing concrete assistance and referral linkages to residents of NYCHA Housing in Queens.
One of the new Community Health Workers is Amado Jaboin who works for Gateway Youth Outreach (GYO) in Elmont. Amado is originally from Haiti and is a medical graduate from the Dominican Republic. He uses his prior medical training and his ability to speak several languages to help engage the Haitian and Latino community into care. He commented, “Saving lives has always been my priority”. To further enhance his skills he is also taking part in a training class for Community Health Workers that is operated by Northwell Health, one of the NQP partners.
NQP is encouraged that these new models and new healthcare career roles will be sustained in a post-DSRIP environment. John Javis, the Director of Behavioral Health for the Nassau Queens PPS said, “Everyone is aware that NYS has aggressively committed to moving to Value Based Payment by 2020. While it is unclear exactly how these arrangements will play out, I believe that whoever holds the risk will want to invest in these new models and staffing patterns in order to achieve required outcomes and to lower overall cost. I’m proud of the hard work that NQP, its hospitals and its community partners have done to implement these innovative approaches”.