Archive for the ‘Healthcare Partnerships’ category

Cost-effective Mental Health Care

October 4th, 2010

Our college of medicine at Penn State is working with a small number of other medical schools to revise the curriculum so med students will learn to work as members of a healthcare team. In recent years, educators have begun to realize that  we’ve been training doctors to be “lone wolves.” Then the new physicians enter practice and find themselves in an increasingly complex environment with multiple other healing professions. In the curriculum being developed, allied professions include nursing and pharmacy. Psychiatrists often work in teams—with psychologists, social workers, nurses, pharmacists, occupational and physical therapists, and many others.

I keep praying for universal access to health care for all Americans. It is essential that psychiatric care is included. But we don’t have enough psychiatrists (especially those qualified to see children and adolescents) as it is, and universal coverage could exacerbate the shortage. For me, the road to excellent universal mental health care will be based on efficient and cost-effective systems. (And no, I don’t mean asking exhausted clinicians to work faster and harder.)

Good clinical research can serve as a model. It is based on teamwork (beginning with the voice on the phone and face at the front desk). And it requires a protocol. Increasingly, electronics help—capturing data about history, target symptoms, and response to treatment; giving feedback to clinicians; enhancing communications between doctors and patients, family members, and other professionals; and supporting clinical decision making.

The teams we must build involve us with fellow professionals. But we also should include “Robbie the Robot”—i.e., information technology (and someday perhaps actual robots, which already are performing surgery). As psychiatrists, we can’t bring about this grand vision by ourselves, but we can and must have a “seat at the table” and participate in system redesign.

Why I am excited about partnerships

June 8th, 2010

I have spent my career trying to bring together various organizations and factions in a community that share a commitment to helping the mentally ill but don’t historically work together to accomplish that goal. A lot of money and effort is wasted when bureaucrats or community activists protect their fiefdoms at the expense of helping patients.

It’s hard to change that mentality, but well worth it.

When I began my career in Massachusetts, I worked at the Erich Lindemann Mental Health Center, a collaboration among the Commonwealth of Massachusetts, Harvard Medical School, and the Massachusetts General Hospital. Together we built systems of care, research, and education—all to serve people with mental illness.

Later when I moved to Arizona as head of the UA Medical School’s Department of Psychiatry, I reached out to the broader community to form coalitions. We were actually quite successful. We were able to create the Community Partnership of Southern Arizona. And eventually the University of Arizona and our physicians’ group practice partnered with Pima County to build and operate a brand-new psychiatric hospital.

Now that I’m in Pennsylvania, I am working with a wonderfully dedicated group to put strong legs under the fledgling Pennsylvania Psychiatric Institute. I talked a little about it in my last blog.

Partnerships must be the future of medicine in this country. There’s too little money and too great a need to put personal power-building ahead of real progress in medical care for people in serious need.

Public-Private-Academic Partnerships

June 1st, 2010

With the nation in the midst of the largest health reform since the advent of Medicare/Medicaid, we will undoubtedly see more public-private partnerships in the health care arena.

Let me tell you how a similar partnership is working for psychiatry in central Pennsylvania.

Two years ago, Penn State Hershey Medical Center (HMC) created a brand- new not-for-profit entity in partnership with Pinnacle Health, also a not-for-profit. Pennsylvania Psychiatric Institute (PPI), serves provides in-patient and out-patient services for patients in the Harrisburg area and across a large swath of central PA.

Of course there were hurdles. It’s never easy to get Medicare certification for a new organization, for example. But some hurdles were avoided by wise planning. For instance, PPI’s board is made up equally of Hershey Medical Center, Pinnacle Health, and community leaders. That balance is reflected in the balanced strategic planning and tactical interventions required of the organization.  (Full disclosure: I sit on the board). And another huge plus: both HMC and Pinnacle were willing to losing several million dollars during the initial phases of start-up, demonstrating a true commitment to the treatment of the mentally ill.

Is the Pennsylvania Psychiatric Institute out of the woods? Certainly not yet, and perhaps not as long as doctors and hospitals try to survive the age of slim reimbursement.  But so far, so good. It’s a very promising partnership, and one that may serve as a model for others. I, for one, am delighted to be part of the team, bringing teaching and research to a system that seeks to provide state-of-the-art care.