As people with HIV are now living longer, HIV needs to be treated along with other chronic medical conditions, and often, in conjunction with behavioral health and substance abuse care. At the same time, the health care system is changing rapidly; more emphasis on care management and coordination, while focusing on cost effectiveness and accountability throughout the health care continuum.
Brightpoint Health has unique experiences treating HIV within the context of integrated care and demonstrating how integrated care improves outcomes for people living with HIV, and others, in communities that have suffered from health care disparities. Founded 25 years ago in the midst of New York City’s AIDS epidemic, Brightpoint now serves 40,000 New Yorkers with over 130,000 health care visits annually.
In their presentations as part of the Tackling Comorbidities: Innovative Strategies and Models of Care Seminar at the 2015 US Conference on AIDS, three Brightpoint Leaders: Barbara Zeller, MD, Chief Clinical Officer; Jessica Diamond, MPA, CPHQ, Senior Vice President Organizational Culture and Quality; and President and Chief Executive Officer Paul Vitale, MPA, FACHE, discuss Brightpoint’s evolution from a single HIV/AIDS residential facility to a multi-location Federally Qualified Health Center; how health care models are being reinvented to drive efficiency and accountability and how Brightpoint has succeeded in tackling some of the toughest challenges of expanded services and care integration: how do we best implement change and how do we pay for it?
In her presentation, Integrating Behavioral Health Care: A Providers Perspective, Dr. Zeller speaks about how Brightpoint’s integrated care model began with a residential care facility in the Bronx which cared for people living with HIV/AIDS who also needed substance abuse treatment. Over time, Brightpoint recognized that there was a need to extend services on an outpatient basis. The Nursing Home facility was only able to treat 300 patients per year, thousands needed help.
Brightpoint’s current outpatient patient-centered medical home model integrates behavioral health care with primary medical care, substance abuse treatment, and social support services. HIV care is seamlessly incorporated within primary care and behavioral health services. Integrated care is especially critical for HIV patients—almost half have behavioral health needs and over 50% need substance abuse help. Over 30% of Brightpoint’s HIV positive patients face both behavioral health and substance abuse disorders.
Today’s goal is further integration of primary and behavioral health care and other services. This is being implemented though both bricks and mortar co-location and virtually between clinics with health information technology. Early results from an intensive integrated care collaboration project with the Institute for Health Care Improvement are very promising. Integrated care has shown improvement in both patient satisfaction and care metrics.
Expansion and integration of services have increased Brightpoint’s ability to serve the HIV positive population. While declining as a percentage of patients served, the number of HIV positive patients under care at Brightpoint has increased 36% since 2011.
Jessica Diamond spoke about Creating Efficient Systems of Care. In the last decade, Federal legislation has sparked dramatic changes in health care delivery and accountability. Adoption of Electronic Health Records, part of the Stimulus Act of 2009, enabled greater coordination of care as well as creating much better tools to assess a variety of metrics. The Affordable Care Act greatly expanded health care access and mandated cost efficiencies in the health care system.
Improving quality is as much a goal as cost cutting. Recently we have seen increased alignment and standardization of quality metrics among health care stakeholders: payors, providers, policy makers and others.
These reforms have created a major paradigm shift in health care, from episodic care to coordinated care and population health. From “what is the matter with you?” to “what matters to you?” This change impacts everything including IT, workforce evolution, care management models, and financial risk. And we now measure everything we can, not only as a “report card” but to inform strategies for improvement.
Paul Vitale’s presentation, Fiscal Concerns: How Do We Pay for Integrated Care? concluded the seminar. Vitale reviewed several of the challenges involved in evolving from HIV care to an integrated care model. These include: potential for loss of funding from HIV grants, capacity and provider recruitment, particularly for behavioral health, and the fact that driving change in any organization is difficult. These complex challenges require multiple solutions, most of which an organization can implement internally; others are based on government initiatives.
Brightpoint Health relies on a robust strategic planning process. All significant initiatives and investments must be in alignment with one of the strategic objectives in ordered to be approved. Health care organizations must recognize that managed care and value-based payments are the future. Health Home care management programs are effective in coordinating care and reducing costly Emergency Department visits and inpatient care. Affiliations and mergers between organizations play a role in preparing for success in the new environment, but they must be informed by due diligence and compatibility between the cultures and the strategies of the organizations involved.
New York State has instituted an aggressive program of Medicaid reform and population health, investing $7B in the Delivery System Reform Incentive Payment Program (DSRIP) dedicating to transforming the state’s health care system, stop explosive growth in Medicaid costs, assure quality care and insure a financial sustainable safety net infrastructure. Although this is a New York State initiative, organizations from all states must be able to predict and prepare for similar programs to begin throughout the country.
Finally, success in a changing health care environment means making tough choices. Brightpoint Health began as a residential facility but new care management and payment models discourage avoidable hospitalizations. Patients can access the same services and quality care on an outpatient basis in the community. This year, Brightpoint made the painful decision to sell its nursing home license in order to ensure long-term success and the ability to serve more patients.
These solutions allowed Brightpoint to meet its overriding objective, The Triple Aim: better care, better health and lower costs. In the end, as in the beginning 25 years ago, it is all about the patients, providing them with the best quality care and improving their quality of life.