Hospital & Clinic Integration Developing and/or Upgrading Integrated PH and MH/SUD Programs
 Complexity Intervention Programs In today's health system, most complexity intervention programs attempt to improve outcomes for patients with serious and/or persistent PH disorders by reversing barriers to PH treatment and/or by augmenting treatment adherence. The same can be said for those designed for patients with MH/SUDs. While there is general recognition that social, health behavior, and health system factors play into the risk improvement equation, many programs either choose to ignore their presence, as commonly occurs with psychiatric illness in the PH setting or general medical illness in the MH/SUD setting, or throw up their hands in frustration and defeat, because social, health behavior, and/or health system barriers are outside their area of expertise and/or influence, i.e. they don't get paid to address them. It is now time to reorganize the clinical delivery system in such a way that it confronts barriers to improvement falling outside of just "medical expertise" to reverse adverse outcomes and increased total health care costs, particularly in the five percent of patients that use fifty percent of health resources. To do this, new outpatient and inpatient clinical strategies (and programs) for those with definable health complexity and/or those who are at high risk for health complexity need to be developed in a system that:
- Recognizes the interaction of PH and MH/SUDs
- See social, health behavior, and health system factors as a part "return to health"
- Have the financial and clinical flexibility to make clinical change for patients happen
- Recognizes the importance of complexity prevention
Cartesian Solutions, Inc.™ consultants have the collective expertise to help clinical delivery systems initiate this process given the hurtles that the current reimbursement system creates. It can assist hospitals and clinics with the development of financially sustainable clinical programs, which:
- Integrate PH and MH/SUD service delivery
- Support the efforts of health managers that target patients with health complexity
- Collaboratively work with purchasers and health plans toward system changes that make complexity prevention and intervention an expected standard of care
This starts with current state and strategic planning consultations but then progresses to assistance with the development of clinical programs designed to seamlessly address the needs of patients with health complexity. Each consultation is designed to
assist general hospitals, general medical and MH/SUD
clinics, and their practitioners step systematically through
the changes needed to create and/or upgrade integrated
clinical programs, which are financially solvent and avoid
barriers to success. Outpatient Complexity Intervention Programs Few financially solvent integrated outpatient programs, which lead to measurable and consistent complex patient improvement, exist in today's healthcare environment. This is due to two overriding factors: 1) the misconception that non-coverage, low reimbursement, or denial of payment for health-related services in complex patients leads to health care cost containment and 2) separate business practices for payment of PH and MH/SUD services. As a result of these two factors and the many corollaries to them, providers, i.e. hospitals, clinics, and physicians, spend as much time trying to avoid patients with health complexity as treating them. Despite the fact that there are few integrated PH and MH/SUD programs serving patients with health complexity, models of intervention for them in the health management and care integration literature have been shown to lead to cost reduction through patient improvement. Cartesian Solutions, Inc.™ consultants are familiar with this literature and how to translate it into what they call clinical "value-added" outpatient programs (see Table below for examples). These form the basis for Cartesian Solutions, Inc.™ outpatient consultations. Some of these programs involve education of medical professionals with little in the way of organizational change, e.g. reframing training for primary care physicians. Others involve an active change in clinical workflows, which incorporate the principles of uncovering health complexity and providing PH and MH/SUDs service integration. Some involve both. 
Inpatient Complexity Intervention Programs Cartesian Solutions, Inc.™ also provides consultations related to the development of "value-added" inpatient programs (see Table below for examples). It is through inpatient programs that the greatest opportunity for enhancing clinical outcomes and reducing cost exists for patients with health complexity. They are also the ones that require the most attention to clinical and financial detail since the delivery of consistent evidence-based service to patients is critical to their success. 
Integrated PH and MH/SUD Centers of Excellence After a decision has been made to create or to upgrade an integrated
physical health and MH/SUD program, Cartesian Solutions,
Inc.™ consultations
provide the expertise needed to maximize clinical outcomes for patients,
to assure profitability, to avoid costly organizational and operational
mistakes, and to facilitate rapid progress to implementation of
integrated services. Cartesian Solutions,
Inc.™ is particularly interested in working with medical centers and/or
clinical departments looking to create Integrated PH
and MH/SUD Centers of Excellence, in which inpatient and outpatient
services function as a unit to insure integrated care capabilities
at all levels of patient acuity and complexity. This can only be accomplished, however, through the collaborative efforts of hospitals and clinics with the health plans that support their services and the purchasers of the health plans' products. --call 952-426-1626 or email integration@cartesiansolutions.com to inquire further--
Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com
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