All in One Setting: Integrated Team-Based Care for Autoimmunity

From left: Theresa Blackburn, Dr. Susan Manzi, Jenna Boswell, Nancy Campbell and Sheila Walshesky take time to huddle and discuss patients scheduled for the day.

Adapting to Integrated Care
Dr. Manzi says the team’s transition to this integrated approach is an ongoing process requiring flexibility. Each provider must adapt to having more interactions and sharing the responsibility of patient care.

“The relationship between a physician and a patient is sacred, and some physicians are reluctant to change this [aspect of care],” Dr. Manzi says.

In the beginning, discussing the model’s benefits helped win over physicians. They soon experienced the value of team-based care firsthand. Dr. Manzi says, “We were able to show them that medication adherence, treatment for depression, patient satisfaction, physician satisfaction and, ultimately, total cost of care improved.”

As the team approach is developing for the RA and IBD pathway, behavioral health has been the most used piece of care integration, which has been eye opening for Dr. Manzi.

“When you walk in the room and your patient is in tears because there is violence at home, it’s invaluable to have a trusted behavioral health colleague there—someone who can do an acute intervention. The truth is, that patient won’t listen to anything else you say if you don’t manage their psychological state first,” she says. “This team support allows the physician to focus on what they do best for their patients.”

How to Incorporate Behavioral Health
The team’s behavioral health consultant Ms. Boswell also continues to gain new perspectives in her role. As she meets with patients, she is developing a better understanding of how autoimmune disease and mental health are interconnected.

“When I first came into this role, I did not have advanced knowledge of autoimmune diseases. So working directly with Dr. Manzi and the team has been invaluable to gaining this knowledge and applying my behavioral health skills,” Ms. Boswell says. “Being able to speak the language of rheumatology and gastroenterology helps me better connect with my patients.”

Both Ms. Boswell and Dr. Manzi believe any rheumatology practice can adopt a more integrated approach to behavioral health as a first step toward collaborative care. Ms. Boswell offers these tips to make the transition easier for providers and patients:

1. Establish a standardized approach to mental health assessment, such as having the patient fill out a mental health questionnaire for depression and anxiety prior to rooming, which will provide insight into mental health issues that may impair the patient’s daily life;
2. Next, have a way to respond to this mental health assessment so there can be direct follow up at the time of the visit;
3. If a patient needs behavioral health support, assist the patient in connecting with services, whether through a specialist in your practice or a company that specializes in helping doctors connect patients with mental health services; and
4. Establish an open line of communication between the physician, behavioral health specialist and patient to track ongoing care.