The Collaboration Between Medical and Mental Health Treatment
At Sanford Behavioral Health, we are always looking for new ways to improve the treatment experience for our clients. In a new collaboration with Grand Rapids’ RightCare Clinic, we are streamlining the process for patients who need medical clearance or stabilization before they’re ready to enter treatment for mental health conditions. Our collaboration between medical and mental health will decrease costs and increase ease and personalization for our clients who need medical care while in treatment at Sanford. We sat down with Dr. Todd Chassee, Medical Director of RightCare Clinic, to get his take on transforming outpatient medical care.
“Sanford Behavioral Health is excited to partner with RightCare Clinic to provide our patients with appropriate care that does not interrupt or misuse resources that are needed for more acute patients. We are able to assess our patients within the facility and utilize RightCare interventions before our patients decompensate to a point where emergency services are needed. These types of services align with the care our patient population may need. It’s exciting to have a trusted resource within our reach.” Natalie Frelix, MSN, RN, Sanford Behavioral Health Director of Nursing
The Collaboration Between Medical and Mental Health Treatment
An Interview with Todd Chassee, MD, FACEP, Medical Director of RightCare Clinic
Sanford Behavioral Health (SBH) – Dr. Chassee, could you tell us a bit about your background?
Dr. Chassee –
I have been a Board Certified Emergency Physician since finishing my training at the University of Pittsburgh in 2006. My wife and I are both from West Michigan. We returned to West Michigan, and I was thrilled to join Emergency Care Specialists (ECS) because it’s a physician-owned group. We’ve seen a lot of growth. When I joined ECS, we had approximately 40 physicians, and we’re now 200 ER physicians and 100 advanced practice providers, seeing 500,000 patients a year.
One of the big evolutions that I’ve seen in emergency medicine, and ECS in particular, is that when I started in emergency medicine, I would see patients in the ER and then send them home, asking them to follow up with their primary care physician. Often, they had trouble getting follow-up appointments. Now, there’s been a change that includes outpatient care in emergency medicine. We have a skill set that we can utilize besides just seeing patients in the ER. And so, the group at ECS has expanded outside of the four walls of the ER.
SBH – How does that work?
Dr. Chassee – Initially, we expanded our care to a complex observation unit for patients needing 24 to 48 hours of care in the hospital. With the increase in behavioral health and substance use disorders, we recognized the importance of expanding our efforts to these areas. We began to work in the outpatient world with local methadone clinics and started an EmPATH unit. Of course, this was outside of the traditional walls of emergency medicine, and that evolution has continued to virtual care. We do virtual follow-up visits for patients who were seen in the ER but can’t get into their primary care. This comes back to the issue of access, which is being able to get the right care at the right time.
SBH – It sounds like your organization, and you have evolved.
Dr. Chassee – As a clinically active emergency physician, I still practice in our pediatric and adult ER and our large, level 1 trauma center in Grand Rapids. However, as my career has evolved over the past 20 years, I have ridden a wave that led to RightCare Clinic. The decision to start RightCare (a division of ECS) was about meeting patients where they are and providing care in the best possible location with the best value.
“We’ll work together with the emergency care specialists at RightCare Clinic to promptly address any emergent medical needs for our patients at a significant cost savings to them.” Dr. Bhandari Sanford Behavioral Health
SBH – Where does RightCare fit in the continuum of medical care?
Dr. Chassee – The base of the pyramid in the graphic is primary care. We are not trying to replicate or replace primary care. In fact, we are always directing patients to their primary as that is the bedrock of care. The next layer is urgent care, and then, between urgent care and the emergency department, is RightCare Clinic.
Urgent care looks different in every community. In West Michigan, urgent care offers low-level services, primarily advanced practice provider-driven. As far as labs, very few tests are offered. They might do strep swabs, COVID and influenza swabs, urine dips, EKGs, and X-rays. The top of the pyramid is the emergency department, which has all of the tertiary or quaternary care to offer to the patients. The downsides of the ER are the cost and the often crowded environment.
Currently, patients are being directed to urgent care and are often sent to the ER due to the lack of services offered. For example, if a 40-year-old with chest pain went to urgent care, they’re likely going to get an EKG and be sent to the ER. Patients who are currently directed to urgent care are more likely to be redirected to the ER, and patients who are currently going to the ER are discharged 70-plus percent of the time. So, our target population includes patients going to urgent care who are going to be sent to the ED and patients sent to the ED who are likely to be discharged home.
SBH – What is not treated at RightCare?
Dr. Chassee – That’s a great question. This is not the place for acute stroke evaluations or severe trauma. When we identify someone who needs surgery, we’re sending those patients to the health systems. But really, everything else could potentially be handled entirely at RightCare or at least start at RightCare. If a condition is found that requires hospitalization, we’re going to work on transferring the patient to the ER or, even better yet, transferring them directly to a room at the hospital.
SBH – How does Sanford Behavioral Health collaborate with RightCare Clinic?
Dr. Chassee – I think Sanford Behavioral Health is a perfect example of collaboration. Previously, when Sanford identified mental health or substance use patients who had medical needs that must be addressed before the patient was ready for treatment, the options were relatively limited. Sanford may have sent that patient back to primary care, but access to timely assessments is a challenge.
They could send patients to urgent care, but if those patients need laboratory studies or imaging that is not available at the urgent care center, they’re not going to get the treatment that they need. Additionally, Sanford might send patients to the emergency department. But then you have patients in the general milieu of emergency medicine. Currently, RightCare Clinic fills the niche for Sanford’s patients who need medical clearance or stabilization before they’re ready to enter treatment.
“Within our residential eating disorder program, our collaboration with RightCare Clinic expedites treatment and provides a well-needed resource. In the past, there were delays in patients entering treatment while waiting for required baseline labs from primary care physicians or pediatricians. We also have frequent medical needs for patients in residence (electrolyte abnormalities, cardiac monitoring, imaging) that RightCare provides in an outpatient setting.” Hilary Fowler, MSN, PMHNP, CPNP, Sanford Psychiatric Mental Health Nurse Practitioner
SBH – How does Sanford schedule patients at RightCare Clinic?
One of the nice things we have is electronic scheduling tools. So the patient can self-schedule or schedule a meeting with a provider at Sanford during their assessment. A Sanford staff member can also call us directly and coordinate with our front office team.
SBH – What other benefits might a Sanford patient derive from this collaboration?
When you have an ER visit, there are at least two components to billing. One is the facility fee, which is the charge for having services available. So, there is a facility fee and ER professional fees. All of the studies that are done (CTS, X-rays, labs) have higher charges because they’re ordered as “stat” tests. Conversely, RightCare is an outpatient specialist office. The office code visits for seeing the provider are at lower rates than the ER charges. Our charges for CTS, X-rays, and labs are all outpatient-level charges that are not as expensive.
I also think that communication, the direct link, is a huge factor. We are a single provider that Sanford or other referring partners are able to communicate with directly. Unlike an ER, we can address questions or concerns directly and provide a warm handoff to a familiar provider. There are others with similar models to ours, but this is not a common model. In fact, we are the first of its kind in Michigan. From our standpoint, this is a great pilot project to prove the concept and value to patients and payers that there are savings here. Hopefully, by demonstrating this, we can create a sustainable model for patients and the RightCare Clinic.
Thank you, Dr. Chassee!
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