In a new partnership aimed at improving care for patients with substance use disorders and mental illness — the latest in one program’s bold expansion from being a substance use provider only to providing psychiatric services as well — Rosecrance Health Network is going to manage the inpatient mental health unit of SwedishAmerican Health System. In addition, Rosecrance purchased SwedishAmerican’s outpatient behavioral health clinic, which will shut down on March 1 and be integrated with existing Rosecrance operations.

More than two years ago, Rosecrance made its first move: the venerable addiction treatment provider merged with the Janet Wattles Center, a mental health provider, and became the parent entity (see ADAW, December 6, 2010).

The new partnership between the two providers, both based in Rockford, Illinois, has fast-forwarded the possibility of geographic scope to Rosecrance, which was founded in 1916 as an orphanage. Prior to the partnership, Rosecrance had two inpatient addiction treatment facilities and the Ware Center (from the Wattles merger) for outpatient mental health services. SwedishAmerican is a large system. The partnership could go beyond one inpatient unit and one outpatient clinic.

Inpatient and outpatient

Under the agreement, which was announced January 31, nurses providing direct patient care will be employed by SwedishAmerican Hospital, and the psychiatrists and therapists will be employed by Rosecrance. The unit will be managed by a Rosecrance employee who will report to SwedishAmerican’s vice president of nursing.

There will be no interruption of outpatient services at the outpatient mental health clinic, now located in Camelot Tower. Rosecrance affiliate Aspen Counseling & Consulting will take over the services at a new location to be announced.

The partnership will provide more comprehensive coverage for SwedishAmerican Hospital's Emergency Department, with additional case management alternatives, according to both organizations.

“Our partnership with Rosecrance will help us to more effectively bridge gaps in the current mental healthcare system, and ensure that patients receive the best possible care in the most appropriate setting, and in a timely fashion,” said SwedishAmerican President and CEO Bill Gorski, M.D. “This is an excellent example of how two respected organizations are coming together to advance the continuity of mental healthcare in northern Illinois with creative solutions.”

“The goal is to connect the dots between the acute care system and community-based services, creating a seamless transition between levels of care within the same network,” said Rosecrance President and CEO Philip W. Eaton.

SwedishAmerican has two hospitals, 30 clinics, a home health care agency and a foundation. It will open a new cancer center this fall.

Rosecrance is a comprehensive behavioral health network providing substance abuse and mental health treatment to more than 14,000 children, adolescents, adults and families each year. Rosecrance has facilities in northern Illinois and southern Wisconsin.

Major adjustments for SPMI

Integrating mental health programming into primarily addiction programs has to be “an intentional journey,” Eaton told ADAW. For example, in Illinois, regulatory and certification implications required major adjustments. “It wasn’t just hiring just a few more counselors,” he said.

The experience of merging the Janet Wattles Center into Rosecrance in 2010 has been successful, and reinforced the fact that “it’s not just doing more of the same and calling it behavioral health.”

In particular, patients with serious and persistent mental illness (SPMI) “come to the table with very different needs than patients with substance use disorders,” he said. “They come with primary healthcare needs, and longer-term case management.” For substance use disorder (SUD) patients, the duration of treatment is days or weeks, said Eaton. “Aftercare could be months,” he said, noting that the importance of aftercare to patients is sometimes missed in community mental health centers.

Support systems

“On the addiction side, we have this wonderful support system, anywhere in the world, for free — Alcoholics Anonymous and Narcotics Anonymous,” said Eaton. “You just open up a phone book and find an AA or NA meeting.” For people with SPMI, this system does not exist, said Eaton. “There is a movement of peer support specialists, but it’s a different type of support,” he said.

The community mental health field has developed two models — the clubhouse model and the living room model, he said. In the clubhouse model, people with SPMI could “drop in” and have psychosocial rehabilitation, skill building and confidence building.

State funds

The challenge in Illinois is the shutdown of state-owned psychiatric facilities due to lack of funding, as the state struggles to meet its pension liabilities first. “So it’s hard for the state to say they’re going to lead this wonderful integration, because they’re not going to pay people for nine or ten months,” he said.

That’s why Rosecrance moved on its own to integrate, said Eaton. “Organizations are trying to work in this new era of health reform, and we’re looking at how we can do this best locally,” he said. “The national initiatives, even parity, still have a lot of issues that have to be worked out at the state level.”

Another reason for the local focus is that providers need to respond to the varied needs of the population. Rockford is very different from Chicago, said Eaton. “We’re an urban setting but still are surrounded by an enormous rural environment,” he said. “In 5 minutes I can be in the middle of cornfields.” In these areas, there are “40-bed hospitals that have no behavioral healthcare whatsoever,” said Eaton.

Payer blend

On the business side, the partnership will “strengthen our private-pay insured commercial business, both for mental illness and substance abuse,” said Eaton. “We know that the strength of our organization is having a good blend of payers,” said Eaton, who has watched the programs, which are solely dependent on state funding, struggle over the past two years. “It’s no secret that those organizations are being choked.”

No wrong door

For several years the Substance Abuse and Mental Health Services Administration (SAMHSA) has endorsed a “no wrong door” policy, in which patients get the treatment they need, regardless of what type of provider they present at. Eaton noted that what Rosecrance is doing by integrating with mental health fits into that concept. The key point is improving the “handoff,” so that when someone is referred to a different service, that person is engaged in it. In fact, often people who need treatment for substance abuse or mental illness have as their first contact their primary care provider (PCP), said Eaton. Most PCPs still have a very difficult time doing the handoff to a behavioral healthcare provider, he said. “We need to streamline that access,” he said. “The goal is for the PCP to be able to refer.”

Most PCPs do screen for substance abuse, but Eaton thinks that they are “terrified” that patients will screen positive. “They’ll say, ‘Yes, I drink two pints of vodka a day,’ and the PCP won’t know how to respond because there’s no place to refer the patient to.

Ideally, the “embedding” concept works, because it facilitates the handoff, said Eaton. Rosecrance is embedded in a federally qualified health center. If a patient is screened by the PCP and answers “yes” to the substance abuse questions, that PCP “can say, ‘I’m going to walk you right down the hall, and we have a staffer right here from Rosecrance who can see you,’” said Eaton. Simply telling someone to go to treatment doesn’t work.

Initially, Rosecrance is not embedded in all of the SwedishAmerican clinics. “We’re in two community-based clinics,” said Eaton. “This is a dialogue that we’re going to work on, going forward.”

Bottom line

Rosecrance is expanding into mental health and primary care by partnering with SwedishAmerican, a large healthcare system also located in northern Illinois. The project will help patients in the area as well as the program’s payer mix.