Maria L. Cannarozzi, M.D., the medical director of UCF Health at University of Central Florida in Orlando, talks about a one stop shop approach to medical care.
Interview conducted by Ivanhoe Broadcast News in November 2016.
How would you describe integrated care and describe what you’re doing?
Dr. Cannarozzi: Integrated care is really trying to take care of more than just the medical needs of the patient. Our goal here is to take care of the medical needs as well as psychosocial needs. We’re really trying to take care of the patients mind and spirit in addition to the body. We know that all this is an interwoven so the more that we can do to help people have a healthy mind, the more it’s going to help them immeasurably in their physical health.
What is the benefit to having that team approach, to having behavioral specialist on hand right here physically?
Dr. Cannarozzi: It’s more than just being co-located. But really, by being integrated we are working together. So myself and the psychologists are working together to create a treatment plan for the patient. I think the benefits are obviously to the patient that we are communicating, and I think that’s immeasurably huge in the fragmented health care that we have today. For the clinician, having the ability to call in a specialist to talk to the patient and greet them is priceless. I can say: “I have a clinical psychologist here. I’d like for you to meet with her and see if you all could set up something to work on your…” whatever it might be, like anxiety. I can pull her and introduced her and kind of introduce us as a team. Then, as clinicians, it’s so valuable for us to have a resource for people and not to say: “well I need to write down this name down on a piece of paper for you.” It’s: “I have somebody here right now who’s here who can talk to you about this problem.” The capture rate that we have in getting those people to come back for therapy or come back for group sessions is significantly more than what it would be if we had to send them somewhere else.
I want to talk about those numbers a little bit, if you don’t mind, because as you mentioned if you are just handing a patient a name or a referral on a slip of paper, what is the likelihood that they will actually follow through with that?
Dr. Cannarozzi: It’s around thirty to forty percent in general. We try to do better with that here because we actually have referral coordinators that assist in making appointments for patients. But even so, it’s still probably somewhere in that realm. Certainly less than fifty percent for behavioral health specifically because it’s a difficult referral to make in terms of the stigma associated with it, that patient’s frustrations, and maybe lack of understanding in the community resources that we have. If we have the provider come into the visit and do what we call the warm hand off, where we actually introduce them and explain our concept, we’re closer probably to seventy or more percent in keeping those patients in treatment.
It sounds like a simple question why is it that the warm hand off can make such a difference?
Dr. Cannarozzi: I just think it’s part of the fact that if the patient trusts me and I bring the behavioral health specialists in, then they have a lot more instant trust in that specialist. Again, the fact that we’re here together; whether it’s for behavior health or not. I think a lot of our patients come to us because of the fact that we communicate with each other. We are definitely communicating and they don’t have to carry reports from one office to another. It’s the relationship that they see in the providers and me, and the other providers in the facility.
What happens to the patients that fall through the cracks when it’s just a referral and there is no follow up on behavioral health or mental health issues?
Dr. Cannarozzi: We try to follow up with each patient on every referral that we make. It is fraught with obstacles so patients may not return our phone calls. They may have incorrect phone numbers, or we may make appointments for them, but they may not show up at those appointments. We have to be very persistent in getting them to seek their care, which is challenging. There’s a number of ways that those people might ultimately not get the care that they need. Obviously, if they’re in house, it’s much easier to track them and to reach out to them if they don’t come for a visit or if they cancel an appointment.
Do you have any antidotal in tales and stories or success stories in your mind of people where these services really did make a huge impact on their life or health?
Dr. Cannarozzi: Yeah, I have several. We’ve had people who have really turned their life around. I have patients who have stopped excessive alcohol use and become involved in community organizations, and embraced relationships at their work that they did not have before. In our weight group we have several people who have made significant strides in weight loss and served as mentors to other people in the group. We’ve had patients who have really been able to turn around their psychological illness with a combination of medical therapy and support in a behavior health settings such that they been able to function well in society, whereas they were really not even participating before. They were closed off before and now really are back to work or back to being successful in school.
What are the stumbling blocks, as a general practitioner internal medicine specialist, when you have these other issues and obviously have the medical expertise; what challenges do you have in your profession in getting these people the extra help that they need without the warm hand off, without having the person here?
Dr. Cannarozzi: Insurance is huge. Depending on the type of pay or plan it is, we have much better success with PPO models than with HMO models, and some of the government assistance. We struggle to find providers that will care for them. We know that happens in communities and healthcare. Behavior health care in the community is a lot of pill pushing; it’s a lot of fifteen minutes visits; it’s a lot of substandard care, unfortunately. That may not be the answer that people want to hear but unfortunately even if we get people to offices we know that their waits are going to be long. Sometimes we try and make urgent appointments for psychiatric referrals and they are in excessive of three months away, which is just totally inappropriate. Or, people get very discouraged with the process because their placed on a lot of medication very quickly. The lack of providers is just a huge barrier for us.
Let me talk a little bit about this as a potential model for other places. This is pretty unique what you have set up here.
Dr. Cannarozzi: Yes, we’re very fortunate to be here in the academic environment where we can do it. We have access to trainees, people, learners, that we can use to staff our facilities. You know everything; every person in a facility, if they are not a trainee, they’re going to cost the facility dollars. We have the ability to use this as a learning environment, kind of a living clinical laboratory for them, and to provide excellence in integrated care for our patients at same time. It is a unique approach and we really believe in the interdisciplinary care model here, we’re also opening that up to pharmacy. We have now a pharmacist that’s starting to come as well. Our goal would be to incorporate all of our colleges and bring more learners and specialties to our patients.
Could this be a model for other institutions across the country, for other healthcare, larger healthcare systems?
Dr. Cannarozzi: I would think so, yes. I think that there’s a lot of literature out there that actually shows how this this type of integration not only helps patients in many different ways like we discussed, but actually helps with provider burnout, stress, workload, satisfaction, and productivity. If I’m stuck in a room with a patient that I openly don’t have the expertise to give them, then that patient is really not getting long term basis care. From the provider’s aspect, I think it’s a fantastic model that we should be embracing across the country.
Is there anything that I didn’t ask you that you wanted to let people know?
Dr. Cannarozzi: I think that it’s a lot of fun from a provider’s standpoint, to work with other disciplines. We learn a lot from each other, we really have a lot of fun taking care of patients together. If I attend the group sessions, I learn so much from their discipline, from the behavioral health world that I use in the exam room. Another thing that we have done here, as part of the behavioral health initiative, is some shared medical appointments where we’ve have brought patients together in one large group medical appointment. They might have a similar condition, such as diabetes and we’ve done kind of medical teaching and behavior health training in one session. That’s something that makes us really enjoy our work more as well as patient care and research. We find a lot of ways to make it more fulfilling as providers as well. That’s super important for the physician and provider retention which is really important.
END OF INTERVIEW
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