Legacy Clinic Emanuel Integrates Behavioral Health in Primary Care Renewal Project
By Maileen Hamto, CareOregon Communications Writer

Legacy Clinic Emanuel manager Maryna Thompson (left) with Dr. Melinda Muller, Medical Director for Legacy Clinics. Photo by Eleanor Gorman

How does a clinic that serves patients in difficult social situations offer top-quality, proactive and cost-effective patient care? For Legacy Clinic Emanuel staff, changing the way primary care is delivered is the first step toward healthier patients.

As one of the four clinics that are part of CareOregon’s Primary Care Renewal (PCR) initiative, Legacy Clinic Emanuel is developing a team-based approach in providing care, while also integrating behavioral health services and resources. Focusing on patients with diabetes, Legacy Clinic Emanuel is enhancing systems and processes to improve patient outcomes.

About 40 percent of Legacy Clinic Emanuel patients are CareOregon members. The PCR initiative focuses on the medical home primary care model that establishes high-functioning clinical teams that will allow more patients to receive the care they need. Teams promote respectful team-patient relationships that engage patients to take a more active role in their health care.

Legacy Clinic Emanuel’s PCR effort leverages the success of a prior project that looked at ways to improve outcomes for patients with comorbid diabetes and depression, says Melinda Muller, M.D., Medical Director for Legacy Clinics. The project was funded by CareOregon’s Care Support and System Innovation (CSSI) program, which supports innovative clinic and hospital projects that focus on improving health care delivery.

A diabetes registry allowed the clinic to provide comprehensive yet cost-effective case management for patients with complex, comorbid (two or more diagnosed conditions) diseases.

“There is a correlation between depression and diabetes in our population. People who are diabetic and depressed have the worst outcomes. What we found is that depression is dealt with in primary care, because many patients do not have the resources to see a psychiatrist or therapist. If we identify and treat depression, the patient’s diabetes also gets better,” says Muller.

Clinical teams at Legacy Clinic Emanuel are made up of physicians, a nurse case manager, two medical assistants, a pharmacist, a behavioral care specialist and a resource specialist. Members of the team perform “at the top of their license,” says David Labby, M.D., Medical Director for CareOregon. “Providers are responsible for doing the things they do best. Because there is more division of labor, providers are better able to more effectively take care of patients,” he says.

While work on the clinic’s PCR project continues, substantive progress already has been achieved. “We identified that many of the problems among our patients in case management are psychosocial issues,” Muller says. A resource specialist and behavioral health specialist were hired to work in combination with a nurse case manager to deal with psychosocial issues.

“Our biggest accomplishment is integrating behavioral health into the disease management program. As a result, patients who are being case-managed are getting better. Their blood sugar levels are more constant, emergency room visits went down, blood pressure got better, and they are more adherent to medication,” she says. “We’re connecting with patients in a different way, because we are more focused on specific issues related to their health care.”

Maryna Thompson, Legacy Clinic Emanuel clinic manager, is at the helm of implementing process changes for the PCR project. She is a strong believer in the importance of the integrative team approach to providing care for patients.

“PCR very much fits the philosophy and direction at Legacy, because it creates a holistic mechanism to provide health care services. We stress the importance of preventive and proactive health care measures. When patients are more attentive to their health care needs, we are able manage disease processes more efficiently – and as cost-effectively – as possible,” Thompson says.