Summary: Community Healthcore proposes to expand and enhance its current delivery of coordinated, integrated primary and behavioral health care to better Bowie, Cass, Gregg, Harrison, Marion, Panola, Red River, Rusk and Upshur counties. This unique area, which borders Oklahoma, Arkansas and Louisiana, has been challenged by insufficient health care resources for generations, causing residents to relocate to access care, or do without.
Project Name: Northeast Texas CCBHC Network
Population to Be Served: Uninsured, low income children and adults diagnosed with serious mental illness, serious emotional disturbance, or co-occurring mental illness and substance abuse disorders who have co-morbid physical health conditions and chronic diseases. Healthcore estimates that at least 30,000 residents of the nine counties meet this definition, and African Americans and Hispanics are over-represented in comparison to regional demographics.
Strategies/Interventions: Healthcore is a state-certified CCBHC provider. Healthcore proposes to continue operating an integrated care clinic in Longview, and add three additional CCBHC-certified clinics (located in Red River, Harrison and Bowie counties) over the project period. The primary intent is to implement a networked model of care with the capacity to improve consumer health, enhance the consumer experience of care, control the cost of care. Care management will be a key implementation strategy; multi-disciplinary care management teams in each of the four CCBHC clinics will provide or arrange comprehensive, individualized primary and behavioral health care services and recovery supports, guided by an integrated health care plan.
Project Goals and Measurable Objectives: Goal: Provide quality-focused, patient-centered, recovery-oriented, trauma-informed, integrated physical and behavioral health care and treatment in four integrated care clinics. Objectives: 1. Hire, prepare and assign four care teams to the integrated care clinics. 2. Use evidenced-based screening and assessment tools to diagnose physical and behavioral health conditions and provide indicated primary care and behavioral health treatment to 8,500 consumers. 3. Follow an outside the 4-walls service philosophy that features peer leadership and increases consumer capacity for effective self-management. Outcomes: 8,500 children and adults receive integrated physical and behavioral health care; 250 veterans have their immediate physical and behavioral health care needs met and are connected to specialized continuity care resources in the region; 8,500 adults and children receive case management; and, 5,000 adults and children receive social support services, recovery support, peer support, and/or employment or housing connections.
Number to Be Served: 3,500 unduplicated adults and children in 2020-21, and 5,000 unduplicated children and adults in 2021-22, for a project total of 8,500.