A Matter of Compliance
It’s an easy concept to understand, Rosemarie Ansel said: medicine is useless if it’s not taken.
And prescription non-compliance is a common problem in the behavioral-health realm, said the executive director of River Valley Counseling Center. That can lead to rehospitalization in many cases, or worse.
“Whether it’s outpatient mental health or day treatment or services in schools, the idea is to provide support for people and help them manage their medical diagnosis so they remain in the community setting and not be hospitalized,” Ansel said. “Behavioral-health patients are a big part of who visits emergency departments. We try to provide services so it doesn’t get escalated to that level.”
That’s why she’s excited about River Valley’s new partnership with Genoa, the largest provider of pharmacy, telepsychiatry, and medication-management services for the behavioral-health and addiction-treatment communities. The company recently opened a pharmacy inside River Valley’s main clinic in Holyoke, Genoa’s fourth such location in Massachusetts and the first in the Greater Springfield region.
Genoa’s 380 pharmacies, all set in behavioral-health clinics across the country, serve than 550,000 individuals annually in 45 states, filling more than 13 million prescriptions annually.
“The focus is on behavioral-health medications, although they provide all medications for any of of our clients, their families, my staff, and my staff’s families,” Ansel said. “River Valley isn’t going to make any money on this; just a little bit of rent for the square footage in the building. It’s a partnership, in that the goal was to have the clients be more medication-compliant.”
A 2016 study published in the Journal of Managed Care and Specialty Pharmacy showed that integrated care models that feature on-site pharmacies produce higher medication adherence rates than community pharmacies, as well as lower rates of hospitalization and emergency-department utilization. In fact, Genoa’s consumers average more than a 90% medication-adherence rate.
And that’s the key, Ansel said. While there’s no guarantee patients will take their prescribed medications, compliance rates rise significantly once they have a prescription filled — which is much easier with a dedicated pharmacy on the clinic site than it is when they must visit a pharmacy off-site.
“One of the things we know in behavioral health is that clients pick up scripts and never fill them, or they don’t adhere to the recommended instructions, and they’re back in the hospital, and the cycle continues,” Ansel said. “We have a pharmacist who really understands the importance of being compliant and following their treatment plans to stay healthy.”
In addition, a pharmacist who specializes in the behavioral-health field, and who can easily communicate with a patient’s doctor if there are questions, makes it much easier to quickly answer questions, reducing confusion and further promoting compliance, she added.
For this issue’s focus on behavioral health, BusinessWest spoke with Ansel about this new pharmacy partnership and how it’s just one part of a multi-faceted effort to increase access to behavioral healthcare for clients across the region.
Ansel said River Valley had two ‘asks’ before taking Genoa on as a partner. One was that the pharmacist had to be bilingual in English and Spanish, as are about 75% of the practice’s 165 employees. “That’s a really important feature for us,” she said, considering the demographics of Holyoke. The pharmacist assigned to River Valley, Angel Marrero, fits the bill.
The second was that Marrero would be an active advocate with insurance companies, which often try to block certain medications, forcing practitioners to spend valuable patient time fighting with them.
“It’s time-consuming, it’s cumbersome, you’re on hold for a half-hour before talking to someone,” she explained. “This will free up our prescribers to see more clients. It’s a win-win for them.”
After agreeing to both caveats, Genoa went to work over the winter in converting former waiting-area space into a pharmacy at the front of the clinic. After a soft opening in June, the pharmacy became the only one of its type in Western Mass.
River Valley’s clients — who receive outpatient care clinics in Holyoke, Chicopee, and Easthampton, as well as school-based sites in those three communities, as well as Granby and Springfield — run the gamut of age, demographics, and medical needs, Ansel explained.
For instance, the practice provides therapy in primary-care doctors’ offices, with licensed therapists assigned to the practice. The reason is that front-line providers are often the first to diagnosis a mental-health concern, and for many clients, their doctor’s office is the most comfortable environment for them to receive services.
In the elder-care realm, River Valley has contracts with both WestMass Elder Care and LifePath (in Franklin County) to provide mental-health services to the elderly, including in their homes.
For the younger set, school-based clinics in Holyoke, Chicopee, and Easthampton, as well as a few in Granby and Springfield, bring therapy services to students during the school day.
“Parents are overwhelmed, and the thought of taking the kid out of school and bringing them to therapy, then bringing the kids back — many times, that’s not going to happen. They’re working; they’ve got their own schedules. And transportation can be a huge issue. Even if the kid wants to go to therapy, he may not be able to get there. We go to the schools, which are considered satellites of our main clinic. Kids get taken out of non-core classes to see a therapist right at the school.”
Besides the therapeutic program, these school-based clinics provide a range of general health services, such as immunizations, physicals, dental screenings, and referral services to primary or specialty care. A similar program is offered at Springfield Technical Community College, again, so students can access therapeutic services without having to travel off campus.
Meanwhile, an employee-assistance program allows companies to access therapy services for their workers. “For example, an employee might be having a hard time at work, in their personal life, with finances, with their kids, and they need someone to reach out to. It could be financial problem, dealing with gambling problem, or it could be something that happened at a job site. If there’s a long-term therapy issue, they can link up with those services.”
The common thread with all these models of care? “We go to the clients in an effort to support them in the environment where they feel the most comfortable,” Ansel said. And comfort level is a bigger deal in the mental-health world than it is in other areas of healthcare.
“There’s a stigma around behavioral health. You need to make yourself as available as possible because, if there’s any kind of barrier, they don’t come. When we get just a little bit of snow, the cancellation rate skyrockets. Therapy is work. You’re not just chatting; you’re working on an issue, and that can be hard to face. If you can have it in an environment that’s more conducive, that causes less stress in your life, it makes it easier.”
River Valley Counseling Center, which is part of Valley Health Systems and an affiliate of Holyoke Medical Center, has broadened its reach in other ways as well, such as with a day treatment program launched in Chicopee a few years ago.
“That’s for more chronically mentally ill clients, providing services during the work week with the goal of helping them become more independent and less dependent on such a structured program, so maybe they can get a job or start volunteering someplace and move on. People stay there anywhere from a couple months to a couple years, depending on their level of need.”
The practice also offers an HIV/AIDS support and treatment program, headquartered in Springfield, which provides assessment and referral services, case management, support groups, housing services, and other resources.
Considering all the ways River Valley strives to bring services to clients where they are, Ansel said, the partnership with Genoa, aimed at making medication compliance much easier, just makes sense.
“Everything is customer-friendly,” she said, right down to the bubble packaging Genoa uses to sort and clearly label medications by the dose and time.
“They really have a good, positive energy about their work,” she added. “They do things like send thank-you notes to all patients, hand-signed by the technician and pharmacist. Clients very much appreciate that personal touch. I just love this company.”
Joseph Bednar can be reached at email@example.com