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Integrated Care

Team-based Care

Team-based CareThe continuity practices within our residency program continually strive to optimize team-based care. Among the team-based features that we have built into our practice are:

  • Dedicated time for team building and shared leadership
  • Pre-session huddles
  • Collaboration with community-based organizations
  • Group visits focusing on diabetes, smoking cessation, prenatal care, exercise and wellness
  • Integrated behavioral health therapists and psychiatry residents

Behavioral Health Services (BHS)

The departmental practice hosts an on-site behavioral health satellite of the Department of Psychiatry. Residents refer patients to our behavioral health practitioners and our psychiatrist. To enhance the experience for the residents, therapists, and patient families, joint meetings can be conducted on site with all providers. This collaborative experience develops the residents’ knowledge, skills, and attitude about how to work successfully with mental health practitioners.

“Recently one of my patients retired and decided that he could no longer afford his COBRA insurance coverage. Without telling his providers, he decided to discontinue his psychotropic and blood pressure medications in preparation for not being able to afford them. When the patient told me about his decision during what he said might be our "last session" (because he would no longer have coverage), I discussed Strong Memorial Hospital and Highland Hospital Charity Care and the $4 prescription list. He was meeting with Elder Source a week or so later to discuss his options and I called to check in after that meeting. At that time the patient said that he was shaky and sweaty without his medications. I sent a message to his PCP with an update and he called our patient within an hour and prescribed high blood pressure medication off the $4 list. The patient is able to continue seeing all of his providers as we processed his Charity Care application. I know that my patient felt cared about when his doctor called him at home concerned and willing to problem-solve.”

–Staff Marriage and Family Therapist for Behavioral Health Services (BHS) at Highland Family Medicine Center