Through a partnership with Cheshire Medical Center, Monadnock Family Services opened a new, on-site clinic earlier this year that flips a traditional care model on its head: Rather than requiring people with mental health needs to address their physical needs elsewhere, the clinic brings this care to where they’re already being served.
Monadnock Family Services is a nonprofit community mental health center serving 35 municipalities and 110,000 residents in southwestern New Hampshire, according to its website. The organization provides counseling, support groups and various activity programs for children, seniors and other adults.
The new primary-care clinic, which opened in April at 17 93rd St. in Keene, has one exam room, a waiting room and an office for its sole provider, Christopher Polich, a nurse practitioner from Cheshire Medical.
Services offered include diagnoses and treatment for acute illnesses, as well as blood work and specimen collection to be sent to Cheshire Medical’s laboratory.
The 93rd Street location is Monadnock Family Services’ largest facility, according to CEO Phil Wyzik, who said it houses most of the services for adults. The organization also has a location at 64 Main St., for child and family services and administration offices, and an office on Vose Farm Road in Peterborough.
Opening the clinic has been a long-term goal of the organization’s, according to Wyzik, but the funding just wasn’t there.
“We wanted to make it more convenient for [patients] to get physical health care,” he said.
After Cheshire Medical received a grant from New Hampshire’s Delivery System Reform Incentive Payment (DSRIP) Waiver Program in 2016, though, Wyzik said the clinic finally became feasible.
The waiver program, through the Centers for Medicare and Medicaid Services, is distributing up to $150 million in incentive payments over five years to improve the delivery of care for Medicaid beneficiaries across the state.
Seven regionally based networks of providers, known as Integrated Delivery Networks (IDN), were created to design and implement trial projects aimed at this goal, and must meet certain criteria to be eligible for funding, according to a 2016 presentation by the state Department of Health and Human Services.
Cheshire County is part of IDN 1, which also includes Sullivan County and the Upper Valley. The region has 21,550 Medicaid recipients, data from the N.H. Department of Health and Human Services state.
Monadnock Family Services has a sub-recipient contract with Cheshire Medical to fund the clinic over three years, Wyzik said, beginning in July of last year. Renovations for the clinic started shortly after.
Shawn LaFrance, vice president of population health and health systems integration at Cheshire Medical, said the clinic represents a “reverse integration” project, meaning the physical health component is being brought into a mental health care facility.
Most other integration efforts have brought mental health treatment into hospitals, he noted.
The only other “reverse” model in the state, according to LaFrance, is at Riverbend Community Mental Health in Concord.
“This program is designed for the clients with chronic or persistent mental illness who require a schedule of frequent visits to [Monadnock Family Services],” he said.
Separate from the waiver program, an on-site pharmacy also opened in May at the 93rd Street location for Monadnock Family Services’ clients and employees.
The pharmacy is operated by Genoa Healthcare — a national provider of pharmacy, outpatient telepsychiatry and medication management services — and employs one registered pharmacist and one pharmacy technician.
With both of these services now available at Monadnock Family Services, Wyzik said the organization hopes clients who weren’t actively seeing a primary-care provider begin to.
Many of the adult clients, he noted, weren’t doing so for a variety of reasons.
“When you are faced with significant mental health problems that mess with your thinking and emotions, it’s difficult ... Often times people with disabilities have a harder time doing normal patient stuff,” he said.
But mental illness has a ripple effect, according to the National Alliance on Mental Illness (NAMI), often leading to physical ailments.
The alliance’s website states that people with depression, for example, are at a 40 percent higher risk of developing cardiovascular and metabolic diseases than the general population. This is due to people with depression being more likely to smoke and skip their prescribed medications, as well as being less likely to exercise, according to a 2017 article from Health magazine.
With the clinic and pharmacy at Monadnock Family Services embedded into the mental health practice, Wyzik said, the clinic’s staff work with the psychiatrists to offer the best care to patients.
“The convenience of it all makes it easier for them to get treatment,” he said.
However, he noted, once the grant funding lapses in June 2021, he’s not sure how the clinic’s doors will be kept open. Monadnock Family Services is working with Cheshire Medical, he added, to figure out next steps for funding.
“The primary health insurance that comes into play for this is Medicaid,” Wyzik said. “Whether that’s enough to sustain the effort is not yet clear.”