Running head: INTEGRATED COLLABORATIVE CARE PROJECT 1

A Behavioral Health Integrated Collaborative Care Project

at Union Hospital of Cecil County

Devon Vitti

Wilmington University
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A Behavioral Health Integrated Collaborative Care Project at Union Hospital of Cecil County

Introduction

Union Hospital of Cecil County is a 122-bed non-profit community hospital located in

Elkton, Maryland that provides inpatient, outpatient, and emergency services to residents of

Cecil County and surrounding areas. The mission of Union Hospital of Cecil County is to

provide safe, high quality health services to residents of Cecil County and neighboring

communities. One of the service lines offered are behavioral health services, which includes

behavioral health crisis intervention services in the emergency department, behavioral health

consultations on the medical floors, inpatient behavioral health services, and outpatient

behavioral health services. Outpatient behavioral health services are provided in the medical

professional building near the hospital under the name Union Behavioral Health and consist of

psychiatry and medication management services, psychotherapy by licensed mental health

professionals, and an intensive outpatient program (IOP). Additionally, the hospital also has

outpatient primary care practices associated with the hospital in Elkton and Perryville operating

under the name Union Primary Care. The primary care practice is staffed with several

physicians, nurse practitioners, nurses, and medical assistants. Union Primary Care is the largest

provider of primary care services in Cecil County, Maryland. Overall, Union Hospital of Cecil

County is the largest healthcare provider for this region and plays in integral role in the

improvement of health for the population.

Population & Analysis

Cecil County has a population of 101,108 in 2010 with 42.1% of the population being

considered rural (MD Urban and Rural by Jurisdiction, 2010). Cecil County, Maryland ranks 22
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of 24 counties in Maryland in terms of overall health. These categories include premature death;

quality of life; health behaviors; clinical care; social and economic factors; and physical factors

(County Health, 2016). In terms of clinical care, Cecil County suffers from a major lack of

providers, in terms of patient to provider ratios, Cecil County is double the average of the state

for primary care physicians (2825:1); dentists (2754:1); and mental health providers (610:1) to

patients (County Health, 2016).

Access to care requires not only sufficient financial/insurance coverage but also access to

providers, Cecil County residents require primary care and the other providers mentioned to

manage their overall health. The lack of access to providers may be attributed to several

variables such as lack of recruitment/retention of providers within local hospital system due to its

size as a small independent community hospital; unfavorable health rankings mentioned earlier;

ruralness of the county; education system ranking…etc. Due to the possible inability to secure a

provider or an appointment, patients health problems can and will become more chronic in

nature due to not being able to follow up/monitor conditions and delays in preventative care.

Cecil County currently has a lack of mental health providers, especially psychiatrists, and

has been designated a mental health professional shortage area by the HRSA (“Maryland Mental

Health Professional Shortage Areas” 2010). Consequently, this has led to longer wait times for

appointments. Additionally, there is a lack of intermediate levels of care between inpatient

services and traditional outpatient services. Because of these factors, readmissions for

behavioral health admissions has increased, as well as, the emergency department is constantly

strained with behavioral health patients.

Policies & Procedures

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Union Hospital of Cecil County like most healthcare systems has a variety of checks and

balances in terms of policies and procedures. It would be an enormous feat to describe every

policy and procedure within the organization rather we’ll review the sources which drive policy.

Union Hospital of Cecil County has policies and procedures in place to meet requirements and

mandates from external sources such as the Center for Medicare and Medicaid Services (Federal

level); the Joint Commission (independent healthcare accrediting body); Maryland Department

of Health and Mental Hygiene; Maryland Healthcare Commission (independent regulatory

agency); Cecil County Department of Social Services (state/local level); Commission on Cancer,

American College of Surgeons (disease specific accrediting body for excellence in care). These

external sources drive how the hospital operates and who it reports data and outcomes to. Based

on regulations and laws from these sources, the hospital develops internal policies and

procedures through various committees, groups or departments within the organization. Policies

and procedures are reviewed annually or as designated within the policy.

Structure/Governance

Union Hospital of Cecil County is overseen by a Board of Directors, who oversees the

Chief Executive Officer (CEO). The CEO oversees the executive team which includes the Chief

Nursing Officer; Chief Financial Officer; Hospital Counsel; Chief Medical Officer; Chief

Operating Officer; and Vice President of Provider Enterprise. Each Executive is assigned

departments and programs and their leadership teams whom they are responsible for. Regarding

the collaborative care model project, from the attached organization chart, Aaron Royston is the

Executive leader overseeing Union Multispecialty Practices, which the primary care and

outpatient behavioral health offices are under. Additionally, attached are the organizational

charts for Union Behavioral Health and Union Primary Care.

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Funding

Union Hospital of Cecil County is a 501(c) nonprofit organization. Like most healthcare

systems, Union Hospital of Cecil County receives the majority of its’ funding through revenue

generated by the healthcare services rendered to its’ patients through the various programs and

services offered. Healthcare services are billed to the patients and their insurance company (i.e.

Medicare, Medicaid, or commercial insurer) on behalf of the patient, if applicable. Additional

revenue may also come in the form of contributions or grants awarded to the hospital system or

from investment income. The hospital also conducts fundraising through a separate nonprofit

entity, the Union Hospital Foundation, in which proceeds from events and donations goes

towards various hospital programs, services or projects. In terms of large scale capital projects
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or expansions, the hospital may fundraise, solicit grants or dollars from state and local

government, or secure bonds to finance the project.

Relationships

As the sole hospital and major healthcare provider in Cecil County, Maryland, Union

Hospital of Cecil County does have many relationships with community and human services

agencies. Community physicians and specialists have privileges at the hospital, which allow

then to care for their patients. The hospital partners with other health entities for services and

choices for its patients, such as home health, skill nursing facilities, durable medical equipment,

physical therapy and rehabilitation services…etc.

In terms of the collaborative care model, Union Primary Care will be partnering with

Upper Bay Counseling and Community Services with oversight from Union Behavioral Health.

Upper Bay Counseling and Community Services is the largest provider of behavioral health

services in Cecil County. They offer an array of services for children and adults that include

therapy and clinic services, residential services, psychiatric rehabilitation services, substance use

disorder/co-occurring services, assertive community treatment, and school-based services.

Strengths, Challenges, and Trends

As mentioned earlier, Cecil County presents as a challenge due to notion it is a smaller,

rural county with pockets of poverty and lacks services/resources such as transportation when

compared with other counties in the State of Maryland. Given its’ geographic location to major

metropolitan areas and cities, it makes it increasingly difficult to attract physicians and

specialists to the area. Additionally, there are larger healthcare organizations in neighboring
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counties and states which can make it difficult to compete, as it is not a research organization or

part of a larger system offering expanded services. Thus drives competition.

Despite Union Hospital of Cecil County being a small community hospital, it is the only

hospital and provider of healthcare services in Cecil County. The culture of Cecil County thrives

on a small-town feel and the majority of patients only go to Union Hospital because of this.

Patients feel more connected to the hospital, as they get to know everyone and their family,

friends, and neighbors also often work there. Additionally, Union Hospital of Cecil County is

one of the few remaining independent community hospitals within the State, most hospitals are

part of a larger health care organizations such as the University of Maryland health system or

MedStar Health. Part of this is due to the fact that the hospital is in good financial status and has

made good decisions over the years.

The trend in healthcare is changing and it’s a rather tumultuous time, given constant

changes and political debates. Overall, the focus now is more on population health and taking

care of the community as a whole and care outside of the walls hospital by keeping individuals

healthier. Union Hospital of Cecil County does recognize the changes and it has started to adjust

but it still has room for growth and opportunity. In order to assist with this effort, Union

Hospital of Cecil County has entered into an agreement with Life Bridge Health to merge into

their healthcare system. Life Bridge Health is a nonprofit healthcare system based in Baltimore,

Maryland that currently has 3 hospitals and a variety of healthcare services and ventures it

partners with and owns to improve the health of its’ patients.

My Role
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While I am not interning at Union Hospital of Cecil County as I am a current employee

with the role of Director of Social Work and Outpatient Behavioral Health Services, I did choose

my employer to complete my capstone project. My capstone project is focused on leading and

developing an integrated collaborative care model of behavioral health services within our

primary care practice by partnering with a community mental health agency. The model was

developed by the Advancement of Integrated Mental Health Services (AIMS) Center at the

University of Washington, Psychiatry and Social Sciences Division of Population Health

(aims.uw.edu). This model has proven successful with our regional partner, University of

Maryland Upper Chesapeake Health, and shown to be an effective way to address the mental

health needs of a large population with limited behavioral health providers. As mentioned

earlier, this is a challenge for Cecil County given it has limited mental health professionals.

Conclusion

Health care is an ever changing phenomenon with new models and trends becoming

readily available in order to keep up with the growing demand for quality, affordable care.

Human service agencies in this sector are tasked with the difficulty of keeping up and making

changes from past practices to be more relevant now and in the future.
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References

Cecil County Community Health Advisory Committee. (2016) Community Health Improvement
Plan. Elkton, Maryland.
https://insider.uhcc.com/intranet/data/componentfiles/810/Org Chart 2019 - Functional FY 2019 - TJC
Updated 8-2018.jpgRetrieved from: https://www.uhcc.com/wp-
content/uploads/2015/08/CHIP_FY17-19_Final.pdf

Maryland Urban and Rural Population by Jurisdiction. Maryland Department of Planning, Data
Analysis, and Projections/State Data Center (2010). Retrieved from:
http://www.mdp.state.md.us/msdc/census/cen2010/Urban_rural/PctUrbanRural_County_region_
r2.pdf

“Maryland Mental Health Shortage Areas by Population” (2010, July 1). Retrieved from
http://phpa.dhmh.maryland.gov/opca/docs/Data-
Compendium/Section%205/7%20MH%20HPSA%20by%20Pop7-9-10.pdf