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The big picture: Integrated health care looks at social, physical and psychological needs

Axis Health System’s unique model personalizes medicine
Dr. Luke Casias, left, chief medical officer for Axis Health System; Christian Belman, center, an outreach and enrollment specialist with Axis Health; and Alex Frazier, who works in Axis’ integrated behavior health support, discuss a patient at La Plata Integrated Healthcare in Durango. Integrated health care combines physical, psychological and social care to ensure that providers meet the needs of their patients. (Jerry McBride/Durango Herald)

Axis Health System is best known for its work in behavioral health, offering mental health, crisis care and substance-use treatment.

But the Southwest Colorado health care organization, which has offices in Pagosa Springs, Durango, Cortez and Dove Creek, also offers primary care and dental care as a part of its integrated health care model.

Integrated health care intertwines physical, psychological and social care to ensure that providers meet the needs of their patients. It’s a holistic approach to health and one that Axis Health System takes to an extreme, but the model is ideally suited for rural communities and for patients who believe that health care should be personalized and exhaustive.

“We provide mental health services, primary care, oral health services – but we want to make sure that whatever the patient needs, that we can fit those,” said Lincoln Pehrson, chief integration officer for Axis Health System. “We use all sorts of tools to ensure that we can help the patient in any way, even if the patient can’t necessarily articulate all of their needs.”

According to the American Psychological Association, integrated health care involves collaboration and communication between physicians, nurses, psychologists, dentists and other health professionals to treat each patient.

On its website, the APA writes, “What makes integrated health care unique is the sharing of information among team members related to patient care and the establishment of a comprehensive treatment plan to address the biological, psychological and social needs of the patient.”

By coordinating care across health disciplines, health care systems like Axis can individualize and improve the quality of health care.

“The goal is to ensure that (patients) don’t feel like they’re just another number and they’ve got a 15- or 20-minute appointment and we’re running them in and out,” Pehrson said.

“When I see a patient, I don’t expect to know the full story off the first visit, and I think that you’re naive to believe that you would as a provider,” said Dr. Luke Casias, chief medical officer for Axis Health System. “What the screening tools that are integrated into our care delivery try and do is actually give someone a platform to lay out their needs without having to do it verbally.”

Primary care is the entry point into integrated health care for most patients.

When someone first visits Axis Health System, they go through extensive intake paperwork with background questions that allow providers to initially screen for a list of issues on top of physical medical conditions, including depression, anxiety and substance use.

Keliana Sherman, an integrated behavior health provider with Axis Health System, meets with patients as they make their way through appointments at La Plata Integrated Healthcare in Durango. Axis Health System’s integrated model is meant to bring dynamic health care to patients and make them partners in their own medical care, according to Dr. Luke Casias, chief medical officer for Axis Health System. (Jerry McBride/Durango Herald)

They also answer other questions that aim to identify if there are any circumstances such as poverty, food security and housing stability that could be affecting their well-being.

Of the more than 10,800 social determinants of health screenings that Axis Health System has performed, more than 20% have found that food security is an issue affecting patients.

“It’s a hell of a ride to come into the front door on the first visit because you get hit with some things that you’ve never really seen before,” Casias said. “But that’s to make sure that that’s your starting point into our whole world of integration so that we can broaden out our reach and meet your needs as a team.”

When Axis’ physicians or behavioral health professionals pick up on something, the doctors inform and educate the patient before directing them to other services within Axis Health System or to nearby community organizations that can help.

Unlike more conventional health care systems that require referrals once a need is identified, integrated health care incorporates many secondary services, such as dentistry, into a patient’s immediate medical care.

“It’s not one of the typical referrals (where) somebody from their office will call you in the next few weeks, and if they don’t, ‘please call me back’ type of thing,” Casias said. “You have resources to tie them into the care that they need and (then) give them a warm hand off to the person you’re sending them to.”

Integrated health care also places an emphasis on preventive care in addition to addressing the acute medical concerns of each patient.

“What we’re trying to do is identify needs before their crisis,” Casias said. “It’s easy to see somebody walking in having a behavioral health crisis. But how can we start treatment upstream from that? How can we address somebody when they’re first starting to have the strains and stresses that actually lead to maladaptive coping behavior that manifests in anxiety disorders, depression (or) bipolar disorder?”

While Axis Health System and other integrated health care organizations do offer an array of services, the model does not exclude patients who seek only primary care or mental health support, or who seek outpatient care.

“If they just need a primary care provider, that is absolutely OK,” Pehrson said. “We don’t push additional services on to them. We just want to ensure that they are aware that we do offer additional services and we can be their medical home so that they don’t have to go to multiple locations to receive all of that care.”

A few of the questions new patients are asked when first entering Axis Health System’s integrated health care. When patients first visit Axis Health System, they go through extensive surveys with background questions that allow providers to initially screen for a list of issues on top of physical medical conditions, including depression, anxiety and substance use. (Jerry McBride/Durango Herald)

The concentration of care into a single organization and location makes a difference for rural communities in Southwest Colorado.

Few medical providers serve communities such as Dove Creek or Dolores, often forcing patients to commute for their medical care.

A single location for all of a patient’s medical, behavioral and dental services eases access and removes a significant barrier for rural patients.

“(The integrated health care) model in a rural setting allows for one-stop shopping for patients,” Casias said. “It just makes sense in rural areas to do as many services as you can where you’re operating. Can we do it all? No, but we can try and get you tied in with someone and get it done a lot quicker.”

Axis Health System’s approach to integrated health care is also designed to meet the disparate economic needs often found in rural communities.

Axis Health System accepts Medicare, Medicaid, private insurance and patients who are uninsured or underinsured. It uses a sliding scale based on financial earnings to offer reduced rates to those with lower incomes.

“We provide care to anyone because oftentimes we are the only ones out in those areas that people can access,” Casias said. “There aren’t any other offices to go to or those offices may not take the insurance that you carry.”

For patients, integrated health care can be startling at first because of how involved it is, but the comprehensive and personalized care assuages any concern.

Though Axis Health System is often pegged as a behavioral health organization that works with the unhoused, integrated health care and Axis’ diverse services are available to anyone.

“We take care of folks on both sides of the financial and the psychosocial spectrum,” Casias said. “We take care of everybody.”

That includes outpatient services, but also care coordination or assistance with Medicaid enrollment, Pehrson said.

Axis Health System has grown in recent years as residents of Southwest Colorado have sought more holistic care.

In 2021, the organization served 13,771 patients and fielded more than 130,000 visits across its services.

Casias sees Axis Health System’s integrated model as a way to bring dynamic health care to patients, making them partners in their own medical care.

“The cornerstone of integration is meeting (the patient) where they are and having either the resources yourself or at least the knowledge of how to connect them with the resources to meet their need,” he said.


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