Massive Healthcare Systems Merger Seeks To Integrate Mental, Physical Care

Lilo H. Stainton | January 4, 2019 | Health Care
The joining of Hackensack Meridian Health and Carrier Clinic reflects an attempt to jettison a fragmented approach to the care of patients with multiple needs

L to R: Thomas Amato, Carrier Clinic; Gordon Litwin, Hackensack Meridian Health; Donald Parker, Hackensack Meridian Health Carrier Clinic; Robert Garrett, CEO, Hackensack Meridian Health
Two of New Jersey’s leading healthcare institutions have joined forces in a partnership designed to expand access to addiction care and strengthen the behavioral health system.

The move reflects a growing national push to provide more integrated treatment to those with mental and physical illnesses, while better controlling costs.

The merger between Hackensack Meridian Health, with its 16 hospitals, hundreds of offices and associated medical school, and the 100-year-old Carrier Clinic, which specializes in addiction and psychiatric care, is the first of its kind in New Jersey, according to officials who celebrated the agreement in a ceremony Thursday.

But the model echoes alliances formed in several large cities, including New York and Boston, where large hospital systems have partnered with behavioral health centers and universities to provide better coordinated, more holistic acute-care options, officials said. It also reflects efforts in the Garden State and elsewhere to expand access to mental-health and substance-abuse treatment through primary-care facilities.

“Separate models of care for physical, mental, and addiction health care can’t treat the whole person. It’s time that we designed our healthcare system accordingly,” state Health Commissioner Dr. Shereef Elnahal posted on Twitter, after joining officials to mark the merger. The state has also sought to encourage more integrated care, in part through an effort to unify a separate licensing process for medical and behavioral care facilities, a process overseen by the state Department Of Health.

Upgraded campus, new drug-treatment sites

Among other things, the HMH merger with Carrier is expected to lead to new investment in behavioral health services in particular, including a $25-million upgrade to Carrier’s Belle Mead campus, new drug-abuse treatment sites, and the state’s first nonprofit urgent-care center for those facing addiction or mental-health challenges.

In addition, Carrier will help HMH establish multi-disciplinary behavioral health teams in all its hospital and provide new research and residency opportunities for students at its School of Medicine at Seton Hall University, officials said.

“This plan will create exceptional, comprehensive care at a time of great need for expanded, enhanced, and innovative behavioral health services,’’ said Carrier president and CEO, Donald J. Parker.

Hackensack Meridian Health CEO Robert C. Garrett said this integration is particularly important now, as the heroin epidemic continues to rage in New Jersey.

But it is also critical to the success of a growing healthcare network, he said, based on conversations he and Parker had with leaders at other systems that merged, like Harvard University, Massachusetts General Hospital and McClean Hospital, in Boston. “If you don’t focus on integration of care, you really don’t have a successful merger transaction,” Garrett said.

Integrated approach to patients’ needs

Historically, healthcare in New Jersey, and around the country, has been fragmented. Patients with multiple needs may be treated for physical ailments at a hospital or doctor’s office, but are referred elsewhere to get care for behavioral-health concerns — and may be forced to wait weeks for an appointment. And when a psychiatric or addiction crisis emerges, individuals are now more likely to end up in the hospital emergency room, where providers may not have the resources to meet their needs.

“For too long, health care and coverage have treated physical health and mental health as separate and distinct, rather than recognizing that the brain and the body are part of the same person,” said state Human Services Commissioner Carole Johnson, who oversees a diverse array of state-funded community based mental-health and addiction programs, and has sought to expand Medicaid coverage for behavioral health services.

“If you just focus on the acute medical problems without addressing the others,” including addictions or psychiatric issues, patients are likely to rotate in and out of expensive care, “and you sort of get that vicious cycle,” explained Dr. Justin Sambol, a senior associate dean at Rutgers New Jersey Medical School and vice president of Rutgers Health Group.

The health group is working to expand acute-care options at NewBridge Medical Center, a Paramus hospital that has focused on behavioral care; Rutgers has also partnered with RWJBarnabas, another massive healthcare network, to enhance research, medical education and clinical-care opportunities.

“The concept of integration has been around for a long time, but it’s been a struggle to do,” Sambol said. “But the future is really treating the whole patient. You can’t just pick and choose which aspects to focus on.”

Enhancing care, reducing costs

In fact, offering combined care in one setting has been shown to improve clinical outcomes and reduce costs, according to the Nicholson Foundation, which has funded multiple efforts to improve integration in New Jersey in recent years, including work to support changes in state policies and protocols. Patients may feel less stigma seeking behavioral health services through their primary-care doctor, for one, and early intervention can reduce the need for more complex and costly inpatient treatment later on.

“From our pilot sites we’re learning that these interventions are helping patients get better,” said Barbra Kang, a senior program officer at Nicholson, who oversees the primary-care behavioral health integration project.The organization has helped eight clinics to expand staff, enhance training and improve operations to make these systems more sustainable and hopes to fund four more pilots this year.

“And we knew that would happen,” Kang added, based on results from Cherokee Health Systems, in Tennessee, which has been doing this work successfully for 30 years and is now training others, including teams from the Garden State. “Although they’re in Tennessee, their patients don’t look any different than they do here in New Jersey,” she said.

New training at medical school

Leaders at HMH and Carrier said the two systems are particularly well suited to the merger, which has been under discussion for more than a year. Garrett called the partnership “transformational” and said it would allow them to write a “new chapter” in the treatment of mental health and substance-use disorder.

Hackensack already operates some behavioral health programs, and is in the process of adding more than three dozen beds to the 150 spots it currently has for inpatient psychiatric patients. It has launched a psychiatry residency program and plans to add similar training systems for child and adolescent psychiatry, officials said. And training at the Seton Hall medical school is designed to integrate future physicians into families and communities so they can better understand how a patient’s social background impacts health.

Carrier Clinic runs a short-term acute-care psychiatric hospital in Belle Mead, with nearly 300 beds and a range of distinct programs, both inpatient and outpatient, for patients of different ages and clinical needs. It also operates a middle school and high school for children with serious emotional disorders and a detox facility for those suffering from opioid, alcohol and other addictions.