The Free Press, Mankato, MN

October 14, 2013

Finding their way to better care with COMPASS

Program treats people suffering from chronic, mental illness

By Robb Murray
The Mankato Free Press

---- — It wasn’t there when he was in high school. It wasn’t there when he was in college.

But by the time Ron Steinberg hit his mid-20s and was married with children and starting his career as a teacher of languages, it began to show up. Subtle at first, but eventually depression would hit him in a way that would change his life. Before he got help, Steinberg would become an alcoholic.

Today, however, Steinberg is healthy and has figured out a way to manage both his mental illness and the chronic illnesses he deals with: diabetes, irregular heartbeat and high blood pressure.

He credits a new initiative at Mayo Clinic Health System in Mankato called the Care of Mental Physical and Substance-use Syndromes program, or COMPASS.

Kicked off with a three-year start-up grant from the Centers for Medicare and Medicaid Services, COMPASS is available to current MCHS patients who suffer from both mental and chronic illnesses. The program recognizes that caring for chronic illness can be made more difficult when depression is added to the mix, so it offers patients tools to better deal with that part of their lives.

Steinberg says it helped him a lot.

“It organizes your effort to help yourself with your health matters rather than going to a couple of different providers who can pull you in a couple different directions,” Steinberg said.

Added his wife, Carmen, “There’s a cohesion. That’s how we felt. Like we were right in the middle of the circle of caregivers, and we felt very thankful for that.”

The grant MCHS received to start COMPASS funded two care coordinators, one at the clinic’s Eastridge location, and one at Northridge. While the care approach was funded by a grant, MCHS said that once the three-year grant is up it will be absorbing the COMPASS approach permanently.

It’s approach is fairly simple.

COMPASS is a team-based method of caring for patients whose chronic conditions are made more complicated by mental illness. COMPASS teams are made up of a primary care provider, a care coordinator, a consulting psychiatrist and the patient. The team is not designed to replace the primary care doctor, but rather complement the doctor’s care and possibly supplement it with additional services.

Care coordinators typically interact with patients weekly. Some of that interaction is in person, some of it may be via phone. The care coordinator checks in with the patient and reviews their treatment plan. Consulting psychiatrists review cases as well, and recommend appointments with behavioral health specialists.

Jean Reynolds, a patient who suffers from apical ballooning (also known as the broken heart syndrome), is one such patient who says frequent visits have helped her immensely.

A depression sufferer most of her life, Reynolds said she also suffers from fibromyalgia. Her apical ballooning intensified after menopause, and after encouragement from her husband, she sought medical attention. Her doctor suggested the COMPASS program. After taking a screening test — patients must have a certain score to qualify for the program — she was admitted.

After being in the program in late spring, she said her life has improved. Her mood is better and she has more energy. Also, the care team examined her medications and make adjustments that resulted in her sleeping better at night.

“It’s made a big difference to have someone to talk to, to work closely with me,” she said. “I know the doctors can’t possibly sit and listen to everyone. Plus, I can tell she cares.”

The “she” in this case is Jennifer Pollitt, a registered nurse who is one of two care coordinators in the COMPASS program.

She said proof in how effective the program is can be seen in how often the doctors take her advice: almost always, she said.

“The majority of physicians really appreciate that they’ve got a team looking out for their patient’s care,” Pollitt said. “COMPASS is geared toward putting the patient back in control.”

Patients with a chronic illness, Pollitt said, are 15 percent more likely to have depression, just like Steinberg and Reynolds.

“Ron came to me not feeling very good (and suffering from depression),” she said. “That makes the motivation lacking.”

To break through that, care coordinators such as Pollitt talk with patients weekly. And it’s not just a quick phone call. It can be up to an hour if need be.

Reynolds said that after those meetings issues that arise are addressed and taken care of quickly.

“When I go there, I know whatever issue I have is going to be handled exponentially quicker, sometimes even in the same day,” she said. “And that has made a big difference. It’s good to know they’ll help me and get right on it. And my mood has been a lot better. Even beyond medication, it’s great to know there’s someone I can talk to.”