Transcript Care is coordinated and/or integrated

Behavioral Health Integration;
Experiences of RIPCPC and RIBHN
2010 - 2013
 A bit on history and background
 Development of current model
 Demonstration of point-of-care database referral
system
 Prospects for the future
 Questions
History of RIPCPC
 RIPCPC formed in 1994 as an Independent Practice
Association (IPA) with a focus on quality
improvement

Originally formed to:
Challenge insurers that were lowering reimbursement
 Combat the trend of hospitals buying up community based
practices

 RIPCPC is the largest IPA in Rhode Island



140 Primary Care Physicians (began with 40)
Cover over 300,000 Rhode Island Lives
25% of Rhode Island’s Pediatricians are Members
RIPCPC’s Focus on the Patient Centered
Medical Home
 Principals of the PCMH
 Personal physician provides care
 Physician directed medical practice
 Whole person orientation
 Care is coordinated and/or integrated
 Enhanced access for patients
 Focus on safety & quality improvement
 Payment appropriately recognizes the added value
provided to patients
Behavior Health’s Integration is Essential to
Improving Outcomes!
Patient Centered Medical Home Model
 PCMH effect:
 Care
delivered by primary care physicians
in a Patient-Centered Medical Home is
consistently associated with better
outcomes:
 Reduced
mortality
 Fewer hospital admissions
 Lower utilization
 Improved patient compliance
 Lower healthcare spending
Collaboration with Specialists/Providers
 True patient care coordination can only happen
with meaningful & efficient provider collaboration
 We can improve outcomes and the effectiveness and
efficiency of our care delivery systems by embracing
this concept
 Our effectiveness and efficiency as clinicians will
soon be directly tied to our reimbursement
Behavioral Health Committee Focus
 Mission Statement:
 To improve the health of our patients by facilitating
communication and coordination of care between
Rhode Island Primary Care doctors and Behavioral
Health Professionals in Rhode Island
 We have assembled a team of primary care
doctors along with our IT professionals and
behavioral health professionals and we have
created a forum with regular monthly meetings
focused on:


Improving access to Behavioral Health Providers
Improving communication between Behavioral Health
Providers and PCP’s
 Support the IPA by addressing behavioral
health’s role in the PCMH, helping satisfy
our behavioral health contract components
Behavioral Health Committee Initiatives
 Evaluate/Revise/Approve BCBSRI policies and
procedures stated within the three-way contract
between BCBSRI, RIPCPC & Behavioral Health
Provider

Both the Co-located & Collaborative Model Agreements
 Creation of a comprehensive list of Behavioral
Health Providers and facilities for our physicians
membership

Listing will be compiled and posted on our website
 Refine pilot between the Behavioral Health
Providers and PCP’s focused on securely
exchanging standardized clinical
correspondence


Patient Clinical Summaries / Referrals (from PCP)
Behavioral Health Evaluations (from BHP)
Behavioral Health Committee Initiatives
 Things to Come (in 2012):
 Database to access at point of care to allow for smooth referral
of patients to appropriate providers
 Collaborative agreements to allow for the majority of our
physicians to enter into arrangements that enhance access and
improve communication
 Network wide ability to use the secure, HIPPA-compliant
communication system piloted in 2011.
Goals of Behavioral Health Integration
 Improve 2-way communication between
clinician and the referring PCP
 Better access to BH for our patients
 Formation of quality metrics that can
prove better outcomes with BH
 Delivery quality comprehensive
coordinated care to our Patients!
Behavioral Health Integration
 Through collaborative agreements spelling out
expectations on both sides, a behavioral health pod
within RIPCPC was formed:



Timely response to referral (same day for urgent referrals, 72
hours for routine) with willingness to accept patients
Thorough 2-way communication with detailed referral from
PCP, and with regular progress notes for ongoing therapy
Emphasis on electronic communication
Point-of-Care Referral Database
 A web portal, accessible at the point of care
 Allows PCP to appropriately tailor referral to the
needs of the individual patient with respect to
geography, age, insurance, behavioral or mental
health goals and need for comprehensive care.
 Can refer to individuals, group practices or facilities
 Preferred communication is electronic, but can be
via web, fax or phone depending on providers
preferences
What we accomplished..
 Formalized an affiliate membership between the
RIPCPC physicians and behavioral health providers
 Established a RIPCPC Behavioral Health Pod
 Created a RIPCPC Behavioral Health provider and
facility portal

This is a searchable database of BH providers that RIPCPC
member physicians can filter by:


Specialty, insurance, city, hours of availability,
insurances accepted & population treated
Utilize ‘Direct’ messaging to communicate
with BH providers
Things to Come




A focus on the collaborative model approach
Strengthen network and build lasting relationships
Assist patients in making better choices and measure those
patient outcomes (healthier lifestyle = lowered health care
costs)
Improve our communication and access with BH specialists for
the benefit of our patients, this will help us better manage our
patient population in an ACO/AQC/RISK environment
 Successful behavioral health integration is
vital to containing costs!