Transcript The Evolution of Integrated Healthcare at a Behavioral

The Evolution of Integrated Healthcare at a
Behavioral Health Organization in an Urban Community
Sara Gotheridge, MD
Chief Medical Officer
Alice Geis, DNP, APN
Director of Integrated Healthcare
Mary Colleran, MSW
Chief Operations Officer
John Mayes, LCSW, CADC
President/CEO
Trilogy Behavioral Healthcare
Chicago, IL
Agenda
 Who is Trilogy?
 Defining the Need
 The Integrated Healthcare Model
 Program Outcomes
 Challenges
 Lessons Learned
 Future Directions
Who is Trilogy?
Trilogy’s mission is to assist people in their recovery from serious mental
illness by helping them discover and reclaim their own capabilities and life
direction.
Who Trilogy Serves
 950 clients currently
When coming to Trilogy:
 48% of clients have co-occurring substance use issues
 75% of clients do not have a psychiatrist
 40% of clients do not have a primary care physician
 18% of clients are homeless
 Average # of Primary Care encounters annually: 7
 Average # of Psychiatry encounters annually: 6
 Average # of Medications: 8
THE TRILOGY TEAM
The Need for Integrated Healthcare
 Individuals with Serious Mental Illness (SMI) die on average 11-32
years earlier than individuals without SMI, almost always due to
highly preventable or manageable medical co-morbidities
 Stigma
 Insufficient Access to Primary Care
 Fragmented Health System
 Complex psychosocial and biological conditions
The Integrated Healthcare Model
EDUCATION
CULTURE
TECHNOLOGY
NURSING
PRIMARY
BEHAVIORAL
PARTNERSHIPS
LEADERSHIP
HEALTH
HEALTH
WELLNESS
CONSUMERS
PEER STAFF
WORKFORCE
SERVICES
OCCUPATIONAL
SUSTAINABILITY
SMOKING CESSATION
OUTCOMES
THERAPY
CULTURE
 Well-coordinated Care
 Quality Care
 Person-Centered
 Shared Mission
 Creativity
 Flexibility
Primary
Behavioral
Care
Health
 Co-location
 Layout of site
 Workforce
 Care coordination
WELLNESS
SERVICES
 Exercise
 Nutrition
 Illness Management
 Self-care
 Education
PARTNERSHIPS
 Heartland Health Centers
 Rush University College of Nursing
 Chicago House
SUSTAINABILITY
FQHC Billing
Utilizing Students
Maximizing reimbursement value
WORKFORCE
DEVELOPMENT
 Academic Partnership
 The Center for
Integrated Healthcare
Education
 Peer Ambassadors
TECHNOLOGY
 Electronic Medical
Records
 Sharing
Information
PEER
SPECIALISTS
 What is a Peer Specialist?
 Paid staff person who is willing to self-identify as a person
with a serious behavioral health disorder with lived
experiences.
 Service Activities:
 Peer mentoring/coaching
 Recovery resource connecting
 Facilitating & Leading Groups
 Building Community
CONSUMERS
 Consumer Advisory Council
 WRAP (Wellness Recovery Action Plan)
 WHAM (Whole Health Action Management)
 Trauma-Informed Care
COMMUNITY
OUTREACH
 Wellness Fairs
 Family Nights
 World AIDS Day
 Suicide Prevention Week
 BBQs
 Landlord Meet & Greet
OCCUPATIONAL
THERAPY
 Practice Apartment
 OT Assessments:
 Includes Hygiene, Cooking, Safety,
Cleaning & Leisure Activities
 Adaptive Devices
 Involvement in Care Team
SMOKING
CESSATION
 Smoke-Free Campus
 Participation in the American Cancer Society “Great
American Smokeout”
 Ask about tobacco use at every visit
 Staff & client groups
 Staff trained in Ask, Advise, Refer
 Panelists on SAMHSA Webinar: "Craving Change:
Implementing Tobacco Free Policies in Behavioral
Healthcare"
LEADERSHIP
 Frequent communication
 Administrative & financial investment
 Technological integration & data management
 Build trust between partners
 Focus on mission
 Buy-in
 Development Memoranda of Understanding
 Clear policies, procedures and workflows
EDUCATION
 The Center for Integrated Healthcare
Education:
 Pilot Course: “Integrated Behavioral Health,
Primary Care, andWellness: An Interprofessional
Approach.”
 Mental Health First Aid & Youth Mental
Health First Aid
 Certified Alcohol and Drug Counselor
Training
MANAGING
WITH
OUTCOMES
 Data Collection
 Monitoring
 Evaluation
 Dashboards & Reporting
Co-Morbidities and Disparities
Biomarker or
Disease
Our Clients
Nationally, individuals
with SMI
Overall
Population
BMI (n=486)
Obese: 50%
60% of patients with bipolar
disorder, 70% of patients with
schizophrenia, & 55% of patients
with depression
Obese: 35.7%
Diabetes (n=776)
15.7%
15%-18% of individuals with
schizophrenia
11.3%
Tobacco Use (n=748)
54%
75%
18.1%
Blood Pressure
(n=529)
Hypertension: 22.5%
21.9% of adults identifying with
any mental illness experienced
high blood pressure
Age 18-39: 7.3%
40-59: 32.4%
60+: 65%
(Overall: 31.4%)
Integrated Healthcare Outcomes
Over 1,000 clients have participated in the Trilogy Heartland
Integrated Healthcare program over the last four years.
Of clients who completed the NOMs (National Outcome Measures)
assessments:
 47% have an improved BMI (weight management)
 44% have an improved HgBA1C (diabetes management)
 58% have improved cholesterol
 18% have improved blood pressure
 36% have improved Breath CO level (smoking cessation)
National Outcome Measures Results
National Outcome Measures (n=440)
Healthy Overall
Functioning in Everyday Life
No Serious Psychological Distress
Use of Illegal Substances
Use of Tobacco Products
Binge Drinking
Had a Stable Place to Live
Attending school regularly and/or employed
Involvement with Criminal Justice System
Socially Connected
Outcome Improved
19%
62%
14%
8%
4%
6%
14%
13%
2%
47%
Consumer Smoking Status
2012
38%
2014
Smoker
Smoker
62%
Non-Smoker
46%
54%
Non-Smoker
Challenges
 Need to continually redesign workflows
 Need for staff training
 Stigma
 Inadequate space
 Establishing efficient documentation process
 Integrating technology
Addressing Challenges
 Leadership Learning Community
 Development of new financial model
 Increase administrative support
 Expand role of consumers
 Increase relevance, accessibility & effectiveness
of training
 Include evaluation in program planning
Lessons Learned
 Need for ongoing staff training
 Be flexible & patient
 Focus on qualitative results as well as
quantitative
 Take time to recognize successes
 Focus on wellness
Future Directions
 Sustainability
 Enhancing performance measurement and
reporting progress of the IHC
 Identify high risk clients through reporting
 Population Health Management
 On-site Pharmacy Services
 Marketing, and an emphasis on outcome materials
 Northside Collaborative
Questions?