Transcript Integration of Behavioral Health and Primary Care

The Integration
Train is Moving –
Are You
Onboard? If Not,
Learn How to Get
Your Ticket!
Presented by:
• Mark A. Engelhardt, MS, MSW, ACSW
• Rick Hankey, MA
• Laureen Pagel, PhD, MS, CAP, CPP, CMHP
• Rita Chamberlain, MBA
• Kay Doughty, MA, CAP, CPP
• Phillip Brooks, LMHC
Learning Objectives
• Identify national, state and local models of behavioral
healthcare and primary health integration
• Identify and describe the continuum of healthcare
integration models
• Use the tools and tips provided to establish an
integration action plan for beginning and/or enhancing
integration efforts
• Self-assess where their organization stands on the
integration continuum model.
• Leave with a list of contacts/resources pertaining to
integration
2
Integrated Behavioral Health &
Primary Care
National/State/Local
Development
FADAA/FCCMH Annual Pre-Conference
Mark A. Engelhardt, MS, MSW, ACSW
USF – FMHI – Dept. of Mental Health
Law & Policy
3
The Case for Integrated Care
• People with mental health and substance abuse
disorders die 25 years earlier that the average person,
mostly from untreated and preventable chronic
illnesses like hypertension, diabetes, obesity and
cardiovascular disease.
• Poor health habits, such as inadequate physical
activity, nutrition, smoking and substance abuse
• Barriers to primary healthcare & complex systems
• Solution – Integrated behavioral (SAMH) and primary
healthcare produces better outcomes for people with
complex needs involved in multiple systems of care.
• Quality of Integrated Care & Cost to Person/System
4
Organizational Support (2003-14)
• World Health Organization
• Substance Abuse and Mental Health Service
Administration (SAMHSA)
• Health Resources Services Administration (HRSA)
• National Council for Behavioral Healthcare –
Community Mental Health Centers and Integrated
Substance Abuse Providers
• Community Health Centers – Federally Qualified
Health Centers (FQHC’s)
• Health & Behavioral Healthcare Advocates
5
Four Quadrant Model
• Population Based (NCCBH)
1. Population with low to moderate risk/complexity for both
behavioral and physical health issues
2. High Behavioral health risk/complexity and low to
moderate physical health risk/complexity
3. Low to moderate behavioral health risk/complexity and
high physical health risk/complexity
4. High risk and complexity for both behavioral and physical
health ( SAMHSA – HRSA Grant focus)
6
Integration Models (A Few)
• Primary Care in Behavioral Health Settings;
Behavioral Health in Primary Care Settings or BiDirectional
• Patient-Centered Health Homes (Approach, Not a
Physical setting) – Integrated Treatment Planning
• Chronic Care – Disease Management Models
• Improving Mood – Promoting Access to Collaborative
Treatment – IMPACT – Early Evidenced-based
• Cherokee Health Systems – Fully Integrated (Tenn.)
• Range: Coordinated – Co-Located – Integrated – More
on Slide 13 with Hand out & Afternoon discussion
7
SAMHSA – HRSA Solutions
• Target = People with Serious Mental Illnesses
• 100 Current SAMHSA-HRSA Primary Behavioral
Health Care Integration grants
• Center for Integrated Health Solutions – National
Technical Assistance
• http://www.integration.samhsa.gov
• Supplemental Health Information Technology
(HIT) One Year Grants to supports the
development of Electronic Health Records (EHR)
with grantees
• New PBHCI Grant applications to be awarded in
2015?
8
Southeast Learning Community
•
•
•
•
•
•
Seven (7) Florida
Grantees
Apalachee Center –
Tallahassee
Coastal Behavioral
Healthcare – Sarasota
Lakeside Behavioral
Healthcare – Orlando
Lifestream Behavioral
Healthcare – Leesburg
Henderson BH (V)
• Miami Behavioral Health
Center – Miami
• Community Rehabilitation
Center – Jacksonville
• 7 Others in HHS Region
 Georgia = 3 Community
Service Boards
 4 = Kentucky (I); S.C. –
State DMH; NC & TN (V)
 Cohorts I – V (2009-14)
9
National Outcome Measures
• Functioning – Wellness
Healthy Overall
• Functioning in
Everyday Life
• No Serious
psychological distress • Using Illegal
Substances
• Not binge drinking
• Retained in the
community
• Housing Stability
• Education and
Employment
• Criminal Justice
Involvement
• Perception of Care
• Social Connectedness
• Positive outcomes
overall
• Rand Evaluation
10
At Risk Criteria & Tracking TRAC
•
•
•
•
•
•
Blood Pressure (130/85)
Body Mass Index (Greater of equal to 25)
Waist Circumference (Male – 102cm; Female 88 cm)
Breath CO – ( Greater than or equal to 10)
Fasting Plasma Glucose ( Greater than 100)
Cholesterol (HDL less than 40; LDL, Greater than or
equal to 130; Triglycerides, Greater than or equal to 150
• The big one = SMOKING
11
Rand Research Questions
• Process Evaluation – Is it possible to integrate Primary
and Community-based Behavioral Health agencies? –
Structural and clinical approaches
• Outcomes – Does integration lead to improvement of in
SAMH and health of a population of individuals with
serious mental illnesses (& co-occurring)
• Model Features – Which models or “features” of
integration lead to better SAMH and Healthcare
• National data (NOMS and TRAC) - Progress
12
Grantee Evaluation: Rand Corp.
•
•
•
•
•
•
•
56 Grantees included in the National Evaluation
67% Partnered with FQHC’s
Over 16,000 served since 10/1/09 -2012
Outcome (Data), Process and Model Evaluation
78% of Grantees are urban programs in 26 states
Use of Evidenced-based practices
Challenges - Data, recruiting staff and consumers,
licensing, info-sharing
• 1% arrested in past 30 days; 63% in stable housing
13
Rand Corporation Report
•
•
•
•
Early Programs – SAMH in Health Care Settings
Now Primary Care in SAMH Settings
Common Features:
Embedded Nurse, On-site Physician, Health
Screenings, Illness Management & Recovery
Programs; Wellness Recovery Action Plans;
Screening – Brief Intervention- & Referral to Tx
(SBRIT); Peer Specialists; Case management
• Diverse Models – Clinic Based to Home visits
14
Levels of Integrated Healthcare
• Coordinated = Key element = Communication: usually
minimal to basic coordination
• Co-located = Key = Physical Proximity: usually basic to
close collaboration on-site
• Integrated = Key = Practices Change: usually close
collaboration to a fully transformed/merged integrated
practices – Clients experience a seamless response to
all of their health and behavioral healthcare needs
 Heath, Wise & Reynolds March 2013 (CIHS)
 HAND OUT
15
Workforce Issues
•
•
•
•
•
Peer Support Specialists
Shared Decision Making – Person Driven
Nursing – Physicians Assistants
Access to Psychiatry; Outpatient SAMH Treatment
Training – On-line, Certificate Programs (UMASS);
Numerous Webinars; Cross-training among
disciplines, attitudinal changes; case and care
management models; Recovery-oriented care
• Recruitment and retention (Future Medicaid
Expansion and Affordable Care Act)
• Cultural proficiency
16
Clinical Considerations
• Screening Tools ( I.E. SBIRT – Screening, Brief
Intervention & Referral to Treatment)
• Health Indicators ( Substance use, tobacco, blood
pressure, cholesterol, weight, nutrition, etc.)
• Motivational Interviewing
• Medication Assisted Treatment – Pharmacology
• Pain Management (Agency Policies)
• Trauma Informed Care
• Targeted Populations
17
PBHCI Programs
• Million Heart Campaign – National HHS campaign
to prevent 1 Million heart attacks & strokes in 5
years
• Wellness programs = Strategies – Education,
healthy eating, physical activity, stress
management, recovery processes, peer support,
diabetes management, etc.
• Tobacco cessation (I.E., Univ. of Colorado)
• Substance abuse prevention/relapse
• Targeted populations = homeless, drop-in centers,
“housing is healthcare”, in-vivo.
• Interns , students, volunteers, existing programs
18
Administration & Operations
• Memorandum of Understanding with partners (I.E.
FQHC’s) – Array of services ; who will provide what?
• Contracts and formal agreements: Partners
• Clarify Billing Opportunities and Revenue Sources –
Grants, Medicaid, Medicare, Physical Health &
Behavioral Healthcare – Now & Future (Affordable
Healthcare Act – Prospective)
• Health Information Technology – Electronic Health
Records – Confidentiality & Integration
• Meaningful Use & Data Analysis
19
Organization Readiness
• Are you providing Primary Healthcare? If so, is it a
Bi-directional On-site & Off-site Service?
• Do you have signed contracts with FQHC’s,
County Health Departments, Medicaid Managed
Care Plans (I.E. Magellan, HMO’s) or Private
Funding Panels
• Are there shared staffing agreements?
• Do you provide Wellness programs on-site or with
a community partner?
• To what degree are peer specialists employed?
• Do you have Integration Strategic Plan?
20
Organizational Readiness
• Have you conducted an “Integration Readiness
Assessment” for the agency or pilot program?
• What does your workforce look like? – Physicians,
SAMH Professionals, Nurses, Psychiatry, etc.
• Do you consider your agency as Co-occurring capable
for SAMH? If so, how? Now, complexity capable?
• Is your agency involved in a network or merger that will
draw on the strengths of all organizations?
• Do you know the mix of Indigent, Medicaid, Medicare,
Dual Eligible or other local payer plans? (Counties)
21
COMPASS PH/BH (Cline, Minkoff)
•
•
•
•
Self-assessment Tool
Program Philosophy
Administrative Policies
Quality Improvement &
Data
• Access to Care
• Screening & Identification
• Integrated Assessment
• Integrated Treatment
Program & Relationships
• Welcoming Policies
• Medication Management
• Integrated Discharge &
Transition Planning
• Program Collaboration &
Partnerships
• Staff Competencies
22
Pilot Tool Kit: MTM & Zia Partners
• Executive Walk through
from a consumer
perspective
• Admin. Readiness
• Self-assessment Program Organizational
Level PBHCI Capability
• Strategic Partnership
Inventory
• Structured Prioritization
Template
• Guidance on design
Performance Plans with
Indicators
• Project Planning and
Organizational Templates
• References for Specific
Materials (I.E. Tools)
23
Homeless Integrated Care
Examples
• SAMHSA - PBHCI Grantee – Seattle, WA. – Downtown
Emergency Services Center (DESC)
• Housing First Model Development – Pathways to
Housing – PA – Primary Care Partnership with Thomas
Jefferson University Dept. of Family & Community
Medicine – Philadelphia Dept. of Behavioral Health &
Office of Supportive Housing
• U.S. Dept. of Veterans Affairs – Homeless Veterans
Patient Aligned Care Teams (H-PACT) – Homeless
Medical Home – 23 Pilots: 37 sites funded in 2012/13
24
Contact Information
• [email protected]
• 813-974-0769 (Direct Line)
• USF – Florida Mental Health Institute
(FMHI) – Department of Mental Health,
Law & Policy
• http://mhlp.fmhi.usf.edu
• www.floridatac.org
Thank You
25
Primary and Behavioral Health Care Integration:
Practical Approaches to Implementation
Rick Hankey, Senior V. P. and Hospital
Administrator
LifeStream Behavioral Center, Inc.
“Mental health
care cannot be
divorced from
primary care,
and all
attempts to do
so are doomed
to failure”
(Frank Degruy)
What is Integrated Care? Our Definition
Integrated care is a service that combines medical and
behavioral health services to more fully address the
spectrum of problems that individuals have
It meets patients “where they are” in their experience of
problems or pain
Integrated care is the structural realization of the
biopsychosocial model
Reunification in practice of mind and body
Collaborative Care-Where Were We?
LESS
Courtesy report of involvement
Referral call for information exchange
Development of special referral relationship
Meeting to discuss cases
Meeting of providers with patient
Working together regularly in delivering services
(Blount, 1998)
MORE
Reasons for Integration: Why We Did It
The burden of behavioral disorders is great.
Behavioral and physical health problems are interwoven.
The treatment gap for behavioral disorders is enormous.
Primary care settings for behavioral health services
enhance access.
Delivering behavioral health services in integrated care
settings reduces stigma and discrimination.
Reasons for Integration: Why We Did It
Treating common behavioral disorders in integrated care
settings is cost-effective.
The majority of people with behavioral disorders treated in
collaborative settings have good outcomes, particularly
when linked to a network of services at a specialty care
level and in the community.
Individuals with serious mental illness die on average
25 years sooner than the general population.
Factors Increasing Health Risk
Less Likely to be Screened
Poverty
Self-Care
Capacity/Resource
Poor Access to Primary Care
Disconnectedness
of “Physical” &
“Mental” Health
Care Systems
Cognitive,
Affective
and Behavioral
Symptoms
Weight Gain
System Navigation Barriers
Tobacco and Substance Abuse
Medications
Reasons for Integration
Major Cause of Death
CARDIOVASCULAR
LUNG CANCER
STROKE
RESPIRATORY
Increased Risk of Death
3.4 X
3X
2 X IN THOSE LESS THAN
50 YEARS OF AGE
5X
DIABETES
3.4 X
INFECTIOUS DISEASES
3.4 X
(Florida Council For Community Mental Health)
Barriers to Integration
 Behavioral and physical health providers have long operated in their
separate silos.
 Sharing of information rarely occurs.
 Confidentiality laws pertaining to substance abuse (federal and state)
and mental health (state) are generally more restrictive than those
pertaining to physical health. While HIPAA is often cited as a barrier to
sharing information between primary care and mental health
practitioners, this is not accurate: sharing information for the purposes
of care coordination is a permitted activity under HIPAA, not requiring
formal consents.
 Payment and parity issues are prevalent.
Culture Differences
PRIMARY CARE
BEHAVIORAL
HEALTH
PACE
15 minute appointment
50 minute session
SETTING
An exam room
Office setting
LANGUAGE
Diagnosis, medical
terminology, complaints
Assessment, behavioral
health terminology, issues
HIERARCHY
Clear – Doctor in charge
Diffuse – Administrator in
Charge with Medical Director
FLOW
Flexible patient flow
Scheduled client flow
Integration Considerations
Space
Policies & Procedures
Documentation
Registration and Scheduling
Primary Acute Care Services –
Offerings and Expense
Partnerships
Labs, blood work and x-rays
Workforce Development
Readiness Assessment
• Leadership and Relationship Building
• High Performing Provider-Access and
Outcomes
• Person Centered Healthcare Home
Participation
• Business Infrastructure
• Consumer Advocacy
Readiness Assessment-Leadership
•
•
•
•
•
•
How active are you pursuing relationship building with leaders in the
healthcare community?
How successful have you been in communicating the importance of mental
health and substance use treatment in improving quality in the healthcare
system?
Are you involved in assessing community needs and designing a local
health improvement plan?
How involved are you in planning and decision making at the state level?
Do you local leaders understand and support integration?
What have you done to develop and implement healthcare reform education
within your organization? At what level has the discussion been held and
what depth? Do you know how integration will affect your organization and
community? What is the organization commitment?
How educated is your community?
Readiness Assessment-High Performing
Provider
• Readiness and recovery deeply embedded into your culture?
• How quickly can individuals get access to care? Two hours for
emergent? 24 hours for urgent and no later than 7 days for routine
care requests?
• How much is evidence based practices and programs utilized in
your organization? Does leadership prioritize and promote the use
of EBP?
• Does your organization use person centered care planning and
consumer engagement?
• Are care management models utilized in your agency? Does your
agency know the difference between case and care management?
• Are you familiar with “treat to target” approach?
• Are you a high performing provider?
Readiness Assessment: Person Centered Healthcare
Home
• Have you worked closely with your community’s primary care
partners to determine how involved to ensure that all consumers
with mental health/substance abuse disorders have a personcentered healthcare home?
• How capable are you of being a good neighbor to the Person
Centered Health Home, including
a) effective communication, coordination and integration with health
homes;
b) appropriate and timely consultations and referrals;
c)efficient, appropriate and effective flow of patient/care information;
d)providing guidance in determining responsibility in comanagement situations; and
e) supporting the health home as the leader of the care team
Readiness Assessment: Infrastructure
• Where is your organization regarding information technology? Do
you have a electronic record that is available and appropriate for all
staff? Is your information technology able to support real-time
clinical decision making, quality improvement and effective
management?
• Is quality improvement part of your organizational culture or just as a
department? How quickly can you complete Rapid Cycle
Improvement?
• How effective is your revenue cycle management?
• Are you familiar with new payment models? If not, are you willing to
learn them?
• How bullet proof is your compliance plan and does it address
healthcare reform, fraud and abuse?
Readiness Assessment: Consumer Advocacy
• Do you have a workforce expansion plan?
• How well educated are you on federal parity
implementation? Do you have linkages with federal and
state organizations to support or educate your agency on
the implementation of federal parity regulations for
Medicaid, Health Exchanges and private health
insurance?
• Do you have an enrollment strategy that provides
outreach, assistance with the enrollment process and
advocacy for the removal of structural barriers?
• Are you ready to meet the needs of the additional
population?
The Wellness Integration Network
(W.I.N.) Clinic
W.I.N. Clinic Philosophy
CARE
MANAGEMENT
MENTAL HEALTH
TREATMENT
PREVENTIVE CARE
SPECIALTY SERVICE
CONSUMER CENTERED
APPROACH
HEALTH HOME
PRIMARY CARE
SUBSTANCE ABUSE
TREATMENT
WELLNESS
ACTIVITIES
CONTINIOUS
CARE
The W.I.N. Clinic Model
Components
 Integrated services
 Screen/registry tracking and
outcomes
 Primary care staff located in
behavioral health setting/no
FQHC
 Embedded Nurse Care
Managers
 Wellness/prevention
programming
Evidence Based Models
 SBIRT
 IMPACT (Improving MoodPromoting Access to
Collaborative Treatment) Model
 Motivational Enhancement
Techniques (MET)
 Eli Lilly Wellness Program
W.I.N. Clinic-Our Program
 Integration Model: Co-locate primary care physicians in behavioral health facilities to
provide routine primary care services and serve as a consultant to the psychiatric care
team; all staff are employed by LifeStream. There is no FQHC involvement.
 Service delivery: includes providing wellness programming and incorporating
integrated services; psychiatric and primary care are offered during the same visit.
The clinic serves as a “Medical Home”. Specialty care is provided through agreements
with community partners.
 Enrollment Target: 1,000 during the four year grant period.
 Populations Served: Adults with serious mental illness living in Lake County who do
not have access to primary care services or a medical home.
W.I.N. Clinic-Our Program
SERVICES PROVIDED:
 Integrated Primary and Behavioral Health Care; both services provided during the
same appointment (when applicable), along with appropriate follow up. Emphasis
is on preventive care.
 Home visits by LPN Care Managers to coordinate and monitor care and assess
goals.
 Referrals to specialists and enhanced care coordination. The clinic has had great
success with coordinating free and/or reduced rates with the specialists in our
community for our clients.
 Transportation to appointments when needed.
W.I.N. Clinic-Our Program
 Wellness Activities and workshops on topics such as exercise,
diet and nutrition, weight management, and tobacco cessation.
 Wellness activities include: wellness testing (fitness and medical
tests), health risk appraisals, hypertension screening and
education, disease management seminars, in home education
with care managers, stress management activities, and time
management workshops
 Access to LifeStream’s full continuum of care, including
behavioral health and substance abuse services.
W.I.N. Clinic Work Flow
Client identified as not having PCP and referred
to the program
Initial Visit with Care Manager: Client is
screened for medical and behavioral health
issues by Care Manager. Client is seen by
medical staff for history and physical.
SBIRT used to identify co-occurring issues
Consultation with appropriate parties, including
the client
Treatment Plan
Insufficient
Response
Assess Treatment
Response
through Weekly
Contact
Maintenance
-Relapse Plan
-Follow Up
Complete
Response
W.I.N. Clinic-Staff
Medical Provider
 Performs examinations, wound care, assigns care managers, prescribes medications, and completes histories,
physicals and psychiatric evaluations.
Lead LPN Care Manager
 Assists the medical provider, monitors all care managers, prepares education packets for clients, recruits new
clients and is responsible for marketing.
Care Managers
 Responsible for home visits, charting, monitoring progress, wellness activities, treatment plans, education and
teaching of consumers.
Follow-up Specialist
 Responsible for contacting clients at 6, 12, and 18 months; monitoring progress towards treatment plan goals;
assisting clients with affordable prescriptions and referrals for patient assistance and transporting.
Administrative Support
 Responsible for completing the “NOMS”, scheduling appointments, contacting referrals, and data entry.
The W.I.N. Clinic-Successful Strategies
 Care Managers educate clients on nutrition and the importance of eating the
right foods.
 A personalized diet plan with weekly menus is provided.
 Weekly trips to the grocery store teach clients how to shop for nutritious foods.
 Cooking lessons are provided on how to prepare healthy meals and show
clients that healthy food does not have to be unappetizing or expensive.
 As a result, average weight loss is 15 pounds. Over 48% of the consumers
report weight loss.
 Care Managers utilize MET with consumers with regard to exercise regimen,
often starting out with basic exercise such as walking. Care Managers often
participate in activities to encourage consumer participation.
What Does our Data Suggest?
Outcome
WIN Data
All Grants
Functioning in every day
life
79%
32%
No serious psychological
distress
44%
18%
Retained in the community
41%
9%
Stable Housing
25%
12%
Education/employment
27%
12%
Overall Healthy
56%
22%
Illegal substance use
15%
7.3%
Social Connected
19%
18%
Lessons Learned
Hurdles, challenges and obstacles, oh my!!
-Personnel issues
-Cultural change/paradigm shift
-Lab work, medications, specialty care
-Workforce development
What may seem simple often is not.
-Referrals
-EHR Considerations
-Wellness Activities
Lessons Learned (continued)
It takes a village to raise a child
-Partnerships are important
-Teamwork; Are you ready???
Just when things are working smoothly…
-Systems Issues/Client flow
-Program fidelity
-Funding Issues/Sustainability
Recommendations for Implementing Integrated Care
Think big, start small
Improve physical proximity
Keep a joint medical record
Focus on primary care providers as important customers
for mental health providers
Explore new practice styles
Senior management buy-in is critical
Learn and understand billing codes and funding sources
Recommendations for Implementing Integrated Care
Include mental health consultation earlier in the course of a
patient’s evaluation in order to minimize unnecessary
expenses
View patients as people the organization is committed to
working with over time, rather than people presenting a
series of isolated treatment episodes
It’s not all about your organization but the people we serve
Teamwork, partnerships and thinking outside of the box are
very critical for success.
Rick Hankey, Senior Vice President and Hospital
Administrator
LifeStream Behavioral Center,
Leesburg, Florida
Email: [email protected]
Telephone: 352-315-7810
Integrated care on a small
scale
Laureen Pagel
CEO
Starting Point Behavioral
Healthcare
Integrated care - Important Facts
• Bi-directional integration is critical for
improving patient care and containing
costs
• Changes due to HCR will have a great
impact on the way SAMH services are
delivered and financed
• Health homes is seen as a move toward
integration
Integrated Care - How do I begin?
• Identify community partners
FQHC
Rural health clinics
Primary care practices
Hospital
Managed care plans
Integration Core Competencies
I. Interpersonal communication
II. Collaboration & teamwork
III. Screening & assessment
IV. Care planning & coordination
V. Intervention
VI. Cultural competence & adaptation
VII. Systems oriented practice
VIII.Practice-based learning & Quality improvement
IX. Informatics
Integrated care - What’s in it for me?
• The most successful integration attempts are
those in which the needs of the medical care
setting are considered primary.
• Ask yourself – How can integration be seen as
solving an existing problem in primary care?
• Educate primary care about the efficacy and
cost effectiveness of integrated care.
• Model must be a good fit for that setting.
Integrated care – How did SPBH do it?
• Partnered with another agency to write an
FQHC planning grant
• Met for a year with community stakeholders
to gather health data and identify unmet
needs
• Reached out to RHC on west side of county
about co-location of services
• It took a year of relationship building to make
any progress.
• These are examples of core competencies I
& II.
Integrated care - Our integration model
• Worked with nursing staff at RHC to get “buy-in”.
• Surveyed their clients to determine need and
motivation for SAMH services.
• Placed an LCSW on site 1 day a week. Conduct
screenings using the PHQ, crisis intervention, and
individual sessions from 30-60 minutes. (core
competencies III and V)
• We bill the clients for her time. Most clients have
Medicaid.
• All services are documented in our electronic
health record. (core competency IX)
• Use Outreach for her screening time.
Integrated care - Another opportunity
• Our community partner wrote us in on a Blue
Foundation grant for MH services at their medical
clinic.
• We wrote them into a WGA grant for MH services
for women and girls with trauma.
• Both grants were awarded. Evidenced-based
practices are utilized for both grants.
• We have 10 hours of MH services at their clinic paid
by Blue Foundation and 24 hours paid by WGA
• A therapist is on site 5 days a week
• We can bill Medicaid for all eligible services
Integrated care - Next Steps
• Meet with staff at medical clinic weekly to
review process and make adjustments as
needed (core competency VII)
• Working with our local hospital on strategic
partnerships.
• In talks with our Hospital President about
having a social worker and case manager
team to screen patients in the ER.
Thank You!
Laureen Pagel, PhD, MS, CAP, CPP, CMHP
Starting Point Behavioral Healthcare, CEO
[email protected]
904-225-8280 ext. 416
www.spbh.org
Community Healthcare
Integration: A Coalition’s Role
Rita Chamberlain, MBA
Associate Director, Manatee County
(FL) Substance Abuse Coalition
Rationale
•
•
•
•
•
•
The Affordable Care Act is an opportunity to make prevention services a
national priority
There are numerous opportunities to expand and integrate prevention with
the services of other healthcare providers
People want more than treatment for illnesses, they want to be kept healthy
Prevention has a major role to play in promoting and preserving wellness
ACA requires insurance companies to cover preventive care
Coalitions are the voice for prevention in communities
Source: The Power of Prevention, Healthcare Reform: The role for substance abuse prevention,
by Terese Voge and Kerrilyn Scott-Nakai, Community Prevention Initiative, 2011.
ACA’S DEFINITION OF
PREVENTION
• Reduction of obesity through physical
activity and improved nutrition
• Addressing smoking and other tobacco
use with prevention and cessation
programs
• Prevention of HIV
• Increasing mental health and
substance abuse prevention services
that promote wellness and reduce risk
for serious emotional problems
Source: The Power of Prevention, Healthcare Reform: The role for substance abuse prevention, by Terese
Voge and Kerrilyn Scott-Nakai, Community Prevention Initiative, 2011.
From CADCA’s Coalitions and
Community Health: Integration of
Behavioral Health and Primary Care
“Together, coalitions and community
stakeholders can address integration
comprehensively and ensure that the
community experiences measurable and
meaningful improvements in populationlevel outcomes as a result.”
Keep in mind
the social geography
of the issue !
How To Work Together – Coalition Thinking
Vertical integration
• The role of the convener
• Adaptive vs. Technical problem
• Solutions for complex problems &
Theory U
Coalition as Catalyst:
Adaptive Approach
• Loose connections
• Mapping (linking)
• Passion
• Emotional intelligence
• Trust in process
• Inspiration
• Tolerance of ambiguity
• Hands off approach
• Receding
• Backing away as work advances
And--pointing at the “pole star”
A new group
wants to jump to
solutions
But a wise convener
leads them through the U
To a realistic
shared solution
C. Otto Scharmer (2007); Theory U
Thanks to Gary Oftedahl for the Theory U diagram
Five Specific Roles Coalitions Can Play
1. Promote Collaboration
2. Educate About Integration
3. Engage in Outreach and Enrollment
Activities
4. Support Integrated Care Service
Development and Delivery
5. Support Integrated Care Workforce
Development
SunCoast Regional Plan for
Coalitions*
1.
2.
3.
4.
5.
*Developed
Promote Collaboration
•
Coalition and Provider Survey
•
SAFE Rx Initiative
•
Engage Treatment Providers
Educate about Integration
•
Regional Presentation on ACA and Integration
•
Engage Treatment Providers
Engage in Outreach and enrollment opportunities
•
Tie into surveys being conducted in our community
•
Have info pages at office or in displays and community health fairs
Support Integrated Care Services Development and Delivery
•
Speakers bureau based on survey for providers to help lay the ground work
Support Integrated Care Workforce Development
•
Provider Survey and Speakers Bureau in regards to education and training
by Chrissie Parris, Coalition Coordinator, Alliance for Substance Abuse Prevention - ASAP of Pasco County &
Lisa Jones, Central Florida Behavioral Health Network, Inc. Prevention Program Manager
Need More Information?
Resource Links:
CADCA
http://www.cadca.org/
Coalitions and Community Health
http://www.integration.samhsa.gov/
Power of Prevention
http://www.carsrp.org/publications/PowerOfPrevention/POP_0102.pdf
Thank You!
Rita Chamberlain, MBA
Manatee County Substance Abuse Coalition
(MCSAC)
Associate Director/CFO
Email: [email protected]
Phone: 941-748-4501 X 3477
www.drugfreemanatee.org
Behavioral Health Integration
to Primary Care
Kay Doughty, MA, CAP, CPP
VP, Family and Community
Services
Operation PAR, Inc.
Phillip J. "P.J." Brooks, LMHC
Vice President, Outpatient and
Youth Services
First Step of Sarasota, Inc.
What’s in it for me?
• Why integrate?
– Parity
– Affordable Care Act
Our world is changing
• Making change
– Understanding what you can control
• Funding
– Consider repurposing funds.
Our History
• Small Steps
• SAMSHA grant working with FQHC’s
• Circumstances
• Collaboration
Rate of Fetal Substance Exposure
Rate of Diagnosis of Selected Fetal Substance Exposure
per 1,000 Live Births, 2005-2011
10
9.4
Fetus affected by narcotics (760.72)
Neonatal Abstinence Syndrome (779.5)
Either Diagnosis
8
7.8
6
4
2
0
2.0
1.7
1.1
0.7
2005
2006
2007
2008
2009
Source: Hal Johnson, MPH, Florida Department of Children and Families.
2010
2011
THE PROBLEM
What can be done in Pinellas
County to intervene with mothers
who have delivered (or will
deliver) an NAS infant?
CONCEPT
• A program designed to
engage pregnant or post
partum prescription using
mother into services with a
Behavioral Health
Consultant with the
ultimate goal of engaging
the mother in substance
abuse services and the
completion of in-home
parenting classes
WHAT WAS DONE?
• Introduce concept to Substance Exposed
Newborn workgroup--Collaboration
• Met independently with staff from Neonatal
Intensive Care Units (NICU’s) to introduce
concept with how to’s (our expectations of
Behavioral Health Consultants) and
– 1. Elicit their willingness
– 2. Brainstorm actual practice and identify
barriers, needed actions, and next steps.
Care
Coordination
WHAT WAS DONE?
– 3. Determine key individuals whose approval
needed. Collaboration
• Internal planning to complete follow-up
connections, forms, etc.
• Next meeting with hospital staff to review
actions to date; same process
Collaboration
• Set start date and pilot
WHAT WAS DONE?
• Continual meetings with key players to assess
implementation and remove barriers identified.
Collaboration/Care Coordination/System
Orientation/Cultural Competence/ Practice Based
Learning
• Quarterly meetings with hospitals ****
• Expand reach to High Risk Pregnancy center
and Methadone Treatment Programs.
• Report out to SEN committee
Motivating New Moms
• Consultants receive referrals
from Hospitals, High Risk
Pregnancy Centers, Child
Welfare, and Substance Abuse
Treatment Facilities.
Screening/Assessment
• Consultants begin engaging
mother with in home/hospital
visits using the Nurturing
Parenting Curriculum and
providing referrals to community
based programs to help support
the mother Intervention
Collaborative Expansions
• LAUNCH grant opportunity
– Implementation of Parenting Prevention
Services integrated into Community Health
Center services (Planned Expansion)
– Implementation of S-BIRT services at
Community Health Center (in process)
Help Primary Care with their “Problem”
• Help them see what they don’t know about their
“problem” patients
• Primary care is just as concerned and confused about
the impact of the Affordable Care Act
• Find an “in” through a secondary partner i.e. Healthy
Start, Child Welfare, etc.
• Offer Staff training on Motivational Interviewing, SBIRT,
etc.
• Synchronize our target populations
• Learn how to approach primary care practices from
Pharmaceutical/Medical supply industry
• Sell your Managing Entity on Integrated Intervention
Contact Information
Kay M. Doughty, MA, CAP, CPP
VP, Family and Community
Services
Operation PAR, Inc.
(727) 545-7564 ext. 274
[email protected]
Phillip J. "P.J." Brooks, LMHC
Vice President, Outpatient and
Youth Services
First Step of Sarasota, Inc.
941-552-2078 ext. 1303
[email protected]
94
Resource
• The SAMHSA-HRSA Center for Integrated Health Solutions
(CIHS) promotes the development of integrated primary and
behavioral health services to better address the needs of
individuals with mental health and substance use conditions,
whether seen in specialty behavioral health or primary care
provider settings.
• The Center provides training and technical assistance to 100
community behavioral health organizations as well as to
community health centers and other primary care and behavioral
health organizations.
• http://www.integration.samhsa.gov/about-us
•
•
•
•
•
•
•
•
Social Workers
Addiction Treatment
Professionals
Psychiatrists
Peer Specialists
Case Managers
Behavioral Health Consultants
Frontline staff
P.S. Primary Care Clinicians
Questions/Group
Activity/Discussion