Transcript MHCA Integrated Health Learning Community Introductory Session

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Maryland Addiction Director’s Council:
Integrated Behavioral Health and
Primary Care Learning Community
Technical Assistance Session
Presented by:
Joan Kenerson King RN, MSN, CS
Kathleen Reynolds, LMSW
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Today’s Call
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Project Overview: purpose and rationale
What is a learning community
Project timeline
Questions????
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Why this project?
• Standing on the threshold or crossing over into
transformational change in health care
• Build on the strengths of individual providers (SUD,
MH and primary care) by creating a context for
partnership development or expansion
• Addressing the current context:
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The Affordable Care Act: Four Key Strategies
U.S. health care reform, with or without federal
legislation, is moving forward to address key issues
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Medicaid Expansion: 2014
Expanded Eligibility for
Children and Parents
• 133% Federal Poverty Level
• April 1, 2010 State Plan Option
Expanded Eligibility for
Childless Adults
• 133% Federal Poverty Level
• April 1, 2010 State Plan Option
Benchmark Coverage for
Newly Eligible Childless Adults
Increased Federal Share and
PCP Payments
Maintenance of Eligibility
Coverage for Former Foster
Care Children
•Based on Deficit Reduction Act benchmark coverage
•Limited array of services available
• FMAP = 100-90% in years 2014-2020+
• 100% of Medicare Reimbursement
• Eligibility standards maintained until Exchanges open.
• Compliance tied to receipt of federal matching funds.
• Does not prevent states from expanding coverage.
• States may extend coverage, including EPSDT, to former
foster children until age 26
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Healthcare Models of the Future
• Coverage expansions are ONLY
sustainable with delivery system
reform
– Collaborative Care
– Patient Centered Healthcare
Homes
– Accountable Care Organizations
• Accountability and quality improvement are hallmarks
of the new healthcare ecosystem
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Primary Care and Behavioral Health
• Most PCPs do a good job of diagnosing and beginning
treatment for depression (Annals of Internal Medicine, 9/07)
• 1,131 patients in 45 primary care practices across 13
states
• PCPs did less well following up with treatment over
time—less than half of patients completed a minimal
course of medications or psychotherapy
• Lowest quality of care occurred among those with the
most serious symptoms, including those with evidence of
suicide or substance use
• “Right now PCPs don’t have the tools necessary to
decide which patients to treat and which to refer on to
specialized MH care”
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Morbidity and Mortality in People
with Serious Mental Illness
• Persons with serious mental illness (SMI) are dying 25
years earlier than the general population
• While suicide and injury account for about 30-40% of
excess mortality, 60% of premature deaths in persons
with schizophrenia are due to medical conditions such as
cardiovascular, pulmonary and infectious diseases
• People with co-occurring SUD die at age 45
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Co-morbidity and Substance Abuse
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Inhalant use among 12‐17 year olds and depression are increasing;
Patients in chemical dependency programs are 18 times more likely to
have major psychosis, 15 times more likely to have depression and 9
times more likely to have an anxiety disorder;
Substance use increases the risk for hypertension (x2) , congestive
heart failure (x9) and pneumonia (x12);
HIV patients with a substance use disorder are more likely to be
non‐adherent;
Medicaid patients with a substance use disorder are more likely to be
readmitted to a hospital within 30 days;
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Co-morbidity and Substance Abuse
• Substance use creates increased rates of complications with hip
replacements;
• Patients treated with medication for alcoholism had fewer
detoxification, alcohol related inpatient days and emergency
room visits;
• High cost Medicaid recipients with HIV had an average annual
cost of $157,000; including 40% costs more for treatment
comorbidities with MH/SA disorders as the most common
comorbidity;
• Treating patients with substance abuse related medical
disorders in an integrated setting can achieve cost savings
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Co-morbidity and Substance Abuse
• Almost 25% of general healthcare patients report
they have a co-morbid substance use conditions
likely related to the physical sequelae that result from
untreated substance misuse and dependency (NSDUH, 2005)
• Substance use conditions often complicate
management and treatment of other chronic diseases
in primary care such as diabetes, hypertension,
asthma and others (PRISM, 2008)
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Co-morbidity and Substance Abuse
• More than 1.7 million visits to hospital EDs are
related to some form of substance misuse or
dependency (DAWN, 2006)
• Drug and alcohol disorders are associated with about
3% of hospital stays and $12 billion in costs. (HCUP,
2006, 2007)
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New Paradigm – Primary Care in
Behavioral Health Organizations
Funding starting to
open up for
embedding primary
medical care into
CBHOs, a critical
component of
meeting the needs of
adults with serious
mental illness
Clinical Design for Adults with Low
to Moderate and Youth with Low to
High BH Risk and Complexity
Food
CBHO
Mart
Clinical Design for Adults with
Moderate to High BH Risk and
Complexity
Food
CBHO
Mart
Primary Care
Clinic with
Behavioral
Health
Clinicians
embedded,
providing
assessment,
PCP
consultation,
care
management
and direct
service
Partnership/
Linkage with
Specialty CBHO
for persons who
need their care
stepped up to
address
increased risk
and complexity
with ability to
step back to
Primary Care
Community Behavioral Healthcare
Organization with an embedded
Primary Care Medical Clinic with
ability to address the full range of
primary healthcare needs of
persons with moderate to high
behavioral health risk and
complexity
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Addressing the need: MADC learning
community
Primary Goal: to increase the adoption of bi-directional
integration for the treatment of individuals with
substance use disorders in primary care, substances
use treatment and community mental health
programs as a means to encourage their sustained
recovery and improved health across safety net
settings.
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Addressing the need: MADC learning
community
Secondary Goals:
•Create sustainable local community teams consisting
of community health centers, specialty substance use
treatment settings and community mental health
treatment programs.
•Improve communication, collaboration and coordination
among the teams and the organizations they represent.
•Improve selected local community’s capacity to provide
bi-directional integration
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What is a Learning Community?
• Collection of like-minded organizations and/or
individuals with a common mission related to a
common topic
• The expertise is generally available within the group
• Expert facilitators organize and manage the meeting
and bring needed expertise if it is not available in the
group
• Active involvement of all parties – need people at all
levels of implementation
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Benefits to Learning Community
Participation
• Reduce the amount of time it takes to bring research
into practice
• Learn from others in areas of need
• Teach others from your successes
• Consistent support and coaching from facilitators
• Webinars on topics critical to development
• Access to the National Council’s National Integrated
Health Resource Center
• List serve
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Next Steps:
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Applications from teams of three due January 7, 2013
Notification will be made by January 28, 2013
Total team cost for participation: $1800
One day kick off Feb. 5, 2013 (face to face)
MADC conference May 2013
Mid point meeting June 2013 (face to face)
Webinars
Coaching calls
Individual consultation
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Questions? Contact:
Jackie McNamara
[email protected]
443-310-4250