Partnerships in Primary and Behavioral Health Care ACO Survival Integrated Care

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Phillip Harvey
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1 Partnerships in Primary and Behavioral Health Care ACO Survival Integrated Care Ensuring Success for ACOs September Joyce Wale LCSW Vice President, Institute for Behavioral Healthcare Improvement

ACOs September 22 23 Joyce Wale LCSW Vice

2 Pursuing the Triple Aim through ACO s ACO s: A healthcare delivery and payment system that ties together provider reimbursement through incentives, and quality metrics, connected to a specific patient population. 2

together provider reimbursement through incentives,

3 The Model Differs Based on Partnership Structure Health Plan Developed ACO Jointly Developed ACO between Health Plan and Employer, Health plan and physician group, insurers, hospital system etc. Outcomes are all about the same 3

Plan and Employer, Health plan and physician group,

4 An ACO should support Patient-centered and coordinated care A high preforming network of providers Transparency Health information technology Patient Engagement Outcomes-oriented measurement 4

5 Evidence of the Need for Mental Health Care Overwhelming evidence that treatment works National studies: Over 1-year period up to 30% of US adults meet criteria for one or more mental health conditions Mental health conditions are 2-3 times more common in patients with chronic diseases (Diabetes, Heart disease, chronic pain, Arthritis) Many problems patients bring to primary care have no recognized medical etiology or course of treatment 5

conditions are 2-3 times more common in patients with chronic diseases (Diabetes, Heart disease, chronic pain,

6 Opportunities for ACO s to Integrate Care Mental and Substance Use disorders are leading causes of disability worldwide, are associated with increased medical care and employer costs and lead to premature mortality Primary care is the de-facto source of care due to stigma and limited access to BH providers Providers can improve efficiency with on-site behavioral health support 6

to premature mortality Primary care is the de-facto source of care due to stigma and limited

7 A high preforming network of providers should use integrated care delivery models Chronic Care Model Patient Centered Medical Home Integrated Co-located care 7

8 Chronic Care Model (CCM) Promotes: Enhanced access and continuity through delivery system design Care planning and management through decision support guidelines, self-management, linkages to community resources, tracking and coordination of care, measurement and performance improvement 8

decision support guidelines, self-management, linkages to community

9 Patient Centered Medical Home Transition from a clinic to a comprehensive service model with focus on o Access o Accountability o Comprehensive Person o Coordination of care Designed to produce higher quality, reduce costs in a team approach 9

Accountability o Comprehensive Person o Coordination of care

10 Integrated Co Location of Care Bringing care to the patient o Within PCMH Team Care Embedded behavioral health (Psychiatrist, NP, Social worker, etc. o Within BH Clinic Internist, Family Practice, NP, PH, etc. 10

health (Psychiatrist, NP, Social worker, etc.

11 Components of Integrated Care Cultural shifts o Mind / Body connection Role of PCP o Diagnostic Assessment o Development of Care Plan o Monitoring and Follow-up Redesigning workflows to allow BH Care Integrated Care o 15 minute scheduling / psychotherapy 11

Care Plan o Monitoring and Follow-up Redesigning workflows to

12 Components continued Care Management: The Glue o Opportunities to integrate o Social work & nursing o Mind / body responsibility o Competence / skills, health & BH o Ongoing screening o Roles change with matching patient need and staff competency 12

responsibility o Competence / skills, health & BH o Ongoing

13 Range of tasks Communications broker / feedback loops Gate keeper for implementation of Care Plan Patient engagement agent Addressing basic and social needs Medication management and compliance Wellness coaching Navigator for the complex system 13

agent Addressing basic and social needs Medication management

14 Patient Centered Consumer Driven Care Using people with lived experience through Peer Support creates hope Peers provide opportunities for improved patient engagement Member satisfaction is enhanced 14

hope Peers provide opportunities for improved

15 Timing Is Everything Transitions of care Readmission (all cause) Screening of members o Who o What o When o Where 15

16 Behavioral Health Providers are taking steps to get involved with ACO s How do you currently operate? Is the delivery system integrated? Do you know your BH providers? Can you tell who does a good job? Do you manage your high utilizers and what % have BH conditions? 16

Is the delivery system integrated? Do you know your BH providers?

17 17

18 Key Points Integrating care is critical Evidence supports it Lot s of opportunities Transforming PCMH & Co-Location of Services Care coordination vital Using data to understand needs Effective integration of behavioral health can save money 18

Services Care coordination vital Using data to understand

Day 1 Follow-Up: Panelist Suggestions and Final Topic Ranking. IHS Advisory Panel Meeting April 20, 2013 (Day 2) Chad Boult, MD, MPH, MBA Director

Day 1 Follow-Up: Panelist Suggestions and Final Topic Ranking IHS Advisory Panel Meeting April 20, 2013 (Day 2) Chad Boult, MD, MPH, MBA Director 1 Suggestions From Panelists 2 Use One Care Management