Integration of Behavioral and Primary Health Care

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Alban Everett Jennings
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1 Integratin f Behaviral and Primary Health Care Integratin f Behaviral and Primary Health Care (ppt) Integratin f Behaviral and Primary Health Care Diana Knaebe, President/CEO, Heritage Behaviral Health Center Rhnda Mitchell, Interim CEO Cmmunity Health Imprvement Center (CHIC), Decatur, Illinis dknaebe@heritagenet.rg, rmitchell@chealthctr.rg, Wh we are... Heritage Est. March 1956 Funding SAMHSA Fee fr Service State & Lcal Grants SMI and SA Patient Base Medicaid Uninsured / Lw incme CHIC Est. April 1972 FQHC Federal grant Enhanced Reimb FTCA cverage Primary Health Care Patient Base Medicaid Uninsured/Underinsured Previus Cllabrative Effrts United Way Funded Cllabratin Primary Care at OASIS Basic health care services at hmeless shelter Psychiatry services at CHIC Medicatin management

March 1956 Funding SAMHSA Fee fr Service State & Lcal Grants SMI and SA Patient Base Medicaid Uninsured / Lw incme CHIC Est.

2 Supprt and cnsult fr primary care prviders Mental Health Bd Funded Prject Referral services at CHIC by Heritage BH Specialist fr entry int Heritage services Nte: Diagram f Rethinking the Frmat f Visins is cntained in the attached PwerPint The SAMHSA Prject Heritage Behaviral Health Center received a SAMHSA Grant in September 2010 fr its Primary and Behaviral Health Care Integratin (PBHCI) prgram. SAMHSA Prgram Gals Health and Illness Backgrund Infrmatin Used bth as a screening and as a means f dcumenting diagnses (PH and BH) as well as imprtant medical/health histry variables SF-36 (shrt frm) Persn Centered Healthcare Hme Fidelity Scales and Prtcls Accmplishments Develped by ur evaluatr, TriWest Based n the cnceptual wrk f Barbara Mauer and cllabratrs 2-day cllabrative assessment prcess Established a Health & Wellness Suite, including a Primary Care Office at Heritage Cntracted with CHIC Primary Care Clinic t place a Primary Care Physician's Assistant n site - this is prving invaluable Relatinship with team members Labs Drawn n Site - picked up = results available t Nurse Care Managers nline quickly Already seeing many psitive health utcmes Weight Lss; Bld Sugar Stabilizatin; Bld Pressure Imprvement Health and Wellness Activities Fd Pyramid Educatin weekly Healthy Cking Classes weekly Chair Zumba twice per week Mdified Yga weekly Daily Walking Activity Healthy Fd Shpping As Needed 1:1 Fd Cunseling and Review f Fd Tracker as needed Weekly Off Site Exercise

3 Health and Wellness Objectives Our pprtunity t prvide Hlistic Care Extending Wellness Mdel thrughut rganizatin Decrease smking - clients and staff Prvide fully certified smking cessatin classes internally with clients cnnectins with staff Health Educatin, i.e., diabetes educatin, nutritin, and exercise Have peer supprt/mentrs as part f the prgram Challenges Electrnic Health Recrd Training time Reduced prductivity Separate recrds / duplicatin f data Cultural / Organizatinal Larger Issues Cmmunicatin bstacles between prgram staff - Time cnsuming and labrius Supervisin / Directin fr Primary Care Prvider Streamlining prcesses in different rganizatinal systems Different funding streams Internal "Marketing" Clients and Staff Adding in number f hurs frm Primary Care PA Prductivity still nt up t expectatins Time required t get CIS apprved with HRSA and Medicare / Medicaid enrllments fr new site Sustainability challenges with lw prductivity vlume - grant imperative fr start up Unreimbursed csts - time required fr administrative and supprt staff Lessns learned.. What wrked well? Existing partnership - tp dwn driven Shared patient base Advantage f having mst f BH services in ne site and then integrating Primary Care int that site and wrking as a team Tk time t hire the "right" staff Having psitive client utcmes - part f RAND "drill dwn" fr successes What wuld we d differently?

time Reduced prductivity Separate recrds / duplicatin f data Cultural / Organizatinal Larger Issues Cmmunicatin bstacles between prgram staff - Time cnsuming and labrius Supervisin / Directin fr

4 Leader wh was n staff every day (althugh current leader an excellent chice she wishes she was arund mre fr the staff) Cnduct all-staff infrmatinal meetings and annual updates Develp imprved prcesses fr patient reminders Health Hmes / Behaviral Health Hmes Timing is gd The Illinis Innvatins Prject has asked fr health hmes Establishment f Managed Care and Case Crdinatin Entities Affrdable Care Act - Healthcare Refrm We are seeing sme early psitive clinical utcmes - indicatrs thrugh ur SAMHSA prject Weight lss - + BMI change Bld Sugar Stability Bld Pressure - hypertensin rates much imprved Nte: Diagram f Heritage Behaviral Health Center's Persn-Centered Healthcare Neighbrhd is illustrated in the attached Pwer Pint Number Served Number f Cnsumers Served - FFY12 Annual Gal Number Served Heritage % 64 PBHCI Prgrams Natinwide 22,727 21,532 94% Nte:Nw up t 345 enrlled clients Nights f Care Out f Hme % Received Nights/Times in Truble! Baseline (n=65) 12 Mnths (n= 65) (past 30 days) % Any Mean Ttal nights % Any Mean Ttal nights Nights Hmeless 9.1% % 0,89 58 Nights in Hspital (fr M.H.) 13.6% % Nights in Detx 4.8% % Nights in Jail 0.0% % ER Visits 12.1% % Ttal Nights* 27.3% % *t(17)=2.84, p=.011 Nte: Diagram f Baseline vs. 12 Mnths: Ttal Number f Nights Hmeless, In Psychiatric Hspital, In Jail, In Detx, and in the Emergency Rm in 30 Days prir t assessment (N-=65) is in the attached PwerPint

- Healthcare Refrm We are seeing sme early psitive clinical utcmes - indicatrs thrugh ur SAMHSA prject Weight lss - + BMI change Bld Sugar Stability Bld Pressure - hypertensin rates much imprved Nte:

5 Current Challenges.. We are appraching smking cessatin much mre aggressively. Each visit we will be asking if the client wuld like help with cutting dwn r smking cessatin. Sme are beginning t tell the team they want t decrease r have set a stp date Experiencing sme staff turnver.

California DSRIP 2.0 Recommendations for Domain 4: Prevention

California DSRIP 2.0 Recommendations for Domain 4: Prevention Califrnia DSRIP 2.0 Recmmendatins fr Dmain 4: Preventin 1. Brad Recmmendatins a. Leverage the State f Califrnia s recent effrts related t preventin Frm the Let s Get Healthy Califrnia Reprt and the wrk