Mental Health Integration Program (MHIP) 3/2/12. Integrated Mental Health Care: closing the gap between what we know and what we do.

Transcription

1 Integrated Mental Health Care: closing the gap between what we know and what we do. Jürgen Unützer, MD, MPH, MA Professor & Vice-Chair Psychiatry and Behavioral Sciences University of Washington Join the Webinar To join the audio portion of this training, please dial Password at prompt: # This webinar will be recorded To minimize disruption, all attendee phone lines will be muted. 1 of 15

2 University of Washington Building on 25 years of Research and Practice in Integrated Mental Health Care Principles of Effective Integrated Behavioral Health Care Patient Centered Team Care Effective collaboration between PCPs and Behavioral Health Providers. Population-Based Care Behavioral health patients tracked in a registry: no one falls through the cracks. Measurement-Based Treatment to Target Measurable treatment goals and outcomes defined and tracked for each patient. Treatments are actively changed until the clinical goals are achieved. Evidence-Based Care Treatments used are evidence-based. Accountable Care The delivery system is accountable and reimbursed for quality of care, clinical outcomes, and patient satisfaction, not just the volume of care provided. 2 of 15

3 From Research to Practice: implementing effective integrated care programs The Mental Health Integration Program Betsy Jones, MSW, MBA Director of Product Development Community Health Plan of Washington Mental Health Integration Program (MHIP) Betsy Jones, MBA MSW Director of Product Development Community Health Plan of Washington March 2, of 15

4 Background Managed medical care pilot started in 2004 in King and Pierce Counties (urban Seattle/Tacoma), serving unemployed adults with short term disability due to mental health / substance abuse problems (Disability Lifeline/DL Program). CHPW worked successfully with the legislature to add an integrated mental health benefit for DL in Program named MHIP (Mental Health Integration Program). Expanded to additional populations in King County in 2008 with county based levy funding: at risk moms, kids, uninsured veterans and older adults. Expanded DL program statewide Nov A real world example: Mental Health Integration Program (MHIP) MHIP is an example of a mature integrated care program Funded by State of Washington and Public Health Seattle & King County (PHSKC) Administered by Community Health Plan of Washington and PHSKC in partnership with the UW AIMS Center Initiated in 2007 in King & Pierce Counties & expanded to over 100 CHCs and 30 CMHCs state wide in ~ 25,000 clients served. nw.org 4 of 15

5 Mental Health Integration Program (MHIP) 17,500 clients served across Washington State More than 25,000 patients served in over 100 Community Health Centers in WA. Mental Health Integration Program (MHIP) Description A stepped care treatment program that emphasizes integrated and evidence based services provided mostly in the primary care clinic, that includes specialty MH services when indicated 5 of 15

6 Principles of Effective Integrated Behavioral Health Care Patient Centered Team Care Team members collaborate effectively. Population Based Care Patients are tracked in a registry: no one falls through the cracks. Measurement Based Treatment to Target Treatments are actively changed until the clinical goals are achieved. Evidence Based Care Treatments used are evidence based. Accountable Care Providers are accountable and reimbursed for quality care and outcomes. What s Unique About the Program: Integrated/embedded MH care coordinator Caseload management (using MHITS) Psychiatric consultation Emphasis on evidence based practices Use of screening and tracking tools Use of Quality Aims/pay for performance 6 of 15

7 Collaborative Team Approach PCP New Roles Core Program Patient BH Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Optional Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources Challenges Support for serving a high risk population in managed care Stable funding Serving a high needs, disenfranchised population Consistent application of evidence based practices Provider engagement Development and maintenance of an adequate workforce Assuring outcomes (Triple Aim) 7 of 15

8 Support for Managed Care Stakeholder roundtable meetings began in 2007 and have been a key part of the success of the program CHPW has engaged a wide range of community partners in all aspects of program development and implementation, and as a result have a huge degree of ownership in the program We hold quarterly regional meetings all across the state to keep stakeholders informed and engaged This approach has enabled us to work very closely with advocates and other community partners and has been invaluable as we have fought to keep the DL program alive during legislative sessions 15 Stable Funding The DL program has been maintained by the legislature for the next biennium thanks to strong joint advocacy efforts. DL is now a Medicaid waiver program (was paid for by state general funds previously). CHPW will use the MHIP model to serve blind and disabled (SSI) enrollees beginning in July of 2012 under contract with the state of Washington. Dual eligibles (Medicare and Medicaid) may be enrolled in managed care beginning in January of 15

9 Serving a High Needs Population Washington State Senate Ways and Means January 31, of 15

10 Clinical Diagnoses Diagnoses % Depression Anxiety (GAD, Panic) Posttraumatic Stress Disorder (PTSD) Alcohol / Substance Abuse 71 % 48 % 17 % 17 %* Bipolar Disorder 15 % Thoughts of Suicide 45% plus acute and chronic medical problems, chronic pain, substance use, prescription narcotic misuse, homelessness, unemployment, poverty,. Consistent Application of Evidence Based Practices 10 of 15

11 Systematic Quality Improvement Team building and implementation support Provider training and ongoing support Weekly caseload based psychiatric review Outcomes based Feedback and QI Pay for performance program (P4P) Initiated in % of payment depends on meeting quality indicators Sample Community Health Center (6 clinics; over 2,000 clients served) Population Mean baseline PHQ 9 depressio n score (0 27) Follow up (%) Mean number of care coordina tor contacts %with psych consultati on % with significant clinical improvemen t Disability Lifeline % 8 69% 43 % Uninsured % 8 59% 50 % Older Adults % 8 55% 43 % Vets & Family High risk Mothers % 7 54% 53% % 7 50 % 60% Data from Care Management Tracking System (CMTS); 11 of 15

12 Pay for performance based quality improvement cuts median time to depression treatment response in half. Estimated Cumulative Probablility Weeks Before P4P After P4P In Press, American Journal of Public Health. Workforce Development and Maintenance 12 of 15

13 Workforce Development/Training CHPW funds care coordinators, psychiatric consultation, specialty mental health services, and the client registry (MHITS) CHPW funds training for care coordinators and PCPs 3 unit checklist of web based modules Monthly Peer Support Conference Calls Telephone based clinical supervision trainings Bi monthly Webinar Clinical Trainings Weekly Telephonic Psychiatric Consultation Periodic TA Site Visits/Regional Meetings PCP Training & Support Assuring Outcomes 13 of 15

14 Mental Health Integration Program (MHIP) 3/2/12 Promising Trends in Outcomes Reduced inpatient admissions Smaller increases in inpatient psychiatric costs Lower increases in homelessness in clients receiving services through MHIP Reduced arrest rates in clients receiving MHIP services Demonstrated clinical outcomes Hospital savings of over $11.2 million in initial 14 months of statewide MHIP implementation 14 of 15

15 Questions? 15 of 15