Integrating Behavioral Health and Primary Care through an Electronic Health Record (EHR) and sharing across organizations OCHIN April 2011

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1 Integrating Behavioral Health and Primary Care through an Electronic Health Record (EHR) and sharing across organizations April 2011 Key learning points and the possible effect a Health Information Exchange (HIE) could have on future outcomes.

2 A Health Center Controlled Network National non-profit collaborative headquartered in Portland, Oregon Provider of integrated HIT software products and services to community health clinics, mental health services and small practices serving the medically underserved 120 living wage jobs

3 Oregon s Health Information Technology Regional Extension Center 2010 won a competitive federal grant to start Oregon s Health Information Technology Extension Center (O-HITEC) Provider of education, outreach, and technical assistance to facilitate successful implementation, and meaningful use of certified electronic health records Nearly 700 individual Oregon providers signed on to date Over a dozen service provider/partner contracts signed Major partnerships with OMA, OPCA, OAFP, ORHQN, etc. /O-HITEC We strive to transform healthcare Improve quality and deliver value through effective use of information technology

4 Benefits of an Integrated Record Improved care coordination Integrated care teams Improved Health Outcomes Individuals diagnosed with serious and persistent mental illness (SPMI) live on average 25 years less than the general population. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis Volume 3: No Apr. Available from: URL: apr/05_0180.htm.

5 Care Coordination Behavioral Health Alcohol & Other Drug E H R Information Exchange Primary Care Patient-Centered Primary Care Homes (PCPCH) Therapist - Therapist Prescriber - Therapist Prescriber - Prescriber

6 Improved Health Outcomes Assessment & Treatment Planning Integrated Care Service Referrals & Care Coordination Medication Management Integrated Billing Prevents Disease Relapse Crisis Provides Inpatient Stays More independent living, improved daily mood, improved functioning

7 Integration + Coordination BH COUNSELOR PCP EHR AOD COUNSELOR Patients discharging from inpatient mental health stays are less likely to be re-hospitalized when integrated BH, AOD & Primary Care were available. BH PRESCRIBER National GAINS Center for People with Co-Occurring Disorders in the Justice System. (2001) Integrated services reduce recidivism among homeless adults with serious mental illness in California. Fact Sheet Series. Delmar, NY: Author.

8 Challenges to Integration Payor Streams & Coverage Disruption CMSP Medicaid & Uninsured Health Plan Structure Mental Health Addictions PEMMCP Delivery System Hospitals Primary Care Clinics Specialists Mental Health Addictions Medical Many layers of policy and regulation county, state, federal surrounding covered services and reimbursement make it difficult to bill for services and result in disjointed financing. Mauer B, Jarvis D. Behavioral Health, the Changing Healthcare Landscape, and California 1115 Waiver Opportunities January 5, 2009 Webinar Questions and Answers. California Institute for Mental Health. Available from: URL:

9 HIEs as Vehicles for Integration BH COUNSELOR PCP Patient AOD COUNSELOR BH PRESCRIBER True integration of care means interoperability of information systems.

10 Clinical Integration

11 Strategic Initiatives Strengthen Network Goals: 1. Strategically Increase Volume 2. Add more capacity & capability 3. Add more software capabilities 4. Add more business services 5. Be conscious of price and value Connecting Communities and Patients Success: 1. Connecting to HIOs 2. Connecting to HIEs 3. Collecting clinical data 4. Engaging Patient through technology Care Management and Population Health Outcomes: 1. Achieve meaningful use 2. Integrated data collection for all services: bio, psycho, socio 3. Research on triple aim and safety net health services 4. Support all strategies to improve the HC delivery system 5. State and Fed Reporting

12 Strategic Initiatives Strengthen Network Objectives: 1. Strategically Increase Volume 2. Add more capacity & capability 3. Add more software capabilities 4. Add more business services 5. Be conscious of price and value Connecting Communities and Patients Objectives: 1. Connecting to HIOs 2. Connecting to HIEs 3. Collecting clinical data 4. Engaging Patient through technology Care Management and Population Health Objectives: 1. Achieve meaningful use 2. Integrated data collection for all services: bio, psycho, socio 3. Research on triple aim and safety net health services 4. Support all strategies to improve the HC delivery system 5. State and Fed Reporting

13 Strategic Initiatives Strengthen Network Tactics: Measures Connecting Communities and Patients Tactics: Measures Care Management and Population Health Tactics: Measures Spread across the country (go East) Spread to private practice (small practices) Additional EHR vendors State specific functionality Group Purchasing Opportunities CareEverywhere EpicLink MyChart Immunization registries NHIN Connections Aggregate data for PCAs Mental Health Behavioral Health Dental Integration Medical Home reporting Meaningful Use reporting Corrections Health

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