UW Medicine Integrated Mental Health Care. Laura Collins MSW, Darcy Jaffe ARNP Jürgen Unützer, MD, MPH, MA

Transcription

1 UW Medicine Integrated Mental Health Care Laura Collins MSW, Darcy Jaffe ARNP Jürgen Unützer, MD, MPH, MA

2 Why Behavioral Health Care in Primary Care? 1. Access to care: Serve patients where they are 2. Patient-centered care: Treat the whole patient 3. Effectiveness of care: Help patients get better.

3 Primary Care is where the patients are National Comorbidity Survey Replication Provision of Behavioral Health Care: Setting of Service General Medical 56% No Treatment 59% 41% Receiving Care MH Professional 44% Wang P et al., Twelve-Month Use of Mental Health Services in the United States, Arch Gen Psychiatry, 62, June 2005

4 Outpatient visits with MH claims diagnosis at UW Medicine in Patients Visits Ambulatory Care Psychiatry

5 Patient Centered Care Chronic Physical Pain Cancer 10-20% 25-50% Smoking, Obesity, Physical Inactivity Mental Health / Substance Abuse Neurologic Disorders 10-20% 40-70% Heart Disease 10-30% Diabetes 10-30%

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.

7 IMPACT Team Care Model Effective Collaboration Prepared, Pro-active Practice Team Practice Support Informed, Activated Patient

8 IMPACT Doubles Effectiveness of Care for Depression 50 % or greater improvement in depression at 12 months % Usual Care IMPACT 0 Unützer et al., Psych Clin NA Participating Organizations

9 Better Physical Function 41 SF-12 Physical Function Component Summary Score (PCS-12) P<0.01 P< P=0.35 P< Usual Care IMPACT Baseline 3 mos 6 mos 12 mos Callahan et al., JAGS 2005; 53:

10 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

11 Integrated Care Team Building Process Define Scope and Tasks of integrated behavioral health care team. Assess current resources and workflow: team building tool Define team member responsibilities and new collaborative workflows Hire and train staff: onboarding checklist

12 Workflow: Identify Core Tasks Patient identification and diagnosis Engagement in integrated care Evidence Based Treatment Systematic Follow-up/Treatment Adjustment Communication, Care coordination and Referrals Systematic Psychiatric Case Review Program oversight and Quality Improvement

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14 Primary Care Provider PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources

15 Primary Care Provider Oversees all aspects of patient s care Diagnoses common mental disorders Starts & prescribes pharmacotherapy Introduces collaborative care team Makes treatment adjustments in consultation with care manager and team psychiatrist

16 BH Care Manger PCP Core Program Patient BH Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources

17 Staffing: BH Care Manager Who are the Care Managers? Typically MSW, LCSW, RN, MA, PhD or PsyD What makes a good Care Manager? Organization Persistence Creativity and flexibility Willingness to learn Strong patient advocate

18 Behavioral Health Care Manager - I Works closely with PCP Facilitates patient engagement / education Helps manage a caseload of patients in primary care Conducts systematic initial and follow-up assessments. Systematically tracks treatment response Supports medication management by PCPs

19 BHP/Care Manager II Provides brief, evidence-based counseling Reviews challenging patients with the consulting psychiatrist weekly Facilitates referrals to other services (e.g., substance abuse treatment, specialty mental health care and community resources) as needed Prepares client for relapse prevention

20 Consulting Psychiatrist PCP Core Program Patient BH Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources

21 Consulting Psychiatrist Supports care managers and PCPs Provides regular (weekly) and as needed consultation on a caseload of patients followed in primary care Focus on patients who are not improving clinically change or intensification of treatment In person or telemedicine consultation or referral for complex patients Education and training for primary care-based providers

22 Other Behavioral Health Clinicians PCP Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources

23 Incorporate Other Behavioral Health Clinicians Can provide valuable services such as: Comprehensive assessment Evidence-based counseling / psychotherapy Individual or Group Behavioral health interventions focused on health behaviors Chemical dependency counseling / treatment Social work services

24 Silent Partners Administrators CEO, CFO, COO, Clinic Manager Receptionists/Front Desk Staff Medical Director Medical Assistants IT Staff

25 Care Management Tracking System Helps care managers track a population / caseload of patients Structures clinical interactions and follow-up Supports systematic caseload review by consulting psychiatrist Web-based and accessible in ORCA or EpicCare.

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28 Harborview (5 clinics; over 800 patients served) Population Mean baseline PHQ-9 depressio n score (0-27) Follow-up (%) Mean number of contacts % with psych consultation % with significant clinical improvement DL (GA-U) % 8 69% 46 % Uninsured % % 43 % Older Adults % % 46 %

29 UWNC Kent Des Moines* Population (N) Mean baseline PHQ-9 depressio n score (0-27) Follow-up (%) Mean number of contacts % with psych consultation % with significant clinical improvement % % 61% * Program initiated in late Oct, 2010

30 Laura Collins, MSW; Darcy Jaffe, ARNP; Jurgen Unutzer, MD; James D. Ralston