Integrating Behavioral Health into Primary Care Innovation Community Webinar #7. June 17, 2015
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1 Integrating Behavioral Health into Primary Care Innovation Community Webinar #7 June 17, 2015
2 Today s Agenda 1. Updates, Reminders 2. Guest Speaker: Andrea Auxier, PhD Director of Integration, National Strategy and Development - Beacon Health Options 3. Resources & Next Steps
3 In May Amanda Christofferson, Bullhook CHC Shared care planning and ice cream Trish Staiger, STEPS at Liberty Center & Every Woman's House Optimistic, new ways of thinking
4 Measuring Integration: The Integrated Practice Assessment Tool (IPAT) Andrea Auxier, PhD Director of Integration National Strategy and Development
5 What is Integration? Who are the people? Dual Eligibles MH/SUD MH/Medical SPMI with co-morbid medical (Health Homes) Primary medical with comorbid mental health (Medical Homes) Primary medical with no comorbid mental health; focus on modifiable health risk behaviors (Medical Homes) What do we do for them? Care Management Care Delivery (pre-coordinated to fully integrated)
6 Care Management vs. Care Delivery Care management includes care coordination, disease management, and case management; goal is to ensure access to appropriate levels of care by a provider or treatment team. Care delivery is care that is provided directly to a person by a provider or treatment team, accompanied by legal responsibility for that person s care. Integrated Care Approach
7 Where Integration Occurs Primary Systems Primary Care Behavioral Health Substance Use* System Level Health Plan Level Additional Systems Substance Use* Specialty Care LTSS Social Service Care Management Level *Can be primary or ancillary Clinical Practice Level Triple Aim Territory
8 Integration in ACOs Study design: mixed-methods (surveys & semi-structured interviews); n=257 Findings: 84% had at least one contract, covering both commercial and public payers, specifying responsibility for behavioral health care within the total cost of care. <15 % had full or nearly full integration of primary and behavioral health care. 43% had some integration. 43% had little or no integration. ACOs that offered comprehensive chronic care management, as well as those that included at least one participating FQHC, were more likely to have integrated care. Factors associated with higher rates of integration: prevalence of BH issues in the patient population; a low number of BH providers in the surrounding area; payfor-performance contracts that used quality measures related to BH; and inclusion of behavioral health costs in the ACO contract. Lewis et al. Few ACOs Pursue Innovative Models That Integrate Care for Mental Illness and Substance Abuse with Primary Care. Health Affairs, October, 2014.
9 The Problem with Integration
10 A Standard Framework Integrated Health Care Coordinated Care Co-Located Care Integrated Care Minimal Collaboration Basic Collaboration from a Distance Basic Collaboration Onsite Close Collaboration with Some System Integration Close Collaboration Approaching an Integrated Practice Full Collaboration in a Transformed /Merged Practice Heath B, Wise Romero P, and Reynolds K. A Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013.
11 Assessing Integration Pre-coordinated Coordinated Co-Located Integrated P2P communication about shared patients across agencies; some protocols and technology for sharing information exist and are routinely followed. Medical and behavioral health care are provided in different settings, with little, if any, communication between providers regarding shared patients; limited, if any, protocols for sharing information; information technology to support registries or patient information exchange do not exist or are not utilized. We added a level Behavioral and medical providers delivering services in the same physical facility; medical and behavioral care remain mostly divided; documentation of services often occurs in separate records; few-if any standard protocols for integrated service delivery exist. Behavioral and medical providers practicing in a team-based fashion with attention to psychiatric conditions as well as health and behavior change, using real-time interventions, screening protocols, shared documentation, and open access to records.
12 The Integrated Practice Assessment Tool Waxmonsky J, Auxier A, Heath B, Wise Romero P (2014)
13 IPAT Development IPAT is a descriptive, qualitative instrument intended to categorize practices along the integration continuum. Focuses on qualitative change; the elements that comprise a high degree of integration are difficult to tease apart and do not occur separately in the real world setting, but are intertwined. Designed to be user friendly, quick to administer, and equally applicable for both medical and behavioral health settings. Practices find that IPAT is a team undertaking to fill out, and serves a conversation starter for integration.
14 IPAT FAQs What is IPAT? IPAT is a questionnaire used to determine how integrated a clinical practice is. It builds of the SAMHSA-HRSA standard framework for Levels of Integrated Healthcare. How does IPAT work? IPAT asks a series of yes/no questions using a decision-tree model to arrive at the practice s current level. Do I have to provide PHI? No. IPAT does not inquire about patient-level information. Do I have to pay to use IPAT? No. IPAT is in the public domain and is provided free of charge. How will my NPI number be used? The electronic version is linked to the NPI database, strictly for demographic analytic purposes. Will IPAT work only in primary care settings? No. IPAT can be used in behavioral health or medical settings. Who should actually complete the IPAT? IPAT can be completed by medical provider, a behavioral health provider, or a practice manager. Ideally, several members of the care team would collaborate on a joint response. What if I have multiple clinics in my setting? Do I complete just one IPAT? No. Because IPAT is intended to assess clinical operations, a different IPAT should be completed for each clinic.
15 IPAT Potential Uses Tailor product solutions to client need Assess network readiness for integration Establish baseline and monitor performance over time Conduct comparative analysis Assess the association between integration and selected clinical, cost, or utilization outcomes Establish thresholds for differential payment structures
16 How Integrated am I? A part-time social worker in a primary care clinic receives warm-handoffs and provides treatment for mental illness A mental health center hires a psychiatric nurse practitioner A psychiatrist provides P2P consultation to a PCP via televideo A psychiatrist meets with a patient via televideo Psychologists work alongside primary care practitioners, but notes are kept separately and not shared A behavioral health care manager is co-located with a health plan care manager
17 Questions?
18 Resources IPAT Online Integrated Care Models From the Field EHR s: Resource Guide for HIT, EHR Incentive Programs, EHR Contracts, etc.
19 Next Steps July 22, 3-4pm EDT Webinar #8 Squirrel Hill Health Center, IPAT Aug 19, 3-4pm EDT Final webinar IPAT results, summary learnings
20 Slides for today s webinar are available on the CIHS website at: under About Us/Innovation Communities
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