The Doctor of Behavioral Health A Model Graduate Education Program Ronald R. O Donnell, Ph.D. Director ronald.odonnell@asu.

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1 A Model Graduate Education Ronald R. O Donnell, Ph.D. Director ronald.odonnell@asu.edu

2 best doctor gives the least medicines. ~Benjamin Franklin doctor the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition. ~Thomas Edison One quarter Medicare beneficiaries have five or more chronic conditions, sees an average 13 physicians each year, and fills 50 prescriptions per year. ~Clayton M. Christensen, Innovator s Prescription: A Disruptive Solution for Care

3 Arizona State University An upgrade for master s level clinicians Online/Distance learning Clinical and Management tracks Primary care internship program Replaces dissertation w/culminating project 3 Faculty practice topics they teach

4 Drivers for the DBH

5 Economic Burden Chronic and Medical Illness 10% use 65%

6 Medical + Chronic Illness with Co-morbid Medical Chronic Conditions 2x Cost Compared to Medical Only

7 Employers View Lost productivity +Absenteeism +Presenteeism + Disability = 3X cost medical claims

8 Somatizers or Medically Unexplained Symptoms 6 14X Cost High impairment Underlying stress and behavioral problems overlooked Treated for medical disease with unnecessary lab tests and consultations 90% refuse referral to behavioral care 81% accept behavioral treatment in primary care

9 Undetected Untreated Unresponsive Inadequate Treatment in Primary Care

10 Limitations the PCP as Disease Manager Lack Time and Training Medication as first (and ten only) line treatment Reimbursement Model

11 Workforce Challenge and the (DBH) Graduate Degree

12 Problem Chronic illness : poor outcomes/high costs Inadequate treatment in primary care + Medical conditions: high co-morbidities Worse clinical outcomes Higher utilization & cost workforce not trained in integrated care Medical workforce not trained in behavioral health Medical cost-fset opportunities ignored

13 Solution: Integrated Care Medical Literacy Consulting with Medical Team Disease Management Medicine Staff Education Stepped Care Brief, EFFICIENT Interventions Group Treatment e and m

14 Treat all co-morbidities in primary care Diabetes CHD MetS Medical Depression Anxiety Alcohol abuse Overeating Poor nutrition Lack physical activity Lifestyle 14

15 Why DBH? al level new standard in healthcare Ph.D. and Psy.D. tuition expensive, curriculum lengthy, curriculum not relevant to healthcare market demand Glut masters level psychotherapists Decreased patient use psychotherapy combined with increased Rx Opportunities for integrated behavioral care efficiencies and cost-savings in healthcare reform $$$ is in medical healthcare system, not specialty mental health or substance abuse treatment

16 Why DBH? 100% Online Rolling enrollment (fall, spring, summer) Optional Residency Conferences Flexible course curriculum eliminates courses irrelevant to practicing clinicians and adds courses essential to meet the demands healthcare reform Upgrade master s level to in integrated care settings Disruptive Innovation

17 Applications and admissions Fall Fall Fall Spring Summer Fall Spring Summer Fall Applied to program Number fered admission Head count

18 student demographics-spring 2013 Spring 2013 American Indian % Asian % Pacific Islander % % Ethnicity African American % Hispanic % White % Unknown % TOTAL STUDENTS % % Female % % Minority % % International %

19 DBH Faculty 6 Core Full-time 20+ part-time Faculty Associates 5 National expert faculty OPENMINDS consultant faculty for management track

20 DBH Curriculum Clinical or Management Track 84 Credit hours 30 credits from masters degree 54 credits to complete DBH 18 Courses 9 core courses 6 elective courses 2 internship courses (6 credit hours) Culminating project course (3 credit hours) One 3 credit class, 7.5 week session requires: Average hours per week Lecture, homework, web, etc.

21 Curriculum - Overview Medical Literacy Pathophysiology (Clinical Track) Medical consultation Efficient primary care treatment Population health management Brief, focused interventions Business Entrepreneurship care reform, finance Business start-up care Management (Management Track)

22 Clinical Track Core Courses IBC Clinical Pathophysiology IBC Psychopharmacology for the Care Provider Clinical Neuropathophysiology IBC Individual Differences, Psychopathology and Personality (Also known as Evidence Based Interventions 1) IBC Evidence-based Assessment and Interventions II: Medical, Comorbid, and Specialty Conditions IBC Population-based Management IBC Research Design in Care: Quality and Performance Measurement, Improvement and Incentives IBC care Systems: Organization, Delivery, and Economics IBC Business Entrepreneur IBC 680 Internship IBC Culminating Project

23 Clinical Track Elective Courses IBC 590 Pressional Writing Skills IBC care Statistics IBC and Psychological Assessment in Primary Care IBC 613 Cognitive and Affective Aspects IBC 624 Integrated for Children and Adolescents IBC Behavior Change Strategies/Techniques in Primary Care IBC Legal, Ethical and Pressional Issues in Care IBC Evidence-based Interventions III: Advanced IBC Cultural Diversity, and Illness IBC 780 Integrated Care for Substance Use Disorders IBC 780 Management IBC 780 Introduction to Interventions IBC 780 Psychosomatic Illness: Diagnosis and Treatment IBC 780 Integrative Medicine

24 National Expert Courses (1 credit) IBC Chronic Pain & Opioid Misuse Jeff Reiter, Ph.D. IBC 780 Online Psychotherapy, Behavior Change, and Telemental Marlene Maheu, Ph.D. IBC 780 Psychosomatic Illness: Diagnosis and Treatment David Clarke, MD IBC 780 Outcomes Informed Treatment Scott D. Miller, Ph.D. OPENMINDS (Monica Oss): Consultants build & teach DBH Management track courses

25 Management Core Courses IBC Introduction to Interventions IBC Population-based Management IBC Research Design in Care: Quality and Performance Measurement, Improvement and Incentives IBC care Information Management IBC care Systems: Organization, Delivery, and Economics IBC Business Entrepreneur IBC care Management IBC Financial Management in care IBC Cost Savings and Medical Cost Offset IBC Culminating Project IBC Internship MHI care Innovation and the Individual

26 Management Elective Courses IBC Effective Consultation in IBC Contract Negotiation in care IBC Leadership in care HCSD Continuous Quality Improvement: Methods and Techniques MHI Systems Thinking in a Complex Environment MHI Understanding and Applying Principles Evidence-Based Practice MHI Advanced Principles and Concepts Innovation MHI care Policy and Innovation MHI Financing for Innovation MHI Outcomes Evaluation MHI Strategic Management Technology

27 Internship 400 hours in primary care/medical setting 2 days week/8 hours day Weekly case consultation group via webinar Led by Psychologist or DBH Small group 6 students Intern site liaison

28 Internship course requirements Components Objectives Policies Resources Consultation Clinical support Pressional and skill development Peer network Live, synchronous attendance required 5 case presentations Consultant MyDBH dashboard LearningStudio Vidyo meeting room Case presentation guidelines and rubric Internship site Pressional development 400 hours on site 25% direct patient contact descriptions Internship packet Reporting forms Outcomes management & resourcing Outcome-informed care Patient resource support 65% (total patients) administer measures 25% (total patients) resource referrals MyOutcomes Pro-Change Workplace Outcomes Suite Special project Needs assessment Research-informed practice Population-based intervention Develop and lead one group treatment intervention or health management program MyDBH dashboard resources Advisor

29 MyDBH

30

31 ASU DBH Partners: MyOutcomes ProChange Behavior Systems, Inc Scott D. Miller, Ph.D. International Center for Clinical Excellence Telemental Institute Marlene Maheu, Ph.D Chestnut Global Partners

32 Evidence for SUD treatment cost savings what works AND saves $$$ Reducing overuse medical utilization 32

33 SBIRT Cost Savings in the ED Gentilello et. al, (2005) Alcohol Interventions for trauma patients in emergency departments and hospitals, Annals Surgery. 241;4: % ED injuries alcohol-related Net cost $89 per patient screened or $330 for each patient fered intervention Cost savings $3.81 for every $1 spent on screening and intervention If fered nationally potential net savings $1.82 billion annually

34 Kaiser Permanente Outpatient integrated continuing care N = 1,011 Outpatient SUD treatment 12 month pre- and post Post-treatment decreased: 35% inpatient 39% ED 21% medical costs (Parthasarathy et al., 2001) 34

35 Kaiser Permanente Outpatient integrated continuing care Continuing Care: Annual PCP visit Specialty care referral at point PCP visit to SUD or psychiatric treatment N = 991 followed for 9 years SUD receiving all components Continuing Care had lower costs that those receiving fewer components Compared with controls, those not receiving Continuing Care had higher inpatient costs, no difference between CC and controls Parthasarathy et. al. role continuing care in the cost trajectories patients with intakes into an outpatient alcohol and drug treatment program. Med Care (6):

36 Coordinated Care model with high risk medicaid patients - design N = 19, Treatment one year pre- vs 1 yr. post Homeless, psychiatric and medical co-morbidity Identified by algorithm based on 5 year prior claims Coordinated Care Treatment = regular contact with: VNA Methadone programs SA rehabs Outpatient clinics Weekly conference calls (care manager, social work supervisor, housing partner) 36

37 Continuing Care model with high risk medicaid patients - Results Utilization Savings 37.5% decrease in inpatient admits (from 64 pre- to 40 post-treatment) 73.3% patients had fewer inpatient admissions Cost Savings $245,745 =Reduced medical utilization savings $169, 551 = Intervention costs $76,194 = savings Raven et al. An intervention to improve care and reduce costs for high-risk hospital patients with frequent hospital admissions: A pilot study. BMC Services Research :270 37

38 Cost savings for pharmacological treatment sud s Acomprosate, Naltraxone, combined Rx Reviewed 7 studies economic value All pharmacotherapies resulted in net cost savings Cost savings achieved by reduced medical utilization 38

39 Reduced utilization and costs for family members sud patients Identified family members SUD patients based on claims data vs. matched controls Measured patient abstinence at 1 year and healthcare costs for all family members over 5 years Pre-treatment SUD Patient family higher costs, increased psychiatric and medical co-moridities than matched controls For SUD patients abstinent at one year, families had average costs same as controls, and Non-abstinent had higher costs 39

40 DBH Prepares Graduates to: Fit in primary care Demonstrate improved clinical outcomes and cost savings Be entrepreneurs

41 Road Ahead Continued increase in enrollment (domestic and international) Pressional presentations and publications DBH Management Concentration DBH Certificate Training China/International research collaboration and training programs DBH Certificate Training National practicum sites Franchise DBH to other Universities

42 Questions?

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