Accelerating Reform InitiativeAccelerating Reform Initiative

Developing Integrated care:Developing Integrated care:Fayette Companies and Fayette Companies and

Heartland Community Health Heartland Community Health CenterCenter

Mike BolyeMike Bolye

Aim: Aim: Increase role in healthcare and Increase role in healthcare and position organization to be the position organization to be the preferred provider for medical preferred provider for medical

referrals for substance use and referrals for substance use and mental health disorders to prepare mental health disorders to prepare

for increased competition when for increased competition when health care reform covers those health care reform covers those

currently uninsured.currently uninsured.

ChangesChanges

Nurse Care Managers and Wellness Nurse Care Managers and Wellness Coaches implementing health promotion Coaches implementing health promotion activities: diet, exercise, smoking activities: diet, exercise, smoking cessationcessation

Specifications for an integrated PC/BH Specifications for an integrated PC/BH web-based patient registry developedweb-based patient registry developed

Integrated Health Center provides crisis Integrated Health Center provides crisis BH services and a primary care clinicBH services and a primary care clinic

ResultsResults

Evaluation process for PCBHI and IHC Evaluation process for PCBHI and IHC finalized and approved by IRB; measures finalized and approved by IRB; measures include:include:Medical services received including Medical services received including preventive care and screeningpreventive care and screeningImprovement in physical & BH health Improvement in physical & BH health status: PHQ-9,BP, BMI,SF-36,Cholesteralstatus: PHQ-9,BP, BMI,SF-36,CholesteralReduction in ED utilization and Reduction in ED utilization and arrests/jailing arrests/jailing

Next StepsNext Steps

Develop clinical algorithms for AUDIT Develop clinical algorithms for AUDIT DAST and train staff in implementationDAST and train staff in implementation

Study implementation of computerized SBIStudy implementation of computerized SBI

Implement BH brief individual Tx and Implement BH brief individual Tx and groups at HCHC locationsgroups at HCHC locations

Plan feasibility of HCHC assuming Plan feasibility of HCHC assuming psychiatric services and MAT for psychiatric services and MAT for addictionsaddictions

Accelerating Reform InitiativeAccelerating Reform Initiative

Patient / Family Role AIMPatient / Family Role AIM

David MooreDavid Moore

AIM (Plan)AIM (Plan)GOAL:GOAL:

Increase the participation of families in the treatment Increase the participation of families in the treatment process and engage them in learning how to support process and engage them in learning how to support recovery.recovery.

STRATEGIES:STRATEGIES:

Develop measures for baseline, tracking and process Develop measures for baseline, tracking and process benchmarking.benchmarking.

Assess process and staff barriers to engaging families at Assess process and staff barriers to engaging families at all points in the tx continuum. all points in the tx continuum.

Implement engagement strategies across the continuum Implement engagement strategies across the continuum as well as “three tier” model in primary treatment.as well as “three tier” model in primary treatment.

CHANGE (Do)CHANGE (Do)Measurement for Process BenchmarkingMeasurement for Process Benchmarking

Developed new service documentation to accurately measure and track family Developed new service documentation to accurately measure and track family engagement during tx.engagement during tx.Modified tx plan quality assurance tool to address family engagement and provide Modified tx plan quality assurance tool to address family engagement and provide mechanism for feedback to staff.mechanism for feedback to staff.

Process/Systems and Staff AssessmentProcess/Systems and Staff AssessmentConducted focus groups to identify patient/family and staff barriers as well as “what Conducted focus groups to identify patient/family and staff barriers as well as “what works”.works”.Reviewed barriers with supervisors and identified first steps to resolve.Reviewed barriers with supervisors and identified first steps to resolve.– Additional training needed for staff and supervisors Additional training needed for staff and supervisors – ReleasesReleases– Resistance from patient to involve family Resistance from patient to involve family

Implementing Engagement StrategiesImplementing Engagement StrategiesModified assessment tool to focus on engagement strategies at first appointment – Modified assessment tool to focus on engagement strategies at first appointment – obtaining releases and addressing resistance from patient to involve family.obtaining releases and addressing resistance from patient to involve family.Providing training on “three tier” model of engagement. Providing training on Providing training on “three tier” model of engagement. Providing training on managing family sessions for staff. Have implemented family educational sessions.managing family sessions for staff. Have implemented family educational sessions.Working with staff on tx planning for family engagement.Working with staff on tx planning for family engagement.

RESULTS (Study)RESULTS (Study)

Measurement for Process BenchmarkingMeasurement for Process Benchmarking

Have begun to review individual staff family engagement Have begun to review individual staff family engagement rates – and working to identify particular practices with rates – and working to identify particular practices with high performers versus low performers.high performers versus low performers.

Family Engagement TX PlanningFamily Engagement TX Planning

All staff are receiving regular reports on family All staff are receiving regular reports on family engagement indicators that were added to the tx plan engagement indicators that were added to the tx plan

QA tool.QA tool.

Treatment Planning for Treatment Planning for Family EngagementFamily Engagement

0%

10%

20%

30%

40%

50%

60%

70%

80%

Feb Mar Apr May June

Prob

Review

Obj-Int

NEXT STEPS (Act)NEXT STEPS (Act)

Continue to look at ways to increase Continue to look at ways to increase participation in family educational sessions participation in family educational sessions as well as ways to engage families further as well as ways to engage families further after educational sessions.after educational sessions.

Develop and conduct surveys for familiesDevelop and conduct surveys for families

Plan for increased use of incentivesPlan for increased use of incentives

IMPACT – Lessons LearnedIMPACT – Lessons Learned

Attempts to engaging families must begin Attempts to engaging families must begin at the front door and continue throughout at the front door and continue throughout the tx process.the tx process.

Much of our work has been working Much of our work has been working through patient’s resistance to getting through patient’s resistance to getting family involved.family involved.

We have a long way to go……… We have a long way to go………