LEARNING SESSION NUMBER IJanuary 29th & 30th, 20148:00 AM – 4:15 PM

The Riley Center at Southwestern Seminary1701 W. Boyce Avenue, Fort Worth, Texas 76115Room 150

Behavioral Health-Primary Care Integration Learning Collaborative

January 30th, 2014

Agenda

8:30-8:40 Welcome and Introductions

8:40-8:50 Learning Session Overview

8:50-9:00 The Case for Integrating Behavioral Health and Primary Care in Region 10

9:00-9:10 Intersection Between the Learning Collaborative and DSRIP

9:10-9:20 Introduce Story Board Gallery Walk 9:20-9:30 Break

9:30-10:15 Storyboard Gallery Walk: Meet the Other Provider Teams

Agenda 10:15-10:40 Model for Improvement, Part 1 Aim

Statements, Monthly Measures, Run Charts

10:40-11:10 Team Meeting#1: Revise Aim Statement, Data Collecting, Planning

11:10-noon The Model for Improvement, Part 2: The Plan-Do-Study-Act Testing Cycle

Noon-1:00 pm Lunch

1:00-1:20 Overview of Change Package for Behavioral Health: What do we know that works?

1:20-2:00 Panel Discussion: The Integrated Care Imperative-Why We Must Succeed

Agenda 2:00-3:15 Introduction to Motivational Interviewing to

Behavior Change

3:15-3:25 Break

3:25-3:55 Team Meeting #2: Planning for High Impact Change, Drafting a PDSA Test

3:55-4:10 Teams Share Their Plans for Action Period 1

4:10 Evaluation

4:15 Adjourn

Learning Session Welcome and Introductions

Aubrie Augustus, RN, BSN, MHA; Senior VP Network Quality, JPS Health Network and

Administrative Director, Learning Collaborative

Learning Session Overview

Gillian Franklin, M.D., MPHClinical Effectiveness & Integration Specialist

Project Manager & Performance Improvement Specialist, Learning Collaborative

Learning Collaborative Model (Breakthrough Series Model)

Learning Session Overview

The Learning Session

Goals And Objectives

Goal: Participants will learn about the Model for Improvement .

Objective: Participants will understand the various aspects of the Model for Improvement and their functions.

Instructional Objective: Participants will work on parts of the Model for Improvement (Plan-Do-Study-Act Testing Cycle) to test change.

Learning OutcomesModel for Improvement

Full engagement as early adopters

Strategies Process Improvement NOT Research

Elements “Best Practice” Changes Learning Collaborative Change Methodology Aim Statements; PDSA Testing Cycle; Monthly Measures; Run Charts etc.

Action Period 1

Inquiry-driven

Formative Feedback

» Knowledge

» New Skills

» Immediate Changes

» Steal Shamelessly

» Share Relentlessly

The Take Away

Wait, Wait Don’t Tell Me!!!

What is a proven way to test potential changes

without disrupting your organization’s day-to-day

operations?

Answer

Model for Improvement&

Plan-Do-Study-Act Cycle

Wayne Young, LPC, FACHEVice-President Operations and Administrator – Trinity Springs

John Peter Smith Health Network Director, Behavioral Health Learning Collaborative

 

The Case for Integrating Behavioral Health and Primary Care in Region 10

The Case for Integrated Care

US Adults Meeting Behavioral Health Diagnostic Criteria

The Case for Integrated Care

29% of Adults with Medical Conditions Also Have

Mental Health Conditions

Adults with Medical

Conditions, 58%

Adults with Mental Health Conditions, 25%

68% of Adults with Mental Health Conditions

Also Have Medical Conditions

Source: Druss, B.G., and Walker, E.R. (February 2011). Mental Disorders and Medical Comorbidity. Research Synthesis Report No. 21. Princeton, NJ: The Robert Wood Johnson Foundation.

The Case for Integrated Care

Total Healthcare Costs of Patients With and Without Depression

Melek, S. P. (2012). Bending the Medicaid healthcare cost curve through financially sustainable medical-behavioral integration. Milliman Research Report.

The Case for Integrated Care

Year

Mean Age at Time of DeathMean Years of Life

Lost Per ClientAll Clients Who Died During Year

Male Clients Who Died During Year

Female Clients Who Died During Year

1997 55.0 52.4 58.1 28.51998 55.0 53.3 56.6 28.81999 54.0 50.8 57.3 29.3

This and next slide reference: 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 [serial online] 2006 Apr [date cited]. Available from: URL: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm.

The Case for Integrated Care

Percentage of Deaths

Questions?

The Intersection of DSRIP and the Learning Collaborative

Mallory JohnsonManager RHP 10

Regional plans should recognize the importance of learning collaboratives in supporting continuous quality improvement, RHPs will provide opportunities and requirements for shared learning among the approved DSRIP projects in the region.

Learning collaboratives should strongly be associated with Performing Provider’s projects and demonstrate a commitment to collaborative learning that is designed to accelerate progress and mid-course correction to achieve the goals of the projects and to make significant improvement in the Category 3 outcome measures and the Category 4 population health reporting measures.

According to the PFM…. Our Learning Collaboratives should…

The continuation of the journey we have all been on together!

Over the last two years we have all experienced together…

What does the Learning Collaborative mean to Region 10 DSRIP Projects?

Shared Learning & New

Experiences

Newly fostered relationships

and collaboration

Regional commitment to

improve care across the

continuum

• A networking opportunity to learn how other similar projects are doing and best practices occurring in our community

• Focus on specific issues where multiple providers will collaborate to see improvement for all

• An opportunity to bring performance improvement practices (CQI) to your projects

• Recognition that it’s not just about the milestones, but the broader impact of participation in the Waiver, willingness to collaborate with peers, and show improvement at the individual, regional, and state levels

What can the Learning Collaborative mean to your DSRIP Projects?

Best practices CollaborationPerformance Improvement

Practices

Regional Impact

TEAM ME

Introduce Storyboard Gallery WalkHunter Gatewood, MSW, LCSW

Break

StoryBoard Gallery Walk: Meet the Other Provider Teams

Model for Improvement, Part 1: Aim Statements, Monthly Measures, Run

ChartsHunter Gatewood, MSW, LCSW

Team Meeting #1: Revise Aim Statement, Data Collecting Planning

Hunter Gatewood, MSW, LCSW

The Model for Improvement, Part 2: The Plan-Do-Study-Act Testing Cycle

Hunter Gatewood, MSW, LCSW

Lunch

• Overview of Change Package for Behavioral Health:

What do we know that works?

Wayne Young, LPC, FACHEVice-President Operations and Administrator – Trinity Springs

John Peter Smith Health Network

 

The Case for Integrated Care

MINIMAL

COLLABORATION

BASIC COLLABORATION

FROM A DISTANCE

BASIC COLLABORATION

ONSITE

CLOSE COLLABORATION/PARTLY COLLABORATED

FULLY INTEGRATED

Separate systems Separate facilities Communication is

rare Little appreciation of

each other's culture

"Nobody knows my name. Who are you?"

Separate systems Separate facilities Periodic focused

communication; most written

View each other as outside resources

Little understanding of each other's culture of sharing of influence

"I help your consumers."

Separate systems Same facilities Regular

communication, occasionally face-to-face

Some appreciation of each other's role and general sense of large picture

Mental health usually has more influence

"I am your consultant."

Some shared systems

Same facilities Face-to-face

consultation; coordinated treatment plans

Basic appreciation of each other's role and cultures

Collaborative routines difficult; time and operation barriers

Influence sharing

"We are a team in the care of consumers."

Shared systems and facilities in seamless bio-psychosocial web

Consumers and providers have same expectations of system

In-depth appreciation of roles and culture

Collaborative routines are regular and smooth

Conscious influence sharing based on situation and expertise

"Together, we teach others how to be a team in care of consumers and design a care system."

A standard framework for levels of integrated healthcare Source: SAMHSA

What Do We Know that Works?

Med Listed in Chart

Smoking Education

Blood Pressure Tested

Nutrition Education

Exercise Education

Cholesterol Screening

Diabetes Screening

Flu Vaccination

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

64%

64%

66%

62%

53%

57%

46%

12%

86%

85%

85%

83%

81%

80%

71%

32%

Integrated Care Usual Care

Integrated Medical Care for Patients with Serious Psychiatric Illness. A Randomized Trial Source: Druss, B., et al. (2001). Archives of

General Psychiatry, 58, 861-868

Improve Screening Rates

Percentage of patients screened with team’s selected cross-specialty screening

Numerator: Total number of patients in the population of focus who have received screening with the selected screening tool within the past 12 months

Denominator: Total patient population of focus for improved care integration at you site.

Behavioral health screenings for primary care settings

• PHQ2/PHQ9 • SBIRT (Screening, Brief Intervention and Referral to Treatment) • Tobacco use screening • Alcohol abuse screening (audit), MAST • Drug abuse screening (DAST) • Screening for risk of harm to self or others

Physical health screenings commonly done in behavioral health settings

• Diabetes screening • Hypertension Screening • BMI Calculation • COPD Screening • Cardiovascular disease screening • HIV, STD, hepatitis

Improve Coordination

Percentage of patients who received the teams’ selected integrated care intervention in past 12 months.

Numerator: Number of patients in the population of focus who have received the selected integrated care intervention in the past 12 months

Denominator: Total patient population of focus for improved care integration at your site.

• Patients with a shared care plan documented at both the PC Provider site and the BH Provider site.

• Patients whose treatment plans include goals for both PC and BH. • Patients whose care was covered in Care Coordination Conferences with PC and BH

Providers in the past 12 months (Note: Teams focusing on more complex patients may want to track patients covered in coordination conferences at more frequent interval. They could to use the different interval in addition to or instead of the 12-month interval) .

• Patients receive a visit with both their PC Provider and BH Provider within a set time period (e.g. past 60 days for more complex patients).

The Case for Integrated CarePercentage of patients receiving integrated care whose condition improved.

Numerator: Number of patients in the population of focus whose care has been documented as improved in past 12 months, as measured by the selected indicator.

Denominator: Total patient population of focus for improved care integration at your site.

Examples of improvement in behavioral health conditions in primary care settings • Screening results no longer positive • Adherence to medication for behavioral

health condition (in DSRIP category 3) • Completion of counseling for behavioral

health condition, based on documented achievement of 1+treatment plan goals

• Reduced PHQ-9 score for all patients with initial scores over 10, to less than 10

• Reduced PHQ-9 score for all patients with initial scores over 10, to less than 5

• Behavioral health condition in remission • Abstinence from alcohol or other drug use • Reduced alcohol or other drug use

Examples of improvement in primary care conditions in behavioral health settings • Screening results no longer positive • Reduced tobacco use • Discontinued tobacco use • HbA1c less than 9% • BP to <140/90 • LDL-C control • Patients engaged in or received treatment

for STD, HIV, hepatitis

Questions?

Thank you

Panel Discussion: The Integrated Care Imperative – Why We Must Succeed

Panel Discussion

Melanie Cooper Peer Support Specialist, JPS Health Network

Karen Dunn Peer Support Specialist, MHMR of Tarrant County

Joan Barcellona Family Member, Community Advocate

Patsy Thomas President, Mental Health Connection

Break

Introduction to Motivational Interviewing to Behavior Change

Scott Walters, PhD.

University of North Texas Health Science CenterSchool of Public Health

Break

Team Meeting #2: Planning for High-Impact Change, Drafting a PDSA Test

Teams Share Their Plans for Action Period 1

Hunter Gatewood, MSW, LCSW

Evaluation

Adjourn