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Integrated Health Care Initiative Collaborative Quarterly Meeting

November 14th, 2018

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Collaborative Introductions

Today we…

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HOPE Clinic Demonstration ProjectRodolfo Orna, M.A. LMFT, Behavioral Health Director

& Shahrzad Afshin Yakta, Behavioral Health Consultant

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MissionTo provide quality healthcare without any prejudice to

all people of greater Houston in a culturally and linguistically competent manner

Rodolfo Orna, LMFTDirector of Behavioral Health

Main Clinic West ClinicAlief Clinic

BHS

PSYCHIATRY

OB -GYNADULT

PEDIATRICS

OPTICAL

DENTAL

Visits & Encounters

2017 104,000 Visits17,898 Patients(BH 3,271 visits)

25%Asian

25%African American

29%Hispanic

1%Multiracial

20%Caucasian

OUR PATIENTSAGE DISTRIBUTION

45-64

20-44

65+0-4

5-12

13-19

Chart1

0 to 4

5 to 12

13 to 19

20 to 44

45 to 64

65 +

AGES

0.16

0.14

0.1

0.39

0.17

0.04

Sheet1

AGES

0 to 416%

5 to 1214%

13 to 1910%

20 to 4439%

45 to 6417%

65 +4%

To resize chart data range, drag lower right corner of range.

Main ClinicPrimary Care

West Location

Primary Care

Alief Location

Primary Care

BHS PSYCHIATRY

2 BHC

Child

Child

Adult

Adult

Child/A

Adult

PCP

BHS

BHC

Psych

BH Coordinator

MA/Front Office

BHC=Behavioral Health ConsultantBHS= Behavioral Health Specialist

Main ClinicPrimary Care

BHC: PediatricsBHC: Adult & OB-GYN

PCP

Visits triggered by:

Screening PHQ-9EdinburghPSC-17CAGEPCP referrals

Integrated Primary Behavioral Health Care Flow Chart

MA Triage + PHQ-9 or Edinburgh Screening

Behavioral Health Consultant

Behavioral Health Specialty: Psycho-therapy(Counseling)and/or Psychiatry

Medical Provider

FollowCrisis Protocol to

determineHospitalization

MEDICALVisit Completed

Coordinates dischargeand referrals to BH

Specialty

Active Suicidal, Homicidal or Psychosis

• Health outcomes• Emotional disturbances• Mental Health Crisis

Additional Screenings: PSC-17, CAGE,DAST,

TRAUMA,

Consultation

Main ClinicPrimary Care

HOPEWest Clinic

HOPEAlief Clinic

BHC: PediatricsBHC: Adult & OB-GYNPCP

PROGRESS : LEVELS OF COLLABORATION/INTEGRATION

LEVEL 4: Close Collaboration Onsite with Some System Integration: Communications, Collaboration, Meeting, Roles

LEVEL 5: Close Collaboration Approaching an Integrated Practice: Treatment Delivery, Patient Experience,

LEVEL 6: Full Collaboration in a Transformed/Merged Integrated Practice: Facilities, Resources, EMR, Leadership

Support,

2018 CFHA Conference Takeaways

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Practice Integration Profile

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• Organizational self-assessment survey www.practiceintegrationprofile.com

• Dimensions:– Workflow– Clinical Services– Workspace– Shared Care & Integration– Patient Engagement

http://www.practiceintegrationprofile.com/

In our practice…1.…BH and Medical Clinicians regularly and actively exchange information about patient care.

2.…there are regular educational activities including both BH and Medical Clinicians.

3.…BH and Medical Clinicians regularly spend time together collaborating on patient care.

4.…patients with BH needs have shared care plans developed jointly by the patient, BH and Medical Clinicians and updated over time.

Practice Integration ProfileDimension: Shared Care & Integration

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CFHA 20th Annual Conference Session B1 Takeaways

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• “Dynamic Evolution of Integrated Behavioral Health: Developing Data Management Systems for continuous Quality Improvement.”

• Presented by the University of California San Diego• Presentation takeaways:

– National trends and needs– Program structure and background– Clinical & operational aspects– Measures of integration (tools)– Financing integration review

Clinical Quality ReportSample

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Provider Productivity ReportSample

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Operational ReportSample

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Measures of Integration

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• Practice Integration Profile (PIP)• PCBH-based Provider Adherence Questionnaire (PPAQ)• TCARE (Targeted Collaborative Assessment and Response Empowerment)

– UCSD’s real-time consultation EHR tool• Recommendation: Define/identify your approach identify outcomes

identify measures. Also, identify resources within department to partner with, to develop systems to input and extract data

http://www.uvm.edu/%7Epip/pip.phphttps://www.mirecc.va.gov/cih-visn2/PPAQ.asp

Individual Profit & Loss ReportSample

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CFHA 20th Annual Conference Session E6 Takeaways

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• “Integrated Behavioral Health at Mayo – Bringing Together Mental Health Disciplines in Primary Care to Better Address a Population.”

• Presented by the Mayo Clinic• Presentation takeaways:

– Program structure & team– Types of services provided– Challenges & recommendations– Tracking of outcomes

The Multidisciplinary Team

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“You Are Not Alone!”

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https://www.ruralhealthinfo.org/toolkits/services-integration/2/primary-care-behavioral-health

https://www.ruralhealthinfo.org/toolkits/services-integration/2/primary-care-behavioral-health

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CFHA 20th Annual ConferenceSession E7a Takeaways

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• “The Validation of Ultra-Brief, Patient Feedback Measures Intended to Improve the Care of Chronic Illnesses in Primary Care”

• Presented by University of New England faculty and Peak Vista Community Health Centers staff

• Presentation takeaways:– “Privileging the patient perspective”– Patient values & preferences as a key

component of evidence-based practice– Partners for Change Outcome Management

System (PCOMS)https://betteroutcomesnow.com/

https://betteroutcomesnow.com/

PCOMS – BH (Behavioral Health)

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Outcome Rating Scale (ORS)Individually:

(Personal well-being)____________________________________

Interpersonally:(Family, close relationship)

____________________________________

Socially:(Work, school, friendships)

____________________________________

Overall:(General sense of well-being)

____________________________________

Session Rating Scale (SRS)I did not feel heard,

understood and respected.

We did not work on or talk about what I wanted to work on

and talk about.

The therapist’s approach is not a good fit for me.

There was something missing

in the session today.

Relationships

Goals and Topics

Approach or Methods

Overall

I felt heard, understood and

respected.

We worked on and talked about what I wanted to work on

and talk about.

The therapist’s approach is a good

fit for me.

Overall, today’s session was right

for me.

• PCOMS – WRS (Wellness Rating Scale)– Personal Health, Relationships, Activities, Quality of Life– Scale from to

• PCOMS – PAS (Provider Alliance Scale)– Relationship, Communication, Partnership, Treatment– Example (Relationship) – I did not feel comfortable asking questions or

raising concerns about my health and treatment. I felt comfortable asking questions and raising concerns about my health and treatment.

• Peer-reviewed validation study: http://link-springer-com-443.webvpn.jxutcm.edu.cn/article/10.1007%2Fs11136-018-1967-4

PCOMS – WRS & PASChronic Illness Measures

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http://link-springer-com-443.webvpn.jxutcm.edu.cn/article/10.1007%2Fs11136-018-1967-4

Workgroups 2019 Projects Overview

MHA Staff

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2019 Work Group Projects

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• Service Delivery Work Group– Screening to Treatment

Roadmap White Paper– Public Education on

Integrated Care– Educational Forums

• Financing Work Group– Sustainability Toolkit

• Institutions of Higher Education Work Group

– Institution Presentations– TMC Policy Institute IHC Course– Professional & Accrediting

Association Presentations

• Public Policy Work Group– 87th Legislative Session Agenda

Planning– 86th Legislative Session

Advocacy Task Force

Evaluation Pathway

www.mhahouston.orgSource: Collective Impact Forum. FSG. “A Framework for Performance Measurement and Evaluation of Collective Impact Efforts”

We are here! Q3 2018

10-Year ReportAccomplishmentsQ4 2025

Biennial ReportProgress to dateQ4 2024

Biennial ReportProgress to dateQ4 2022

Integrated Health Care Initiative Timeline

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2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Early Years (3) Middle Years (5)

18 Guiding Recommendations Developed

Q2 2016

IHCI Launched

Q2 2015

IHCI Report PublishedRecommendationsQ4 2016

Action Plans FinalizedWork Groups

Q4 2018

Stakeholder Meetings

Q3 2015

Today

Collaborative Meeting

Q4 2018

Late Years (2)

Retreat

Interviews

Policy Project

Collaborative & Work Group Meetings

Q1 2017 – Q3 2018

Quarterly/Bimonthly

Collaborative & WG Meetings / Action Plans Implementation

2019 - 2025

Exact Milestones TBA

5-Year ReportProgress to dateQ4 2020

Demonstration Projects / Learning Communities Launched

• Continuing:– Quarterly Collaborative Meetings– Quarterly Networking Events– Monthly Work Group Meeting

– Biweekly Resource Bulletin

– In-depth Educational Events

• Potential Opportunities:– Learning Community Calls (Various Focus Areas)

Looking Ahead Into 2019!

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2018 CFHA Conference TakeawaysMHA Staff

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Thank You!

Integrated Health Care Initiative �Collaborative Quarterly Meeting�November 14th, 2018Collaborative IntroductionsToday we…HOPE Clinic Demonstration Project��Rodolfo Orna, M.A. LMFT, Behavioral Health Director�& Shahrzad Afshin Yakta, Behavioral Health ConsultantSlide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 152018 CFHA Conference TakeawaysSlide Number 17Practice Integration ProfilePractice Integration Profile�Dimension: Shared Care & IntegrationSlide Number 20CFHA 20th Annual Conference Session B1 TakeawaysClinical Quality Report�SampleProvider Productivity Report�SampleOperational Report�SampleMeasures of IntegrationIndividual Profit & Loss Report�SampleSlide Number 27CFHA 20th Annual Conference Session E6 TakeawaysThe Multidisciplinary Team“You Are Not Alone!”Slide Number 31CFHA 20th Annual Conference�Session E7a TakeawaysPCOMS – BH (Behavioral Health)PCOMS – WRS & PAS�Chronic Illness MeasuresWorkgroups 2019 Projects �Overview��MHA Staff2019 Work Group ProjectsEvaluation PathwayIntegrated Health Care Initiative TimelineLooking Ahead Into 2019!2018 CFHA Conference Takeaways��MHA StaffThank You!