Making the Behavioral Health - Primary Care

Marriage WorkCollaborative Family Healthcare Association13th Annual ConferenceOctober 29, 2011Presenter: Cheryl Holt, MA, NCP, BCCP

HOW IS THE INTEGRATED HEALTHCARE PARTNERSHIPLIKE A MARRIAGE?Stages of Partnership

Partner Selection: DatingFormalizing the Partnership: The WeddingThe New Partnership: The HoneymoonProblems Within the Partnership: The Honeymoon is

OverMaking it Work: Marital CounselingThe Mature Partnership: Growing Old Together

FORMULA FOR A SUCCESSFUL BEHAVIORAL HEALTH – PRIMARY CARE MARRIAGE

VisionCommunicationCompromiseOutcomes

VC2O

VISION

DATING: Partner SelectionMutual AttractionDetermining PotentialWooing and CourtingProposal

The WEDDING: Formalizing the PartnershipMerging of GoalsCo-locationFinances

COMMUNICATION

Early Phase: The HONEYMOON Identify a Common LanguageSharing Decision-MakingSynergy

Problems within the Partnership (AKA The HONEYMOON is OVER!)Addressing Internal ConflictsThe Use of CandorTemper Expectations

COMPROMISEMAKING IT WORK

MARITAL COUNSELING:Developing Shared SolutionsDelegate TrustCreate EmpowermentDetermine Expectations

OUTCOMES

The MATURE PARTNERSHIPThe Whole is Greater than the Sum of its PartsAccountabilityEnhanced outcomes through blending of

resources

Individual Health Outcome Indicators

Quarterly● Weight● Height● Body Mass Index (BMI)● Blood pressure

Annual● Blood glucose or Hemoglobin A1C● Lipid profile

Services Outcome Indicators

Track total number of clients:● Receiving primary care services● Screenings for

Hypertension Obesity Diabetes Co-occurring substance use disorders Tobacco product use

Outcomes Data for Decision-MakingAggregate Data

Provide population health dataQuality improvementPlanning

Standard Set of IndicatorsMake effective clinical decisions and Inform the evaluation of future healthcare initiatives

CULTURAL INTEGRATION Understanding and Respect

Workflow Funding streams Restrictions State and federal requirements Pecking order Who liaisons with whom

CEO

VP

CMO

Director Asst VPsMedical

Center Directors

ProvidersBehavioral HealthProvider

CEO

COO

Director

Medical Manager Clinical Manager

Clinical Supervisor

ClinicianPrescriber

Clinical Supervisor

CMO

Clin

ical

Clinic Supervisor

CSB FQHC

MH/Primary Care Integration Options

FUNCTION

MINIMAL COLLABORATION

BASIC COLLABORATION

FROM A DISTANCE

BASIC COLLABORATION

ON-SITE

CLOSE COLLABORATION/

PARTLY INTEGRATED

FULLY

INTEGRATED/MERGED

THE CLIENT/PATIENT and STAFF PERSPECTIVE/EXPERIENCE ACCESS Two front doors;

client/patients go to separate sites and organizations for services

Two front doors; cross system conversations on individual cases with signed releases of information

Separate reception, but accessible at same site; easier collaboration at time of service

Same reception; some joint service provided with two providers with some overlap

One reception area where appointments are scheduled; usually one health record, one visit to address all needs; integrated provider model

SERVICES Separate and distinct services and treatment plans; two physicians prescribing

Separate and distinct services with occasional sharing of treatment plans for Q4 client/patients

Two physicians prescribing with consultation; two treatment plans but routine sharing on individual plans, probably in all quadrants

Q1 and Q3 one physician prescribing, with consultation; Q2 & 4 two physicians prescribing some treatment plan integration, but not consistently with all client/patients

One treatment plan with all clients/patients, one site for all services; ongoing consultation and involvement in services; one physician prescribing for Q1, 2, 3, and some 4; two physicians for some Q4: one set of lab work

FUNDING Separate systems and funding sources, no sharing of resources

Separate funding systems; both may contribute to one project

Separate funding, but sharing of some on-site expenses

Separate funding with shared on-site expenses, shared staffing costs and infrastructure

Integrated funding, with resources shared across needs; maximization of billing and support staff; potential new flexibility

GOVERNANCE Separate systems with little of no collaboration; client/patient is left to navigate the chasm

Two governing Boards; line staff work together on individual cases

Two governing Boards with Executive Director collaboration on services for groups of client/patients, probably Q4

Two governing Boards that meet together periodically to discuss mutual issues

One Board with equal representation from each partner

EBP Individual EBPs implemented in each system

Two providers, some sharing of information but responsibility for care cited in one clinic or the other

Some sharing of EBPs around high utilizers (Q4) ; some sharing of knowledge across disciplines

Sharing of EBPs across systems; joint monitoring of health conditions for more quadrants

EBPs like PHQ9; IDDT, diabetes management; cardiac care provider across populations in all quadrants

DATA Separate systems, often paper based, little if any sharing of data

Separate data sets, some discussion with each other of what data shares

Separate data sets; some collaboration on individual cases

Separate data sets, some collaboration around some individual cases; maybe some aggregate data sharing on population groups

Fully integrated, (electronic) health record with information available to all practitioners on need to know basis; data collection from one source

Dedicated to promoting the development of Integrated Primary and Behavioral Health Services

to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty

behavioral health or primary care provider settings.

About the Center In partnership with Health & Human Services (HHS)/Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA).

Goal: To promote the planning, and development and of integration of primary and behavioral health care for those with serious mental illness and/or substance use disorders and physical health conditions, whether seen in specialty mental health or primary care safety net provider settings across the country.

Purpose: To serve as a National Training and Technical Assistance Center on the bi-

directional integration of primary and behavioral healthcare and related workforce development

To provide technical assistance to PBHCI grantees and entities funded through HRSA to address the health care needs of individuals with mental illnesses, substance use and co-occurring disorders

Individuals trained in specific behavioral health related practices

Organizations using integrated health care service delivery approaches

Consumers credentialed to provide behavioral health related practices

Model curriculums developed for bidirectional primary and behavioral health integrated practice

Health providers trained in the concept of wellness and behavioral health recovery

The Center for Integrated Health Solutions is dedicated to increasing the number of:

Center for Integrated Health SolutionsTarget Populations

SAMHSA Primary & Behavioral Health Care Integration (PBHCI) Grantees HRSA Grantees General Public

Services Training and Technical Assistance Knowledge Development Prevention and Health Promotion/Wellness Workforce Development Patient Protection and Accountable Care Act Monitoring and Updates

Technical Assistance MenuIndividual Technical Assistance:

Phone consultations, e-mail, site visits

Group Learning Experiences: Learning Communities Webinars Trainings Practical Web-Based Resources (CIHS website, e-newsletter,

discussion boards)

Tools: Toolkits/Guidelines Training Curricula Fact Sheets

CIHS Steering CommitteeWilliam Anthony, PhDCenter for Psychiatric Rehabilitation, Boston University Thomas Bornemann, Ed.DCarter Center Mental Health Program Richard Brown, MD, MPHDepartment of Family Medicine, Univ. of WI

Tonier CainNational Advocate and Team Leader for theNational Center for Trauma Informed Care Carl Clark, MDMental Health Center of Denver Regina Dickens, EdD, LCSWNC Center of Excellence for Integrated Care

Michael FitzpatrickNational Alliance on Mental Illness 

 

Joseph Parks, MDMissouri State Department of Mental Health

Janice Petersen, PhDFirst Vice ChairNational Prevention Network

Harold Pincus, MDColumbia University Fred Rachman, MDAlliance of Chicago Richard Rawson, PhDUCLA Integrated Substance Abuse Programs Stephen Somers, PhDCenter for Healthcare Strategies Patricia TaylorFaces and Voices of Recovery Don ThackerShawnee Mental Health Center, Inc

John Gardin, PhD, ACSADAPT, Inc.

Jorge Girotti, PhDHispanic Center of Excellence,Dept. of Medical Education, Univ of IL Ellen Healion, MAHealing Hands Across Long Island Kenneth JueFounder, InSHAPE

Roger Kathol, MD, CPEDepartment of Internal Medicine and

Psychiatry, University of Minnesota

 Paul Lingenfelter, PhDState Higher Education Executive

Officers Organization

Tom McLellan, PhDTreatment Research Institute

Jim O'Connell, MDBoston Health Care for the Homeless

 

SAMHSA/HRSA Center for Integrated Health Solutions

The resources and information needed to successfully Integrate primary and behavioral health care

For information, resources, and technical assistance, contact the CIHS team at:Online: CenterforIntegratedHealthSolutions.orgPhone: 202-684-7457Email: Integration@thenationalcouncil.org

CONTACT

Cheryl Holt, MA, NCP, BCCPDirector of Training and Technical AssistanceSAMHSA – HRSA Center for Integrated Health SolutionsNational Council for Community Behavioral Healthcare1701 K St. NW, Suite 400Washington, DC 20006678-520-7054cherylh@thenationalcouncil.org

Behavioral Health – Primary Care Integration listserve:http://lists101.his.com/mailman/listinfo/pc-bh-integration

@nationalcouncil @cherylholt

Behavioral Health Integration blog: BehavioralHealthIntegration.com

Behavioral Health Integration

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