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UW Health Primary Care / Behavioral Health Integration. United Way Forum September 22, 2014. UW Health Overview. UW Health Enterprise Facts and Figures. UW Health Healthcare Entities UW Hospital and Clinics (566 beds) American Family Children’s Hospital (61 beds) - PowerPoint PPT Presentation
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UW HEALTH PRIMARY CARE / BEHAVIORAL
HEALTH INTEGRATION
UNITED WAY FORUM
September 22, 2014
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UW Health Overview
UW Health Enterprise Facts and Figures• UW Health Healthcare Entities
– UW Hospital and Clinics (566 beds)– American Family Children’s Hospital (61
beds)– UW Medical Foundation (1 of 10 largest
medical groups in nation)
• Facts and Figures– 26,797 Inpatient Admissions– 2,317,332 Outpatient Visits– 43,806 Emergency Visits– 1,200+ Physicians; 10,000+ Employees– Level 1 Adult and Pediatric Trauma
Center– Comprehensive Cancer Center– 48 Primary Care & Specialty Clinics – Outreach sites in 50+ communities
UW Health Primary Care
• 38 Primary Care Clinics*– Family Medicine = 21– General Internal Medicine = 9– Pediatrics = 8
• 194 Primary Care Physicians
• 266,000 medically homed patients– 35,600 with behavioral health diagnoses
• Top diagnoses: depression, anxiety, alcohol
• *8 clinics with on-site Behavioral Health provider
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Family Medicine
General Internal Medicine
Pediatrics
Dept of Psychiatry LocationsBehavioral Health Provider Embedded in Clinic
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Impetus for Primary Care / Behavioral Health Integration • In pursuit of the Triple AIM
– Improve health of populations– Improve experience of care– Reduce per capita cost
• Primary Care Redesign launched 2008– Patient Centered Medical Home Recognition
• Behavioral Health Analysis 2013– Demand exceeds capacity
• 46% of behavioral health care is managed by UW Health PCPs• 85% of PCPs not satisfied with access to behavioral health services
– Depression is #1 outpatient and inpatient diagnosis– Poor access and follow-up for behavioral health services– Poor continuity of care and communication between providers– Insurance barriers– Led to system-wide initiative to improve behavioral health services
Institute for Healthcare Improvement
Primary Care / Behavioral Health Integration Model Development
• Depression Screening launched for age 65+ (July 2014)
• Interventions for patients who screen positive:– RN educational intervention– PCP prescribes medication – Psychiatry advice to PCP – Psychiatry consult
• Foundation for new PC / BH integration model
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Total Depression Screening Rates for all Primary Care Clinics by Week
• Team-based and patient-centered• Co-location is not Collaborative Care. Team members learn to work differently.
Collaboration
• Treat-to-target• Treatments are actively changed until the clinical goals are achieved
• Evidenced-based care
Stepped Care
• All patients tracked in a registry• No one falls through the cracks• Population-based approach
Close follow-up
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Primary Care / Behavioral Health Integration Model Development: Collaborative Care
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DRAFT UW Health Collaborative Care Model
BH Complex Case Management
Specialty/Org Resources
Specialty BH CarePsychiatrist MS TherapistPsychologist
PC Clinic Resources
PCP
PatientCare Manager (RN Care Coordinator
Dep, DM, HTN)
Adapted from University of Washington, 2013
ConsultingPsychiatrist
• September 2014– Endorsed by Primary Care and Behavioral Health
leadership
• October 2014 – January 2015– Model design and build
• February – March 2015– Test model in five Primary Care Clinic locations
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Primary Care / Behavioral Health Integration Model Development
• Strengths– Patient-centered – Evidence-based model– Proven cost-savings– Aligned with UW Health Primary Care Redesign and other
organizational imperatives
• Challenges– Paradigm shift for key roles – Investment in time and resources– Adapting model to variation in UW Health Primary Care clinics
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Primary Care / Behavioral Health IntegrationModel Strengths and Challenges
