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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