Behavioral Health Integration;Experiences of RIPCPC and RIBHN

2010 - 2013

A bit on history and backgroundDevelopment of current modelDemonstration of point-of-care database

referral systemProspects for the futureQuestions

History of RIPCPC

RIPCPC formed in 1994 as an Independent Practice Association (IPA) with a focus on quality improvement Originally formed to:

Challenge insurers that were lowering reimbursement Combat the trend of hospitals buying up community

based practicesRIPCPC is the largest IPA in Rhode Island

140 Primary Care Physicians (began with 40) Cover over 300,000 Rhode Island Lives 25% of Rhode Island’s Pediatricians are Members

RIPCPC’s Focus on the Patient Centered Medical Home

Principals of the PCMH Personal physician provides care Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Enhanced access for patients Focus on safety & quality improvement Payment appropriately recognizes the added

value provided to patients

Behavior Health’s Integration is Essential to Improving Outcomes!

Patient Centered Medical Home Model

PCMH effect:Care delivered by primary care

physicians in a Patient-Centered Medical Home is consistently associated with better outcomes: Reduced mortality Fewer hospital admissions Lower utilization Improved patient compliance Lower healthcare spending

Collaboration with Specialists/Providers

True patient care coordination can only happen with meaningful & efficient provider collaboration

We can improve outcomes and the effectiveness and efficiency of our care delivery systems by embracing this concept

Our effectiveness and efficiency as clinicians will soon be directly tied to our reimbursement

Behavioral Health Committee Focus

Mission Statement: To improve the health of our patients by facilitating

communication and coordination of care between Rhode Island Primary Care doctors and Behavioral Health Professionals in Rhode Island

We have assembled a team of primary care doctors along with our IT professionals and behavioral health professionals and we have created a forum with regular monthly meetings focused on: Improving access to Behavioral Health Providers Improving communication between Behavioral

Health Providers and PCP’sSupport the IPA by addressing behavioral

health’s role in the PCMH, helping satisfy our behavioral health contract components

Behavioral Health Committee Initiatives

Evaluate/Revise/Approve BCBSRI policies and procedures stated within the three-way contract between BCBSRI, RIPCPC & Behavioral Health Provider Both the Co-located & Collaborative Model

AgreementsCreation of a comprehensive list of

Behavioral Health Providers and facilities for our physicians membership Listing will be compiled and posted on our website

Refine pilot between the Behavioral Health Providers and PCP’s focused on securely exchanging standardized clinical

correspondence Patient Clinical Summaries / Referrals (from PCP) Behavioral Health Evaluations (from BHP)

Behavioral Health Committee Initiatives

Things to Come (in 2012): Database to access at point of care to allow for

smooth referral of patients to appropriate providers Collaborative agreements to allow for the majority of

our physicians to enter into arrangements that enhance access and improve communication

Network wide ability to use the secure, HIPPA-compliant communication system piloted in 2011.

Goals of Behavioral Health Integration

Improve 2-way communication between clinician and the referring PCPBetter access to BH for our patients Formation of quality metrics that can prove better outcomes with BHDelivery quality comprehensive coordinated care to our Patients!

Behavioral Health Integration

Through collaborative agreements spelling out expectations on both sides, a behavioral health pod within RIPCPC was formed:

Timely response to referral (same day for urgent referrals, 72 hours for routine) with willingness to accept patients

Thorough 2-way communication with detailed referral from PCP, and with regular progress notes for ongoing therapy

Emphasis on electronic communication

Point-of-Care Referral Database

A web portal, accessible at the point of careAllows PCP to appropriately tailor referral to

the needs of the individual patient with respect to geography, age, insurance, behavioral or mental health goals and need for comprehensive care.

Can refer to individuals, group practices or facilities

Preferred communication is electronic, but can be via web, fax or phone depending on providers preferences

What we accomplished..

Formalized an affiliate membership between the RIPCPC physicians and behavioral health providers

Established a RIPCPC Behavioral Health PodCreated a RIPCPC Behavioral Health provider

and facility portal This is a searchable database of BH providers that

RIPCPC member physicians can filter by: Specialty, insurance, city, hours of availability, insurances accepted & population treated

Utilize ‘Direct’ messaging to communicate with BH providers

Things to Come

A focus on the collaborative model approach Strengthen network and build lasting relationships Assist patients in making better choices and measure those

patient outcomes (healthier lifestyle = lowered health care costs)

Improve our communication and access with BH specialists for the benefit of our patients, this will help us better manage our patient population in an ACO/AQC/RISK environment Successful behavioral health integration is

vital to containing costs!