Improving Access to Care – Thinking Outside the...
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Improving Access to Care – Thinking Outside the Box SARA GAVIN LMFT, LPCC CHIEF BEHAVIORAL HEALTH OFFICER COMMUNICARE HEALTH CENTERS IAN EVANS, LMFT, AOD ADMINISTRATOR HEALTH AND HUMAN SERVICES AGENCY (HHSA)
Transcript of Improving Access to Care – Thinking Outside the...
Improving Access to Care – Thinking Outside the Box
SARA GAVIN LMFT, LPCCCHIEF BEHAVIORAL HEALTH OFFICER
COMMUNICARE HEALTH CENTERSIAN EVANS, LMFT, AOD ADMINISTRATOR
HEALTH AND HUMAN SERVICES AGENCY (HHSA)
Yolo County
Population approximately 220,000
25% are MediCal recipients
Median Income-$57,260
Persons below poverty level 18.7%
Culturally Diverse
Geographically Diverse
Drug Medi-Cal Organized Delivery System (DMC-ODS)
PREVIOUSLY Prevention
Education/Early Intervention
Outpatient
Intensive Outpatient-Perinatal
Residential
AS OF JULY 1ST, 2018All of what was previously available plus…Intensive Outpatient-non-perinatalWithdrawal Management (Detox)Narcotic Treatment Program (NTP)Physician ConsultationCase ManagementRecovery Services
Q1 & Q2 FY1819: • 2617 Contacts (via access line/log entries) • 921 requested SUD Services (35%)
Federally Qualified Health Centers
Integrated Care, Non-Profit
1,330 Health Center Sites in California
6.9 Million People Served
1 in 6 Californians
CommuniCare Health Centers:YOLO COUNTY
SUBSTANCE USE AND PRIMARY CARE SERVICES
SINCE 1972
1 OUT OF 8 YOLO COUNTY
RESIDENTS
27,038 UNIQUE INDIVIDUALS
134,326 VISITS 32 % BH/SUD SPECIALTY MENTAL HEALTH, MEDICATION ASSISTED TREATMENT AND DRUG
MEDI-CAL PROVIDER
Why it works
FQHC Model: • Services under one roof• Integrated, whole person care • Mental Health/Substance Use screening in
Primary Care• Navigation- Warm Hand-offs• Expansion of Medication Assisted
Treatment • Familiar, de-stigmatized setting
Access ConsiderationsWhere are beneficiaries already familiar with the SUD system in Yolo?
How do we increase access, but ensure uniformity?
HHSA is integrated, so should access be specific for DMC-ODS or general to Behavioral Health?
Criminal Justice Partners
Volume of access requests
Programs by Provider
Outpatient/Intensive Outpatient:CommuniCare Health Centers
Turning Point Community Programs
Residential:Yolo Wayfarer Center DBA Walter’s House
Community Recovery Resources
Progress House
Narcotic Treatment Programs/Opioid Treatment Programs:
Bi-Valley Medical ClinicMedmark FairfieldMedMark SacramentoCORE Medical Clinic
Transitional Housing:Yolo Wayfarer Center DBA Walter’s HouseCommunity Recovery Resources
Access Development Request for Proposal provider must be available in 3 major cities
Training ASAM Criteria and Access Log training to all access points Cross-trained existing mental health access/crisis staff
Completely changed how we collect Access Data
Criminal Justice/Legal Partners Letter submitted by Presiding Judge Presentation to District Attorney & Public Defenders Presentation to Probation Presentation to Child Welfare
CCHC: Creating Access
Walk-in ASAM
Referrals from Primary Care, Dental, Walk-in community and other Behavioral Health Services
Streamline to link to ongoing services
MAT Provider
/
CCHC: Substance Use Services
Services offered at:Hansen Family Health Center- Outpatient, Intensive Outpatient
Salud Clinic-Outpatient, Intensive
Outpatient
Day Reporting Center West Sacramento-
Outpatient
Day Reporting Center in Woodland-
Outpatient
Lincoln/1st street-Youth only
Primary Outpatient Substance Use Disorder Treatment in Yolo County
Medication Assisted Treatment at CommuniCare
• Physician/Primary Care• Nurse Case Manager• 2 BH clinicians
July 2016, MAT Started
Hub and Spoke Expansion Partnership with CORE Medical Clinics• Expanded Program• Funding for uninsured • Naloxone/Narcan distribution
Sep. 2017
Hub and Spoke Extension Year Ending April 2020
Adult Substance Use Disorder (SUD)BEFORE DMC-ODS
OutpatientIntensive Outpatient-Perinatal
UNDER DMC-ODS
All of what is currently available plus…
Intensive Outpatient-non-perinatal
Withdrawal Management (Detox)
Narcotic Treatment Program (NTP)
Physician Consultation
Case Management
Recovery Services
Residential
Bill by the minute
Intake/triage
Substance Use Treatment: Performance Measures
Substance Use Treatment Access Data:
18%
31%38%
9%
4%
FY18/19 Access Requests By Type
Risk/Crisis SUD Services MH Services Info. Only Other
FY17/18: • 1827 Contacts• 11 requested SUD Services (.6%)
FY1819: • 5517 Contacts• 1715 requested SUD Services (31%)
Substance Use Treatment Access Data:
23 22
39
0
5
10
15
20
25
30
35
40
45
All SUD Tx Admissions (n=921) Non-Incarcerated (n=902) Incarcerated (n=19)
Aver
age
# of
Day
sFY 18/19 Average Number of Days from Access
to SUD Tx Admission
Substance Use Treatment Access Data:
78260 320 327
511406
413 385
521 462578 551
94 161
16088
6956
43341273
1345
15141385
0
200
400
600
800
1000
1200
1400
1600
Q1 (July-Sept. 2018) Q2 (Oct. -Dec. 2018) Q3 (Jan. - March 2019) Q4 (April - June 2019)
# of
Acc
ess R
eque
sts
FY18-19 Access Requests
Risk/Crisis SUD Services MH Services Info. Only Other Total
Substance Use Treatment Access Data:
985
1715
2112
503
20229
760
89 30 130
500
1000
1500
2000
2500
Risk/Crisis SUD Services MH Services Info. Only Other
# of
Req
uest
s
Access Requests Resulting in SUD Tx Admission
Access Requests (n=5517) Access Request Resulting in a SUD Admission (n=921)
Substance Use Treatment Access Data:
902
19
FY18/19 Admission Data for Incarcerated and Non-Incarcerated Access Requests
Non-Incarcerated (n=902) Incarcerated (n=19)
Substance Use Treatment Access Data:
23 22
39
0
5
10
15
20
25
30
35
40
45
All SUD Tx Admissions (n=921) Non-Incarcerated (n=902) Incarcerated (n=19)
Aver
age
# of
Day
sFY 18/19 Average Number of Days from Access
to SUD Tx Admission
PM 1.1: Client Enrollment49
9
116 16
0
775
264
116
148
528
63 18 5
86
407
94 119
620
13 4 36 5316 0 0 16
OUTPATIENT SERVICES RESIDENTIAL NARCOTIC AND OPIOD TREATMENT PROGRAMS
ALL TREATMENT PROGRAMS
TOTAL CLIENTS AND ENROLLMENT BY AGE RANGETotal Number of Clients Total Clients EnrolledTransitional Aged Youth (16-25) Adult (25-59)Older Adult (60+) Declined to State
From
July
1, 2
018-
Dece
mbe
r 31
2018
PM 1.2: Services Provided
4428
1088480
97
16724
83111
4 1
Services by Programs 4428 Outpatient
1088 Intensive Outpatient
480 Outpatient Case Management
97 Outpatient In-Person Screening andReferral16724 Narcotic and Opioid Treatment
83 NTP/OTP Other MAT Services
111 Residential Clinically Managed Low-Intensity Residential Treatment4 Residential Clinically Managed High-Intensity Residential Treatment 1 Residential Other MAT ServicesFr
om Ju
ly 1
, 201
8-De
cem
ber 3
1 20
18
PM 2.1 & 2.6: General and Access Satisfaction
Percent of beneficiaries satisfied with services and access provided based on Mental Health Statistics Improvement Program (MHSIP).
0%
20%
40%
60%
80%
100%
120%
Outpatient Services Residential Treatment Narcotic and OpioidTreatment
All TreatmentPrograms Avg
General Satisfaction Perception of Access
PM 2.2: General and Access Satisfaction (TPS)
From
July
1, 2
018-
Dece
mbe
r 31
2018
OutpatientServices
ResidentialTreatment
Narcotic andOpioid
Treatment
All TreatmentPrograms Avg
Service Satisfaction 90% 70% 90% 83%Access Satisfaction 79% 74% 75% 76%
0%10%20%30%40%50%60%70%80%90%
100%Percent of beneficiaries satisfied with services and access provided based on Drug Medi-Cal Organized Delivery System (DMC-ODS) Treatment Perception Survey (TPS).
Outpatient andIntensive
Outpatient
ResidentialTreatment
Narcotic andOpioid
Treatment
All TreatmentPrograms
Total days incarcerated while intreatment 9 3 2 14
Total days incarcerated 6 monthsprior to treatment 1291 161 5 1457
0
200
400
600
800
1000
1200
1400
1600
0
2
4
6
8
10
12
14
16
Days
inca
rcer
ated
whi
le in
trea
tmen
t
PM 3.3: Number of days incarcerated & percent reduction Fr
om Ju
ly 1
, 201
8-De
cem
ber 3
1 20
18
Days
inca
rcer
ated
6 m
onth
s prio
r to
trea
tmen
t
PM 3.4: Improved Outcomes from ServicesFr
om Ju
ly 1
, 201
8-De
cem
ber 3
1 20
18
66%
68%
70%
72%
74%
76%
78%
80%
82%
84%
Outpatient Services Residential Treatment Narcotic and OpioidTreatment
All TreatmentPrograms Avg
Perception of Outcomes
FQHCs and County Collaboration
Why Partner with a County?oAligns with mission and vision
oOpportunity
oClient navigation
oProvider Satisfaction
oBetter for patients, services “under one roof”
oImprove health outcomes
Next Steps Analyze data further to ensure we’re capturing the right metrics Incarcerated versus not incarcerated Days into treatment Access once in Continuum
Develop interventions to target quicker access
Opportunity for growth in the system
Questions?
Ian Evans, LMFTForensic/AOD Program CoordinatorYolo County Health and Human Services Agency (HHSA)[email protected](530) 666-8630
Sara Gavin, LMFT, LPCCDirector of Behavioral Health ServicesCommuniCare Health Centers (CCHC)[email protected](530) 405-2815
