Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued...

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National Center Conference: Putting Care at the Center Los Angeles, California Integrated Behavioral Health for Complex Patients: Roadmap, Tools and Technology Jeffrey M. Ring, Ph.D. Elise Pomerance, M.D., M.P.H. Kru Vyas, Ph.D., M.B.A. November, 2017

Transcript of Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued...

Page 1: Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued at work 2. I have everything I need to provide the best care 3. I trust my team

National Center Conference: Putting Care at the Center Los Angeles, California

Integrated Behavioral Health for Complex Patients: Roadmap, Tools and

Technology

Jeffrey M. Ring, Ph.D. Elise Pomerance, M.D., M.P.H.

Kru Vyas, Ph.D., M.B.A. November, 2017

Page 2: Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued at work 2. I have everything I need to provide the best care 3. I trust my team

Faculty Disclosure Dr. Ring is a Speaker for Merck Pharmaceuticals on doctor-patient communication and culturally responsive care.

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Shoulders by Naomi Shihab Nye A man crosses the street in the rain, Stepping gently, looking two times north and south, Because his son is asleep on his shoulder. No car must splash him. No car drive too near to his shadow. This man carries the world’s most sensitive cargo but he’s not marked. Nowhere does his jacket say FRAGILE, HANDLE WITH CARE. His ear fills up with breathing. He hears the hum of a boy’s dream deep inside him. We’re not going to be able to live in this world if were not willing to do what he’s doing with one another.

The road will only be wide. The rain will never stop falling.

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Objectives - Participants will: •  Articulate core competencies for BH

integration for complex patients •  Receive overview of initial project

outcomes •  Understand the successes and

challenges of the BHICCI

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How does one build an integrated complex care initiative? •  Who do you want on your team? •  What skills do you want them to

possess? •  How will you manage data to know

if patients are improving?

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Bibliography / Reference www.bhintegration.com

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Inland Empire Challenges •  55% Minorities •  Limited Education •  Unemployment more than doubled

since 2007 > 14.7% (12% US, 10% CA)

•  Poverty 12.7%

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IE Health Inequities - Mortality 1 Heart Disease 2 Cancer 3 Lung Disease 4 Stroke 5 Unintentional Injuries 7 Diabetes (5x for Latinos/as)

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Our Health Care System •  Few providers •  Isolated Partners •  Disconnected BH •  Fragmented Care •  Poor Health Outcomes •  Lack of IT Infrastructure •  Very High Costs

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Project Goals are consistent with National Goals: Address social factors in payment and performance through incentives and support for health equity efforts •  Office of the Assistant Secretary for

Planning and Evaluation in DHHS •  National Academy of Medicine •  National Quality Forum

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How many of these people with behavioral health concerns will see a mental health provider?

12

No Treatment Primary Care Provider

Wang P, et al., Twelve-Month Use of Mental Health Services in the United States, Arch Gen Psychiatry, 62, June 2005

Mental Health Provider: psychiatric provider or therapist)

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A$30,000,000Investment

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BHICCI Key Commitments •  Improve patient and team experience •  Improve care coordination and integration

of primary, specialty, addiction, and mental health care across and between healthcare/treatment settings

•  Improve complex care management of individuals with chronic conditions

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BHICCI Key Commitments •  Improve population health

management by using data analytics

•  Improve access •  Reduce overall health care costs in

the Inland Empire safety net

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BHICCI Core Elements •  24 month pilot •  30 safety net sites: Primary

Care, BH, Hosp. Ambulatory Clinics

•  Health Homes •  Whole Person Care

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Target Population •  2+ chronic conditions (PH/

BH) •  Benefit from care

management •  High cost •  IEHP members

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BHICCI Roadmap

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Engage Leaders Engage Teams Partner with Patients Data and Measurement Adopt a QI Method Define/Identify Population Build Multidisciplinary, Complex Care Teams/SCR Integrate Behavioral Health Services with Complex Care Sustain Change

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TRIAD TEAMS and Coaches

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Relationship-Centered Care “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” -Maya Angelou

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Registries to Track Progress

AIMS Center: http://aims.uw.edu

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Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months

BHICCI Clinic Site Types BHICCIClinicSiteTypes #ofSites #ofMembersEnrolled(9/1/17)

MedicalClinics 19 2,859BehavioralHealthClinics 3 431Coordina@on-FocusedClinics 3 228PediatricClinics 2 234SpecialtyPainClinics 3 624BHIClinic(nocomplexcare) 1 148

Total 31 4,524

Page 25: Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued at work 2. I have everything I need to provide the best care 3. I trust my team

Workforce Education Sessions

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Core Competencies •  Outreach/engagement •  Health Literacy •  Medication Adherence •  Supporting Self-Management •  Shared Care Planning •  Registry Management •  Transitions of Care •  Cross-System Leadership

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Team and Patient Experience

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Consistency Every Voice Matters

Culture Learning & Contribution

Connection Whole Human Outcomes

EXPerience OBJECTIVES

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“Afocusonexperienceatthebroadestsenseleadstotheachievementofthefouroutcomesleadersaspiretoinvaryingcombina@onsinhealthcareorganiza@onsaroundtheworld:clinicaloutcomes,financialoutcomes,consumerloyalty,andcommunityreputa@on.”-JasonA.Wolf,PhD,CPXP,TheBerylIns@tute

Experience Drives Outcomes

“Thedatapresenteddisplaythatpa@entexperienceisposi@velyassociatedwithclinicaleffec@venessandpa@entsafety,and

supportthecasefortheinclusionofpa@entexperienceasoneofthecentralpillarsofqualityinhealthcare.”

-DoyleC.,LennoxL,BellD.BMJOpen

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PATIENT Participation & Sites Active

265

621

515

578

734

15

21

21

26

31

March

April

May

June

July

Completes SitesAcQve

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Patient Experience Mean & Net Promoter Score

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Mean(avgofthesequesQons)–5pts

1.  Careteamlistenstomeandunderstand

2.  Itrustmycareteam

3.  Careteamalwaysinvolvesmeinthedecisions

4.  Myoverallhealthisbe_er

NetPromoterScore(NPS)–10pts

1.  Howlikelyisitthatyouwouldrecommendthiscarecenter

4.27 4.41 4.3 4.44 4.38

8.84 9.038.52 8.62 8.55

0

1

2

3

4

5

6

7

8

9

10

Marn=265 Apriln=621 Mayn=515 Junen=578 Julyn=734

Mean NPS

PaQentExperience–Mean&NetPromoterScore

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Team Experience Mean & Net Promoter Score

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3.87 3.9 3.94 3.85 3.78 3.89

0 0

8.01

0

7.81

00

1

2

3

4

5

6

7

8

9

Febn=79 Marn=123 Apriln=163 Mayn=167 Junen=179 Julyn=184

Mean NPS

Mean(avgofthesequesQons)–5pts

1.  Ifeelvaluedatwork2.  IhaveeverythingIneedtoprovidethebest

care3.  Itrustmyteamtosupportme4.  Mylifeisbe_er5.  Iplantobeherethreeyears(quarterly)

NetPromoterScore(NPS)–10pts*

1.  Howlikelyisitthatyouwouldrecommend

TeamExperience–Mean&NetPromoterScore

*NPSperformedquarterlyforTeamMembers

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What are some early learnings from the data?

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On average, patients with elevated Behavioral Health scores at Baseline had lower scores, on average, at their last follow-up assessment.

Patients with elevated HbA1c and blood pressure scores at Baseline experienced some improvements in scores, on average.

These results represent a small percentage of all BHICCI patients.

The majority of BHICCI patients are enrolled at Med HCOs and are fairly new to BHICCI (less than 6 months).

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More recent data review: what can we say now?

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Datathrough8-2-17

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37Note:*indicatessta@s@calsignificance

nrepresentsBHICCIpa@entsenrolledforaminimumof1month

ChangeinAveragePHQ-9Scores(BaselineScore>=10)

BehavioralHealthOutcomes–PHQ-9

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Datathrough8-2-17

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Datathrough8-2-17

MeMeBeBe

SpSpBHBH

moderatedepression10

5mild

15

milddepression

average scoresat first assessment

average scoresat last assessment

MedHCO (n=281) * 9.6 8.9CCHCO (n=9) 8.1 7.9SpecPainC (n=15) 10.1 9.6BHI (n=22) 9.2 9.6Overall (n=315) * 9.5 8.9

3

4

5

6

7

8

9

10

11

12

13Change in HbA1c Average Scores (Baseline Score >= 7.0%)

diabetes

normal

prediabetes 5.7%

6.4%

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40Note:*indicatessta@s@calsignificance

nrepresentsBHICCIpa@entsenrolledforaminimumof1month

ChangeinAverageSBPScores(BaselineScore>=140)

PhysicalHealthOutcomes–SystolicBloodPressure

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Physical Health Outcomes HbA1c

41*Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months

PhysicalHealthOutcomes–Diabetes

9.5 8.9

3456789

10111213

OverallAverageScoreatFirstAssessment OverallAverageScoreatLastAssessment

ChangeinAverageHbA1cScores(BaselineScore>=7.0%)(n=132)*

Physical Health Outcomes Systolic Blood Pressure

PhysicalHealthOutcomes–Diabetes(HbA1c)

PoorlyControlledDiabetes

Page 42: Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued at work 2. I have everything I need to provide the best care 3. I trust my team

Physical Health Outcomes Systolic Blood Pressure

42*Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months

151.9

135.3

80

100

120

140

160

180

200

AverageScoreatFirstAssessment AverageScoreofLastAssessment

PhysicalHealthOutcomes–Hypertension(SBP)

ChangeinAverageSystolicBloodPressure(SBP)Scores(BaselineScore>=140)(n=364)*

Stage1Hypertension

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Behavioral Health Outcomes PHQ-9

43*Pa@entHealthQues@onnaire(PHQ-9)–DepressionScreening**Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months

17.1

12.4

0

5

10

15

20

25

30

AverageScoreatFirstAssessment AverageScoreofLastAssessment

ChangeinAveragePHQ-9Scores(BaselineScore>=10)(n=828)**

BehavioralHealthOutcomes–Depression(PHQ-9*)

ModerateDepression

ModeratelySevereDepression

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PreliminaryCostData(UCSD)

Preliminary Cost Data are Trending in the Right Direction

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PreliminaryCostData(UCSD)

Preliminary Cost Data are Trending in the Right Direction

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BHICCICaseRates

•  ProjectGoal– DevelopCaseRatesfortheBHICCITeamsthatwillkickinakerthepilotendsinJuly2018.

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BHICCI Roadmap HealthHomesProgram(HHP)–BHICCIisfootprintforCalifornia1115waiverHHP--startsJanuary2019

BHICCIAwardedDepartmentofCaliforniaHealthCareServicesManagedCareQualityAward–October,2017

Page 48: Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued at work 2. I have everything I need to provide the best care 3. I trust my team

Shoulders by Naomi Shihab Nye A man crosses the street in the rain, Stepping gently, looking two times north and south, Because his son is asleep on his shoulder. No car must splash him. No car drive to near to his shadow. This man carries the world’s most sensitive cargo but he’s not marked. Nowhere does his jacket say FRAGILE, HANDLE WITH CARE. His ear fills up with breathing. He hears the hum of a boy’s dream deep inside him. We’re not going to be able to live in this world if were not willing to do what he’s doing with one another.

The road will only be wide. The rain will never stop falling.

Page 49: Integrated Behavioral Health for Complex Patients: Roadmap, … · 2017-11-15 · 1. I feel valued at work 2. I have everything I need to provide the best care 3. I trust my team

Questions | Discussion [email protected]

[email protected]

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