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www.mhahouston.org
Integrated Health Care Initiative Collaborative Quarterly Meeting
November 14th, 2018
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Collaborative Introductions
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Today we…
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HOPE Clinic Demonstration ProjectRodolfo Orna, M.A. LMFT, Behavioral Health Director
& Shahrzad Afshin Yakta, Behavioral Health Consultant
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MissionTo provide quality healthcare without any prejudice to
all people of greater Houston in a culturally and linguistically competent manner
Rodolfo Orna, LMFTDirector of Behavioral Health
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Main Clinic West ClinicAlief Clinic
BHS
PSYCHIATRY
OB -GYNADULT
PEDIATRICS
OPTICAL
DENTAL
Visits & Encounters
2017 104,000 Visits17,898 Patients(BH 3,271 visits)
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25%Asian
25%African American
29%Hispanic
1%Multiracial
20%Caucasian
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OUR PATIENTSAGE DISTRIBUTION
45-64
20-44
65+0-4
5-12
13-19
Chart1
0 to 4
5 to 12
13 to 19
20 to 44
45 to 64
65 +
AGES
0.16
0.14
0.1
0.39
0.17
0.04
Sheet1
AGES
0 to 416%
5 to 1214%
13 to 1910%
20 to 4439%
45 to 6417%
65 +4%
To resize chart data range, drag lower right corner of range.
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Main ClinicPrimary Care
West Location
Primary Care
Alief Location
Primary Care
BHS PSYCHIATRY
2 BHC
Child
Child
Adult
Adult
Child/A
Adult
PCP
BHS
BHC
Psych
BH Coordinator
MA/Front Office
BHC=Behavioral Health ConsultantBHS= Behavioral Health Specialist
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Main ClinicPrimary Care
BHC: PediatricsBHC: Adult & OB-GYN
PCP
Visits triggered by:
Screening PHQ-9EdinburghPSC-17CAGEPCP referrals
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Integrated Primary Behavioral Health Care Flow Chart
MA Triage + PHQ-9 or Edinburgh Screening
Behavioral Health Consultant
Behavioral Health Specialty: Psycho-therapy(Counseling)and/or Psychiatry
Medical Provider
FollowCrisis Protocol to
determineHospitalization
MEDICALVisit Completed
Coordinates dischargeand referrals to BH
Specialty
Active Suicidal, Homicidal or Psychosis
• Health outcomes• Emotional disturbances• Mental Health Crisis
Additional Screenings: PSC-17, CAGE,DAST,
TRAUMA,
Consultation
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Main ClinicPrimary Care
HOPEWest Clinic
HOPEAlief Clinic
BHC: PediatricsBHC: Adult & OB-GYNPCP
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PROGRESS : LEVELS OF COLLABORATION/INTEGRATION
LEVEL 4: Close Collaboration Onsite with Some System Integration: Communications, Collaboration, Meeting, Roles
LEVEL 5: Close Collaboration Approaching an Integrated Practice: Treatment Delivery, Patient Experience,
LEVEL 6: Full Collaboration in a Transformed/Merged Integrated Practice: Facilities, Resources, EMR, Leadership
Support,
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2018 CFHA Conference Takeaways
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Practice Integration Profile
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• Organizational self-assessment survey www.practiceintegrationprofile.com
• Dimensions:– Workflow– Clinical Services– Workspace– Shared Care & Integration– Patient Engagement
http://www.practiceintegrationprofile.com/
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In our practice…1.…BH and Medical Clinicians regularly and actively exchange information about patient care.
2.…there are regular educational activities including both BH and Medical Clinicians.
3.…BH and Medical Clinicians regularly spend time together collaborating on patient care.
4.…patients with BH needs have shared care plans developed jointly by the patient, BH and Medical Clinicians and updated over time.
Practice Integration ProfileDimension: Shared Care & Integration
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CFHA 20th Annual Conference Session B1 Takeaways
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• “Dynamic Evolution of Integrated Behavioral Health: Developing Data Management Systems for continuous Quality Improvement.”
• Presented by the University of California San Diego• Presentation takeaways:
– National trends and needs– Program structure and background– Clinical & operational aspects– Measures of integration (tools)– Financing integration review
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Clinical Quality ReportSample
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Provider Productivity ReportSample
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Operational ReportSample
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Measures of Integration
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• Practice Integration Profile (PIP)• PCBH-based Provider Adherence Questionnaire (PPAQ)• TCARE (Targeted Collaborative Assessment and Response Empowerment)
– UCSD’s real-time consultation EHR tool• Recommendation: Define/identify your approach identify outcomes
identify measures. Also, identify resources within department to partner with, to develop systems to input and extract data
http://www.uvm.edu/%7Epip/pip.phphttps://www.mirecc.va.gov/cih-visn2/PPAQ.asp
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Individual Profit & Loss ReportSample
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CFHA 20th Annual Conference Session E6 Takeaways
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• “Integrated Behavioral Health at Mayo – Bringing Together Mental Health Disciplines in Primary Care to Better Address a Population.”
• Presented by the Mayo Clinic• Presentation takeaways:
– Program structure & team– Types of services provided– Challenges & recommendations– Tracking of outcomes
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The Multidisciplinary Team
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“You Are Not Alone!”
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https://www.ruralhealthinfo.org/toolkits/services-integration/2/primary-care-behavioral-health
https://www.ruralhealthinfo.org/toolkits/services-integration/2/primary-care-behavioral-health
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CFHA 20th Annual ConferenceSession E7a Takeaways
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• “The Validation of Ultra-Brief, Patient Feedback Measures Intended to Improve the Care of Chronic Illnesses in Primary Care”
• Presented by University of New England faculty and Peak Vista Community Health Centers staff
• Presentation takeaways:– “Privileging the patient perspective”– Patient values & preferences as a key
component of evidence-based practice– Partners for Change Outcome Management
System (PCOMS)https://betteroutcomesnow.com/
https://betteroutcomesnow.com/
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PCOMS – BH (Behavioral Health)
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Outcome Rating Scale (ORS)Individually:
(Personal well-being)____________________________________
Interpersonally:(Family, close relationship)
____________________________________
Socially:(Work, school, friendships)
____________________________________
Overall:(General sense of well-being)
____________________________________
Session Rating Scale (SRS)I did not feel heard,
understood and respected.
We did not work on or talk about what I wanted to work on
and talk about.
The therapist’s approach is not a good fit for me.
There was something missing
in the session today.
Relationships
Goals and Topics
Approach or Methods
Overall
I felt heard, understood and
respected.
We worked on and talked about what I wanted to work on
and talk about.
The therapist’s approach is a good
fit for me.
Overall, today’s session was right
for me.
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• PCOMS – WRS (Wellness Rating Scale)– Personal Health, Relationships, Activities, Quality of Life– Scale from to
• PCOMS – PAS (Provider Alliance Scale)– Relationship, Communication, Partnership, Treatment– Example (Relationship) – I did not feel comfortable asking questions or
raising concerns about my health and treatment. I felt comfortable asking questions and raising concerns about my health and treatment.
• Peer-reviewed validation study: http://link-springer-com-443.webvpn.jxutcm.edu.cn/article/10.1007%2Fs11136-018-1967-4
PCOMS – WRS & PASChronic Illness Measures
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http://link-springer-com-443.webvpn.jxutcm.edu.cn/article/10.1007%2Fs11136-018-1967-4
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Workgroups 2019 Projects Overview
MHA Staff
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2019 Work Group Projects
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• Service Delivery Work Group– Screening to Treatment
Roadmap White Paper– Public Education on
Integrated Care– Educational Forums
• Financing Work Group– Sustainability Toolkit
• Institutions of Higher Education Work Group
– Institution Presentations– TMC Policy Institute IHC Course– Professional & Accrediting
Association Presentations
• Public Policy Work Group– 87th Legislative Session Agenda
Planning– 86th Legislative Session
Advocacy Task Force
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Evaluation Pathway
www.mhahouston.orgSource: Collective Impact Forum. FSG. “A Framework for Performance Measurement and Evaluation of Collective Impact Efforts”
We are here! Q3 2018
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10-Year ReportAccomplishmentsQ4 2025
Biennial ReportProgress to dateQ4 2024
Biennial ReportProgress to dateQ4 2022
Integrated Health Care Initiative Timeline
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2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
Early Years (3) Middle Years (5)
18 Guiding Recommendations Developed
Q2 2016
IHCI Launched
Q2 2015
IHCI Report PublishedRecommendationsQ4 2016
Action Plans FinalizedWork Groups
Q4 2018
Stakeholder Meetings
Q3 2015
Today
Collaborative Meeting
Q4 2018
Late Years (2)
Retreat
Interviews
Policy Project
Collaborative & Work Group Meetings
Q1 2017 – Q3 2018
Quarterly/Bimonthly
Collaborative & WG Meetings / Action Plans Implementation
2019 - 2025
Exact Milestones TBA
5-Year ReportProgress to dateQ4 2020
Demonstration Projects / Learning Communities Launched
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• Continuing:– Quarterly Collaborative Meetings– Quarterly Networking Events– Monthly Work Group Meeting
– Biweekly Resource Bulletin
– In-depth Educational Events
• Potential Opportunities:– Learning Community Calls (Various Focus Areas)
Looking Ahead Into 2019!
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2018 CFHA Conference TakeawaysMHA Staff
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Thank You!
Integrated Health Care Initiative �Collaborative Quarterly Meeting�November 14th, 2018Collaborative IntroductionsToday we…HOPE Clinic Demonstration Project��Rodolfo Orna, M.A. LMFT, Behavioral Health Director�& Shahrzad Afshin Yakta, Behavioral Health ConsultantSlide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 152018 CFHA Conference TakeawaysSlide Number 17Practice Integration ProfilePractice Integration Profile�Dimension: Shared Care & IntegrationSlide Number 20CFHA 20th Annual Conference Session B1 TakeawaysClinical Quality Report�SampleProvider Productivity Report�SampleOperational Report�SampleMeasures of IntegrationIndividual Profit & Loss Report�SampleSlide Number 27CFHA 20th Annual Conference Session E6 TakeawaysThe Multidisciplinary Team“You Are Not Alone!”Slide Number 31CFHA 20th Annual Conference�Session E7a TakeawaysPCOMS – BH (Behavioral Health)PCOMS – WRS & PAS�Chronic Illness MeasuresWorkgroups 2019 Projects �Overview��MHA Staff2019 Work Group ProjectsEvaluation PathwayIntegrated Health Care Initiative TimelineLooking Ahead Into 2019!2018 CFHA Conference Takeaways��MHA StaffThank You!