New and Emerging Services and Primary Care, Behavioral (MH/SA) Health Initiative Presented by:...
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Transcript of New and Emerging Services and Primary Care, Behavioral (MH/SA) Health Initiative Presented by:...
New and Emerging Services and Primary Care, Behavioral (MH/SA) Health Initiative
Presented by:
Kathleen Reynolds, Director of CIHS
PBHCI – SAMHSA/HRSA Center for Integrated Health Solutions GrantAwarded to the National Council for Community Behavioral HealthCare
Four years; $5.3 Million/year
Target Audience SAMHSA Grantees HRSA Grantees General Public
Services Training and Technical Assistance Knowledge Development Prevention and Wellness Workforce Development Health Reform Monitoring and Updates
National Steering Committee
Primary Behavioral Health Care Integration (PBHCI) Program - Grantees• Program purpose
• To improve the physical health status of people with SMI by supporting communities to coordinate and integrate primary care services into publicly funded community-based behavioral health settings, including substance abuse service organizations
• Expected outcome• Grantees will enter into partnerships to develop or expand their offering of
primary healthcare services for people with SMI, resulting in improved health status
• Population of focus• Those with SMI served in the public behavioral (MH/SA) health system
Top Ten Areas for Consideration in Developing and Supporting Patient Centered Health Care Homes
•State Level Leadership
•State Level Management
•Models/Strategies
•Culture
•Workforce
•Collaboration
•Confidentiality
•Finance
•Data
•Training
State Level Leadership
• Identify overarching vision and language for discussions• Language (coming soon)• Wagner Chronic Care Model• Four Quadrant Model• Doherty/Baird/Reynolds Continuum
Language Document – In Press – Available within 30 days
The Consumer and Staff Perspective/Experience
Wagner Chronic Care Model
Four Quadrant Clinical Integration Model
The Four Quadrant Clinical Integration Model
Quadrant II
BH PH
Behavioral health clinician/case manager w/ responsibility for coordination w/ PCP
PCP (with standard screening tools and guidelines)
Outstationed medical nurse practitioner/physician at behavioral health site
Specialty behavioral health Residential behavioral health Crisis/ED Behavioral health inpatient Other community supports
Quadrant IV
BH PH
PCP (with standard screening tools and guidelines)
Outstationed medical nurse practitioner/physician at behavioral health site
Nurse care manager at behavioral health site
Behavioral health clinician/case manager
External care manager Specialty medical/surgical Specialty behavioral health Residential behavioral health Crisis/ ED Behavioral health and
medical/surgical inpatient Other community supports
Be
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ral
He
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(M
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Ris
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Quadrant I
BH PH
PCP (with standard screening tools and behavioral health practice guidelines)
PCP-based behavioral health consultant/care manager
Psychiatric consultation
Quadrant III
BH PH
PCP (with standard screening tools and behavioral health practice guidelines)
PCP-based behavioral health consultant/care manager (or in specific specialties)
Specialty medical/surgical Psychiatric consultation ED Medical/surgical inpatient Nursing home/home based care Other community supports
Physical Health Risk/Complexity
Persons with serious mental illnesses could be served in all settings. Plan for and deliver services based upon the needs of the individual, personal choice and the specifics of the community and collaboration.
Low High
Low
Hig
h
State Level Management
• Using overarching structure – What do you expect?
• This time we need “disruptive innovation” not paying for what we already do. What will be different and how will you know that changes are good change?
• How do you envision substance abuse services to be involved in the Health Home?
Models/Strategies – Bi-Directional IntegrationBehavioral Health –Disease Specific
• IMPACT• RWJ• MacArthur Foundation• Diamond Project• Hogg Foundation for Mental Health• Primary Behavioral Healthcare Integration
Grantees
Behavioral Health - Systemic Approaches• Cherokee Health System• Washtenaw Community Health
Organization• American Association of Pediatrics - Toolkit• Collaborative Health Care Association• Health Navigator Training
Physical Health• TEAMcare• Diabetes (American Diabetes Assoc)• Heart Disease• Integrated Behavioral Health Project –
California – FQHCs Integration • Maine Health Access Foundation –
FQHC/CMHC Partnerships• Virginia Healthcare Foundation – Pharmacy
Management• PCARE – Care Management
Consumer Involvement• HARP – Stanford• Health and Wellness Screening – New
Jersey (Peggy Swarbrick)• Peer Support (Larry Fricks)
Models/Strategies for Involving/Integrating Substance Abuse Services• Wisconsin and UCLA – SBIRT Program• Baltimore – Two FQHC’s integrating co-occurring
services into primary care• Connecticut – Methadone Program became primary
care site• Philadelphia – Horizon House• Medication Assisted Treatment Options
Projects by Region
Culture • Acknowledge the differences between MH/SA/PC
cultures• Do not allow it to deter or delay implementation• Address it through training
• On the job training• Existing resources
• Joint grand rounds
• Webinars
• Train together and separately
• Provide support for moving forward
Workforce
Existing Workforce Needs
• Reviewing and Credentialing standards • Substance Abuse Professionals – Treatment and Prevention
• Mental Health Staff
• Who? Can do What? Where?
• Licensing Standards - Space
• Scope of Practice Standards • Advanced Nurse Practitioners
Future Work Force• Linkages with training programs
Collaboration
• Does this come naturally in your state?
• Does your strategy support creating or breaking down silos?
• Does your strategy make use of the solid investments in existing systems and take advantage of their strengths?
• Will you system pay for or support collaboration for systems and for services now and in the future?
• How has MH/SA collaboration/integration gone in your state?
Confidentiality
• HIPAA allows for sharing information for Health Care Coordination
• 42CFR Part II Issues may impeded information sharing
• Does your state mental health code need revising?
Products at levels one, two, three, and four
FinanceExisting Options
• 96100 series• SBIRT codes• Case Management Reimbursement• Dear Medicaid Director 2005
Future Options• Healthcare Home – expanded reimbursement options• Include what we know works!
DataWhat existing data can you develop/share with pilots
sites?• Medicaid Data Based Integrated for MH, SA and PC?• What are the costs per consumer?• Is it available electronically?
What will you want in the future?• How will you know if you are successful?• Do you have registry option for providers?
Training
• Keys to success• Change management training• Collaborative service provision – like professionals train like
professionals• Health Navigator Training• BH staff (MH and SA) in primary care• PC staff in mental health and substance abuse agencies
CIHS Services to Assist You
• Web-based Resource Center (http://www.centerforintegratedhealthsolutions.org)
• eSolutions Newsletter• National Webinars• Regional and State Based Learning Communities