Successful Integration of Behavioral Successful Integration of Behavioral Health into Medical Hypertension Health into Medical Hypertension ManagementManagement

University Family Medicine—Denver University Family Medicine—Denver HealthHealth

Lowry Family Health Center Hypertension Lowry Family Health Center Hypertension ClinicClinic

Verena Roberts, Ph.D.Verena Roberts, Ph.D.

Session I5 – TapasSaturday, October 29, 2011

Learning ObjectivesLearning ObjectivesLearn how to successfully integrate

behavioral health into medical management of hypertension

Learn innovative approaches to management of patient health

Learn how to deliver brief evidence-based practices on hypertension in a time-limited

Learn how to adapt an integrated approach to your clinic structure

Denver Cares

Denver Cares

Correctional Care

Correctional Care

Denver Health

Medical Center

Denver Health

Medical Center911911

Community Health

Services (CHS)

Community Health

Services (CHS)

Regional Poison

Center & Nurseline

Regional Poison

Center & Nurseline

Denver Health

Medical Plan

Denver Health

Medical Plan

School-based Health Centers

School-based Health Centers

Rocky Mtn Center for

Medical Response to Terrorism

Rocky Mtn Center for

Medical Response to Terrorism

Public HealthPublic Health

Rocky Mtn Regional

Trauma Ctr

Rocky Mtn Regional

Trauma Ctr

Denver Health/CHSDenver Health/CHS

Lowry Family Health CenterLowry Family Health CenterMedical Director/Team Leader (MD)Program Manager (RN)3 FT/3 PT MD Attendings2 F-NPs2-2-2 Family Medicine Residents2 Behavioral Health Consultants (PsyD & PhD)2 RNsPT Patient Navigator6 Medical Assistants a/k/a Health Care Partners (HCPs)PT Pharmacy Dispensary TechnicianPT Family Planning Educator3 Laboratory Technicians Clerical Supervisor5 ClerksResidency Coordinator

From Idea to ImplementationFrom Idea to Implementation How we got started:

◦ PCHM project

◦ Clinic split into two teams

◦ Each team chose a “topic” Hypertension (HTN)

◦ Weekly “HTN Clinic” focused on medical HTN management of patients with HTN who were already diagnosed by their PCP, but blood pressure was uncontrolled

◦ 1 provider sees only HTN patients in 1 afternoon session Medication assessment Educational handout NO BEHAVIORAL HEALTH

Aim StatementAim Statement We aim to improve the identification and management of patients with

hypertension in Lowry Family Health Center. The process begins with the correct diagnoses of hypertension. The process ends with each patient having an individualized care plan. By working on the process, we expect:

- improved health- decreased visits for patients- improved outcomes- patient and employee satisfaction- medication compliance- increased access- decreased cost. It is important to work on this now due to: 1. Access issues 2. Expensive to health care system 3. Decrease mortality and morbidity in patients.

Behavioral Health IntegrationBehavioral Health Integration

Metamorphose of the Lowry HTN clinic◦Idea was introduced to team during monthly

PCMH meeting◦After initial “yes” – more detailed proposal

Logistics Content

◦Continued discussion with medical provider who was conducting the HTN clinic

◦Develop and research evidence-based treatments that can be adapted to short primary care visits

Integrated HypertensionIntegrated HypertensionClinic Key FeaturesClinic Key Features• Half-day scheduled with 8-10 HTN patients• Visit limited to hypertension issues• All patients seen by medical and behavioral health provider

• either together or one after another• Medication adjustment for hypertension• Self-management goal-setting/ Motivational Interviewing• Follow-up during HTN clinic only• Clinic is provider-driven

Clinic FlowClinic FlowPatient

navigator selects patients

from registry or PCPs refer patients

- Patients have to

have HTN dx -

appointment is made by navigator or

HCP

Clerk checks

patients in – HCP

gets vitals and blood pressure, rooms pt.

PCP and BH see patient together Or alone, but tag team,

so that each patient is

still seen by both, PCP and BH- Use

Vocera to communicate & manage

flow

Check out via HCP (if

non-English) or clerk and follow-up

appointment is made

Extending the Team WorkExtending the Team Work• Clerks and HCPs manage visit flow and assist with

check out and follow-up• Patient navigator finds patients via registry and

makes calls• Other PCP’s make referrals to HTN clinic• Remember – this is not a 2 person pony show, but a

team approach

Action Plan SheetAction Plan Sheet

Challenges to IntegrationChallenges to IntegrationData collection Clinic flowTurf protectionFollow-upProvider driven

Key Factors to IntegrationKey Factors to Integration Get your clinic on board!

◦ Talk to leadership

◦ Use PCMH as starting point Start small Be flexible Be persistent Show providers and patients how behavioral health can help Have a plan Do not take “no” for an answer, but come up with solutions – or

better – think of possible problems that may occur and have an answer

Build positive relationships with providers Regroup after each clinic – what works, what doesn’t? Give positive feedback and point out your successes! Involve the entire team as needed

AdaptationsAdaptationsTalk to PCP’s about behavioral health seeing patients

with significant HTN issues via integrated care visits (PCP & BH present at same visit)

Each day, scout out patients and huddle with PCPs regarding which patients are appropriate for BH integrated visits

Advertise how BH can help PCP’s with HTN patients If you happen to be unavailable, have patient see BH in

individual visit or schedule future integrated visit

Questions/DiscussionQuestions/Discussion