The Future of Integrated CareNeftali Serrano, PsyD

Executive Director

Photo Credit: Barbara Davidson, New York Times

Objectives

• To identify the major trends in health information technology and healthcare delivery that are likely to impact integrated care

• To identify the workforce development challenges associated with preparing the workforce for emerging trends in integrated care

• To contextualize current trends within the stream of the history of the integrated care movement and the recent history of developments in healthcare

There are no conflicts of interest or commercial interests to report in this presentation or on the part of the presenter.

–Wayne Gretzky

“A good hockey player plays where the puck is. A great hockey player

plays where the puck is going to be.”

Integrated Care Everywhere

Data Explosion Out-of-The Exam Room

Re-Organization of The Workforce

Paradigm Shifts For Chronic Disease

Management

Payment Reform A New Hope

Community Based Interventions

Emergency Medicine

Specialty Medicine

Inpatient Hospital Care

Behavioral Health Homes

Primary Care

Long-Term Care

Blood Pressure

Heart Rate

Blood Glucose

Mood

Substance Abuse

Medication Adherence

Artificial Intelligence

Risk Management

Including Cost of Care

Team Management Of

Data?

Stratification By Location (eg. ED,

specialty); Payer

Recommendations for Proactive Care Management

Telehealth Digital Communication Thinking Outside of The Exam Room

Patient

PCP

BHC

Care Manager

Consulting Psychiatrist

Consulting Pharmacist

Other Consultants

Train, Sustain, Specialize

Emergency Medicine As An Exemplar, 1961-Present

Innovations In Chronic Disease Management

Aging

Unified Funding Sources For Physical

& Behavioral Health

More Patients Covered Under Global or Bundled

Payment Strategies

More Risk/Reward For Providers

More Fixed Costs For Payers

Higher Overall Costs But Better Containment Strategies

Peace In The Integrated Care Galaxy

Primary Care Behavioral Health

Model (Pipeline)

Collaborative Care Model

(What Comes Through The Pipeline)

SBIRT Clinical Pathway

RegistryConsulting Psychiatry

Role

BHC Role

Warm Hand-Off

Family & Systems Perspectives

Fixing Different Parts Of The Health System

Access To Prescribers Of Psych Meds

Clinical Outcomes For Chronic Conditions Reducing Unhelpful,

Excessive UtilizationConnection With Social/

Community DeterminantsReducing Burden On

Medical Providers/ Teams

Access To Behavioral Health Care

Reducing Transition of Care Issues

Consulting Psychiatry Role • Care Manager Role • Behavioral Health Consultant Role • Registry • Screening • Clinical

Protocols • Physician/ PCP Training • Clinical Pharmacist Role • BHC-Like Nutritionist Role • Peer Support Role

“Here's a look at the stock performance since

President Obama signed the Affordable Care Act into law

on March 23, 2010. Centene: +742%

UnitedHealth: +578% WellCare: +538%

Cigna: +499% Humana: +484%

Aetna: +452% Molina: +355%

Anthem: +289% All eight have outperformed

the broader market. The S&P 500 is up about 220% since the law went into

effect.”“With or Without Obamacare, Insurers Are

Thriving,” CNN Money, Oct. 13, 2017

There Is No Turning Back

The Future of CFHA

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References• http://www.aaem.org/about-aaem/aaem-history

• https://apple.news/ACVmm3GhnQ8qLfXqni8v-IQ

• https://apple.news/AU6603Da4TESc0bStI5NKEA

• Eckstrom, J., Williams, D., Avery, M., & Unutzer, J. (2015). The utility of a caseload registry: perceptions of behavioral health clinicians working in an integrated primary care and mental health program. General Hospital Psychiatry, 37(4), 329–334. http://doi.org/10.1016/j.genhosppsych.2015.03.014

• Johnson-Down, L., Labonte, M. E., Martin, I. D., Tsuji, L. J. S., Nieboer, E., Dewailly, E., et al. (2015). Quality of diet is associated with insulin resistance in the Cree (Eeyouch) indigenous population of northern Québec. Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, 25(1), 85–92. http://doi.org/10.1016/j.numecd.2014.08.002

• Korda, H., & Eldridge, G. N. (2011). Payment incentives and integrated care delivery: levers for health system reform and cost containment. Inquiry : a Journal of Medical Care Organization, Provision and Financing, 48(4), 277–287. http://doi.org/10.5034/inquiryjrnl_48.04.01

• Serrano, N., Cordes, C., Cubic, B., & Daub, S. (2017). The State and Future of the Primary Care Behavioral Health Model of Service Delivery Workforce. Journal of Clinical Psychology in Medical Settings, 28 (Suppl 4), S32–12. http://doi.org/10.1007/s10880-017-9491-1

• Vogel, M. E., Kanzler, K. E., Aikens, J. E., & Goodie, J. L. (2017). Integration of behavioral health and primary care: current knowledge and future directions. Journal of Behavioral Medicine, 1–16. http://doi.org/10.1007/s10865-016-9798-7