CLOSING THE BEHAVIORAL HEALTH GAP THROUGH … · • Utilization review, disease management, and case management • Disease management: depression, ADHD, ... •Development of immediate

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CLOSING THE BEHAVIORAL HEALTH GAP THROUGH COLLABORATION

Kristin Ahrens, M.D. Behavioral Health Medical Director

BlueCross BlueShield of Western New York

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Member example: John Smith, 27, electrician

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• Suffering with pain from injury • Requests pain medication refill from PCP • During evaluation admits to using more

medication than prescribed • Sleeping poorly, feels hopeless, and reports

often feeling depressed • Marriage is suffering

National Statistics

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Source: BlueCross and BlueShield Association Study April 2018

National Statistics

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National Statistics

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Consequences

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SUICIDE

Consequences

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Consequences

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Consequences

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Consequences

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Goal

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Behavioral Health

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• Transitioned services from partner to in-house model in fall 2017

• Fully integrated holistic model to support members’ needs

• Utilization review, disease management, and case management

• Disease management: depression, ADHD, and substance use

• Team of psychiatrists, licensed clinical social workers, licensed mental health counselors, and outreach associates

Member example: John Smith, 27, electrician

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• Referred to local clinic for Behavioral Health assessment but chose to not go

• Depression continues and struggles to use pain medication as prescribed

• Prescribed antidepressant from PCP

• Referred to BlueCross BlueShield’s Behavioral Health team for additional support

• Contacted by disease manager the next day who provided support, education, identified barriers to treatment, and helped obtain appointment with local Behavioral Health clinic

Support at All Levels

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• Healthy, low risk • Lifestyle management • Behavioral change component • Addresses lifestyle and decision-making

Health Coaching

• Mid-level complexity • Chronic condition management • Significant self-management component • Addresses preventive maintenance care • Encourages care driven by PCP

Disease Management

• Higher-level complexity • Driven by event/end stage of chronic condition • Higher level of direct case manager intervention • Works closely with care providers, family, and MDs to establish and maintain plan of care

Case Management

Behavioral Team

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Dr. Kristin Ahrens BH Medical

Director

Tina Lamont, R.N., Director

Pat Hunter, LCSW-R Manager

Utilization Management

Kim Hilliker, LCSW BH UM Supervisor

2 BH UM intake associates - L.P.N.s

4 BH UM specialists - 2 R.N.s - 1 LCSW

- 1 LCSW-R

Disease Management

2 BH DM outreach associates

- MS

2 BH DMs 2 LMSWs

Case Management

1 BHCM outreach associate - BSW

5 BH CMs - 4 LMSWs - 1 CASAC

How Does It Work?

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• Fax or call BlueCross BlueShield Health Care Services

Provider Referral

• Based on referral information, member assigned to appropriate level of care and specialty

Member Assigned • Provide information,

education, and referrals, based on a member’s need and continue to follow member as needed

Member Contacted

• Inform providers of work being done with the member and collaborate to reduce or eliminate gaps in care

Collaboration

Member example: John Smith, 27, electrician

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• Attended behavioral health appointment • Continues to receive regular telephone support from his

disease manager from BlueCross BlueShield • Allows his PCP and BH providers to communicate with each

other • Reports that he is beginning to see improvements in his

health

How to Refer

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• Call care management hotline: 1-877-878-8785, option 2

• Referral form online: bcbswny.com Providers Tools & Resources FORMS

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Gale Burstein, M.D. Erie County Commissioner of Health

Clinical Professor of Pediatrics SUNY at Buffalo School of Medicine

Screening, Brief Intervention, and Referral to Treatment “SBIRT”

• Screening: Universal or targeted screening for assessing use and severity of alcohol; illicit drugs; and prescription drug use and disorders

• Brief Intervention: An interpersonal interaction whose primary impact is motivational, working to trigger a decision and commitment to change

• Referral to Treatment: Referrals to specialty care for adolescents with substance use disorders

What is SBIRT

Making the Case • Most with substance use problems not seeking addictions care

• 2/3 risky substance users see PCP every year

o Substance use problems overrepresented in pts seeking medical care

• Just a 5 min intervention ↓ risky substance use

• Great SBIRT outcomes in primary care

• SBIRT is cost-effective

• SBIRT can be performed by many staff, i.e., NPs, PAs, RNs, LPNs, Nurse Midwives, Psychologists, Licensed counselors, Health Ed

Screening

• First step of SBIRT

• Determines severity and risk level of patient’s substance use

• Validated tools for adolescents and adults available

OASAS-Approved Evidence Based Alcohol and Substance Use Screening Instruments

Source: www.oasas.ny.gov/AdMed/sbirt/index.cfm#screening

Source: www.casacolumbia.org/sites/default/files/files/An-SBIRT-implementation-and-process-change-manual-for-practitioners.pdf

DSM-5 Criteria for Substance Use Disorders

1 Use in larger amounts or for longer periods of time than intended

Severity is designated according to the number of

symptoms endorsed:

• 0 - 1: No diagnosis

• 2 - 3: mild SUD

• 4 -5 : moderate SUD

• 6 or more: Severe SUD

2 Unsuccessful efforts to cut down or quit

3 Excessive time spent taking the drug

4 Failure to fulfill major obligations

5 Continued use despite problems

6 Important activities given up

7 Recurrent use in physically hazardous situations

8 Continued use despite problems

9 Tolerance

10 Withdrawal

11 Craving

Brief Intervention (BI)

• How BI is done guided by 2 main factors: 1. Severity of substance use 2. Resources (time/space for intervention)

• These factors must be addressed simultaneously oDetermine how/who/where/when the BI will be done

Referral To Treatment

• Screening indicates more intense course of action is appropriate o Substance issues too severe for BI management

• Goal: To assure patient accesses SUD treatment • Build referral network

oHotline also option (716-831-7007)

SBIRT Reimbursement

• NYS OASAS and NYSDOH developed SBIRT services reimbursement system through Medicaid

• Providers can bill Medicaid, Medicare, and commercial insurance for SBIRT services

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Code Dx Code Description Medicaid H0049 Z13.9 (Encounter for screening, unspecified) Alcohol and/or drug screening

H0050 Z71.41 - Alcohol abuse counseling and surveillance of alcoholic or Z71.51 - Drug abuse counseling and surveillance of drug abuse

Alcohol and/or drug screening, brief intervention, per 15 mins

Commercial Insurance

CPT 99408 Z71.41 - Alcohol abuse counseling and surveillance of alcoholic or Z71.51 - Drug abuse counseling and surveillance of drug abuse

Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 mins

CPT 99409 Z71.41 - Alcohol abuse counseling and surveillance of alcoholic or Z71.51 - Drug abuse counseling and surveillance of drug abuse

Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 mins

Medicare G0396 Z71.41 - Alcohol abuse counseling and surveillance of alcoholic or Z71.51 - Drug abuse counseling and surveillance of drug abuse

Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 mins

G0397 Z71.41 - Alcohol abuse counseling and surveillance of alcoholic or Z71.51 - Drug abuse counseling and surveillance of drug abuse

Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 mins

Erie County SBIRT Roll Out Plan • Pediatric SBIRT training through CAP PC

oPeds SBIRT ToT in 5/17

• OBGYN SBIRT training and QI oHHS Office of Women’s Health funding award oCheryll Moore at [email protected]

• PCP and other medical specialty SBIRT training

oAdult SBIRT ToT in 12/17 oDr. Arthur Weissman at [email protected]

Erie County SBIRT Roll Out Plan

WHAT WE NEED FROM YOU

Adopt SBIRT into your office practice

103 101 127

256 301

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0

50

100

150

200

250

300

350

2012 2013 2014 2015 2016 2017*

2012 – 2017* OPIOID DEATHS, ERIE COUNTY

SOURCE: ERIE COUNTY MEDICAL EXAMINERS OFFICE, *CLOSED CASES REPORTED THRU 3/26/2018

18 Pending Cases

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Anne Constantino, M.S.

President and Chief Executive Officer Horizon Health Services

Together for Recovery. Changing lives.

Saving lives.

• Horizon offers comprehensive, person-centered care for the treatment of mental health and substance use disorders.

Outpatient counseling

Psychiatry, MAT and integrated health

Crisis Stabilization (detox)

Rehabilitation

Health home case management

Recovery Begins Here.

Intensive outpatient and stabilization available for MH and SUD- rapid access to provider MD/NP EBP and Services

Health Homes Family support Trauma informed Care Motivational Interviewing CBT program for Depression DBT EMDR Recovery Coaches Vocational Rehab

Outpatient

Terrace House: • 68 beds

• Medical stability from withdrawal symptoms identified,

• Increased understanding and acceptance of the risks of withdrawal and potential overdose,

• Development of immediate coping skills and supports for use post-discharge as part of clients’ relapse prevention plan –

• Linkage to next level of care-Rehabilitation

Crisis Stabilization (Detox)

Horizon Village campus provides opportunities for individuals to experience recovery while living in a unique, safe, therapeutic residential setting. The beautiful campus in

Sanborn, NY is designed with our residents’ comfort and safety in mind. General Adult program- 50 beds

Horizon Village

For Veterans/first responders- 25 beds Our program provides intensive substance use disorder treatment to men who have served in the military and/or as first responders, incorporating specialized individual and family services for those who also may have post-traumatic stress disorder (PTSD) or mental health disorders.

Freedom Village

25 beds This facility focuses on the growing need for inpatient rehab for young adults (18-27) in our community. Delta Village aims to offer young adults and their

families the opportunity to learn about the disease of addiction and help individuals regain control of their life without relying on substances.

Delta Village

Aurora Village is a 25-bed, intensive residential treatment facility for women with substance use disorders.

Anticipated to open in 2018.

Aurora Village

The Wellness Center offers medical, psychiatric and recreational services to all campus residents. The facility also provides additional meeting and programming

space to accommodate the growing residential community and their families.

Wellness Center

Horizon’s Parent and Family Support Coordinator specializes in presentations for schools and organizations. Focusing on… Family support and intervention Opiate Overdose Prevention & Narcan Training Therapy Dog Program Awareness on the dangers of alcohol and substance use disorders including

prescription drug abuse and dependency

Recovery Coaching is a form of strength-based supports for persons in or seeking recovery. It is a type of partnership where the person in or seeking recovery self

directs his/her recovery while the coach provides expertise in supporting successful change. Focuses on honoring values and making principle-based decisions,

creating a clear plan of action, and using current strengths to reach future goals.

Recovery Coaches

• Founding Members: • BestSelf Behavioral Health (formerly Lake Shore & CATS) • Spectrum Human Services • Endeavor • Horizon Health Services

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Value Network, IPA, LLC

• A BHCC is a network of providers delivering the entire spectrum of behavioral health addressing the health care needs of their communities through clinical integration and promotion of community-based recovery supports.

• They will enhance quality care and increase cost-effectiveness through the use of data to manage quality and risk, and commit as a system, to continuous quality and performance improvement.

• They will promote social determinants of health, person centered care and prevention through community partnerships, including peer-run organizations and small/specialty/niche providers, and CCBHCs where available.

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Value Network, IPA, LLC

Open Access Center OAC

Erie, Niagara, Allegheny, Cattaraugus, Chautauqua

Sub Hub ECMC

Hub TH

291 Elm (822) Sub Hub

STM

Goals Immediate Access

Referral Linkage

Coordination

Family support and ed

Crisis Services 24/7 Hotline

(716-831-7007 (Register + Report)

Refer to Hub, Sub Hub, or Spoke

Other Family MD/PCP CJ Client REAP

Key Hub/Sub Hub

822 Spokes

Recovery Supports

Together for Recovery. Changing Lives. Saving Lives.

The road to recovery begins with one simple step.

Start today by calling our admissions

team with questions.

(716) 831-1800 [email protected]

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Howard Hitzel, Psy.D.

President and Chief Executive Officer BestSelf Behavioral Health

Who is BestSelf Behavioral Health • Largest Community-based Behavioral Health Organization

serving all ages in WNY • Created June 2017 when Child & Adolescent Treatment

Services & Lake Shore Behavioral Health merged • Annual Budget: $48 million • Employees: 700+ • In 2017 Served: 20,000+ children, adolescents & adults

What We Do: • Mental Health Counseling & Rehabilitation

• Substance Use Disorders & Recovery Supports

• Community & Mobile Treatment Services

• School-Based Prevention & Treatment

• Medicaid Health Home for Children & Adults

Certified Community Behavioral Health Clinics

CCBHC is a 2-year pilot program created to provide fully integrated behavioral health care for children, adolescents & adults

BestSelf CCBHC Clinics provide:

• Immediate Access

• Personalized Care

• “No Wrong Door” Approach

CCBHC services include: • Mental Health Disorders

• Substance Use Disorders (including rapid access to Medication Assisted Treatment)

• Health Assessment & Monitoring

• Targeted Case Management

• Peer support

• Education Assistance & Vocational Services

• Parent-Child Interaction Therapy (PCIT)

• Dialectical Behavioral Therapy (DBT)

• Trauma Focused Cognitive Behavioral Treatment (TF-CBT)

Evidence-Based Programs for Children

Early Intervention for Young Adults with Schizophrenia Evidence-based Interventions: • Illness management/coping strategies

• Supported Education & Employment

• Family Education & Support

Targeted Response to the Opioid Epidemic:

• Mobile engagement, assessment and treatment

• Rapid access to Medication Assisted Treatment

Health Home Services

Adult Health Home (18 +) Free Care Coordination for Medicaid Recipients Eligibility: • Two or more chronic health conditions such as

asthma, diabetes, heart disease, substance use

• Serious Mental Illness

• HIV/AIDs

Services: • Develop individualized care plan

• Coordinating medical & behavioral healthcare

• Links to housing and other community services

Children’s Health Home (up to 21) Free Care Management for Children & Families Eligibility: • Two or more chronic health conditions such as

asthma, diabetes, heart disease, substance use

• Could benefit from this level of care

• HIV/AIDs

• Severe Emotional Disturbance

• Complex Trauma

• Community & Mobile Mental Health and Substance Use Disorder Treatment

• Residential Substance Use Disorder Treatment for pregnant & parenting women

• Recovery Community - free support for people in recovery & their families

• Homeless Outreach & Supportive Housing

Other BestSelf Programs

Thank You

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Jodie Altman, M.S., CASAC

Campus Director Renaissance Addiction Services, Inc.

Kids Escaping Drugs and Renaissance Addiction

Services Inc.

Community Education, Early Intervention, Treatment

Renaissance Campus • Renaissance House: For males 12-20 • Stepping Stones: For females 12-20 “We all have chapters in

our lives, but now we can start an entirely new book.” - Renaissance House Alumnus

Renaissance Campus • Most intensive type of treatment available for ages 12-20

in WNY • Only facility that offers residential care for youth under the

age of 18 • Discovery Program – 4 phases • Families are integrally involved in treatment • Patients continue their education while here • Individual, group, family, and specialty counseling sessions

Renaissance Campus

Renaissance Campus • The Campus is in the process of expanding services

• Elements of Care:

1. Stabilization assistance with detox (ages 14-23)

2. Intensive Rehabilitation 4-5 months of residential care (ages 12-20)

3. Reintegration aftercare and transitional services (ages 14 -23)

Kids Escaping Drugs • Foundation to support the Renaissance Campus;

established over 25 years ago • Proactive Community Outreach Program-Face2Face • All Face2Face programs are 100% offered at no cost

The Face2Face Program Peer to Peer Program

• Students hear directly from their peers about the dangers and consequences of the decisions they made

•Many students indicate that this information is impactful when it comes from someone their own age

The Face2Face Program Face2Face in the Workplace Information is provided to parents, educators and workplaces etc. about current trends and concerns

Factual presentation covering current signs, symptoms and trends as well as services available to assist families.

This has been presented to various companies, school staff, parents, doctors

offices, law enforcement, and more.

Early Intervention Program • One time meeting; lasts 1-1.5 hours • Students are referred by educators and parents • Attendance by student, and at least one parent (or guardian) is required • The following takes place at an Early Intervention:

– Students and parents have an opportunity to have confidential conversations with a counselor

– Students and parents have an opportunity to speak with adolescents in recovery

– Families are provided with information regarding current trends and concerns as well as various treatment options

CONTACT US Jodie Altman

Email: [email protected]

Phone: 827-9462 x303

Website: www.ked.org

A division of HealthNow New York Inc., an independent licensee of the BlueCross BlueShield Association.

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