New and Emerging Services and Primary Care, Behavioral (MH/SA) Health Initiative Presented by: Kathleen Reynolds, Director of CIHS.

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

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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