PowerPoint Presentation · Psychiatry and Behavioral Sciences, University of Washington School of Medicine Contracts (current & recent) California Institute of Behavioral Health Solutions
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Transcript
11/4/2014
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How Can Population Based Care Models
Be Applied to Improve Health Outcomes
for Persons with Serious Mental IllnessOctober, 15, 2014
Marc Avery, MDClinical Associate Professor of Psychiatry
Associate Director for Clinical Services,
Department of Psychiatry and Behavioral Sciences
University of Washington School of Medicine,
Jennifer Clancy, MSWAssociate Director, California Institute for Behavioral Health Solutions
Deborah M. Scharf, Nicole K. Eberhart, et. Al., December 2013. EVALUATION OF THE SAMHSA PRIMARY AND
BEHAVIORAL HEALTH CARE INTEGRATION (PBHCI) GRANT PROGRAM: FINAL REPORT, U.S. Department of
Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term
Care Policy.
SAMSHA
Grantees
I II III IV V VI
13 9 34 8 30 9
Training and T.A.
National Council
Evaluation
RAND
SAMSHA Primary and Behavioral Health Care Integration (PBHCI)
Program
Study Questions:1.Is PCBHCI Possible?2.Does it improve outcomes?3.What components work best?
SAMSHA Primary and Behavioral Health Care Integration (PBHCI)
Program
Core Elements:Required:• Screening and Referral for Primary Care Prevention• Use of Clinical Registry or Tracking System• Person-Centered Care Management• Prevention and Wellness Support Services
Optional:• Co-Location• Population Consultation• Embedded RN care managers• Preventive EBPs
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SAMSHA-HAS Primary and Behavioral Health Care Integration (PBHCI)
Program
Deborah M. Scharf, Nicole K. Eberhart, et. Al., December 2013. EVALUATION OF THE SAMHSA PRIMARY AND
BEHAVIORAL HEALTH CARE INTEGRATION (PBHCI) GRANT PROGRAM: FINAL REPORT, U.S. Department of
Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term
Care Policy.
Models:1.Coordinated Care2.Co-located Care3.Integrated Care
• Partner with primary care organization• Hire primary care team
The Fresno County Care Coordination Partnership Team will make changes to improve the whole health status of adult individuals by coordinating services for the clients with the most serious mental illness and substance use disorders.
Behavioral Health and physical health care’s coordination has, thus far, been driven by individual providers rather than system change. Long-term change must be driven by the systems rather than pushed forward by a few practitioners.
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Overall Theme Across All Agency Partners
• Recognize the importance of physical and mental health care to overall well-being of an individual
• Shared goal and all agency partners benefit!
Agency Catalysts for Care Coordination/Population Health:
– Mental Health (Medical Director)
– CalViva Heath Plan
– Primary Care
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Key changes the Team has been working on
• Multidisciplinary Clinical Care Conferences (routine & ad hoc)
• Develop routine SUD screening
• Support of client self-management
• Ensuring and monitoring routine medication reconciliation
• Ensuring and monitoring authorizations for sharing client PHI
• Referral process between MHP and PCP
• Sharing of patient physical exams, test & lab results
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CC measures data collection process
• Excel spreadsheet (tracks key health indicators, ROIs, etc.)
• MHP’s EHR system (Avatar) - Data reports created specifically for CCC & embedded into EHR for ease of generating data
Who is responsible for collection?
• PCPs and MCPs collect data for their respective measures.
• MHP data analyst responsible for MH data collection, synthesis of data from MCP & PCPs, and reporting out to CiBHS
ACC(PCP)EPIC
CSV (FQHC)NextGen
CalViva(MCP)
DBH(MHP)Avatar
CiBHSCCC
Agency-Specific CCC Data Measures & Client List
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Maintain key personnel from partner agencies
Buy-in from executive leadership
Right People at the Table with the Right Personalities:
• Client centered and dedicated providers
• Providers who follow through and are accountable
• Providers who are real learners. “Care coordination and population health is so different from what has been done before- given the learning curve, the team members must be learners”.
• Providers who are honest, transparent, and “leave their egos at the door”
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Solutions for Coordinated Care Partnerships for Autism Population Health
Autism Assessment Center of Excellence
(Medi-Cal Managed Care Health Plan as Convener)
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Age diagnosis
can be reliable &
valid
The Problem:
Late Diagnosis = Late Intervention =
Diminished Quality of Life & Higher
Life-Long Care Cost
National
Ave Age of
diagnosis
Average
age of ASD
diagnosis in
the
Inland
Empire
Average age
of ASD
diagnosis of
Latino
Childrenin the
Inland
Empire
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Delay in diagnosis =
Lost early intervention =
Diminished life-long
functioning
Quality of Life
Lack of clinical criteria
Lack of essential
medical personnel
Kids with
Autism
Deserve an
Answer!
Fragmented System
Treatment is not well
understood or coordinated
Decisions based on cost
rather than clinical criteria
Scarce Resources
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Autism Society
Inland Empire
Concept Desert
Mountain
Special
Education
LPA
Children’s
Network
First 5
Riverside &
First 5 San
Bernardino
Counties
Inland Empire
Health Plan
(IEHP)
The Solution:Formation of the Inland Empire ASD Collaborative
Inland
Regional
Center
Riverside
County Mental
Health
Department
Riverside
County Office
of Education
San Bernardino
Department of
Behavioral
Health
Dept of
Pediatrics
Loma
Linda
University
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Inland Empire (IE) ASD Collaborative
Vision:
“Every child in the Inland Empire will have access to a collaborative, organized, integrated and Trans-Disciplinary Assessment/treatment resource for Autism.”
Mission:
“To meet the autism community’s needs through shared responsibility for a comprehensive and Trans-Disciplinary assessment, Treatment Recommendations, Referrals and Resources in order to maximize the quality of life for children in the Inland Empire with Autism and their families.”
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Early Intervention
Access to treatment
at an earlier age
leads to a higher
Quality of Life &
functioning
AACE Center:
Integrated & Child-Centric
Inter-agency
collaboration
Improves
referrals and
aligns providers
and educators
Comprehensive
assessment
Eliminates
wasted time &
duplicative
assessments
“One Stop Shop”
Reduces parent’s
burden of having to
advocate and
coordinate across
multiple agencies
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The AACE Center Opens 2014
and Promises to:
Be recognized by medical treatment providers,
school districts and social service programs as a
trusted and credible assessment provider
Provide families and providers with useful,
appropriate and actionable treatment
recommendations, referrals and resources
Be financially self-sustaining 2 years after start-up
Create a model that can be replicated in other
communities.
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Creating Population Health
When a Solution Depends on Shared Responsibility, there Must Still Be a “Convening Organization”
Collaboration takes Longer to Implement
Bringing Everyone Along takes Shared Vision and Mission which must be centered on the Target Population - not any single Agency
When Commitment and Perseverance Prevail a Collaborative Strategy often yields The Best Result for Population Health as it is a: