addiction professionals of north carolina october...
TRANSCRIPT
Addiction Professionals of North Carolina October 17, 2012
Presented by:
David R. Swann, MA, LCAS, CCS, LPC, NCC Chief Clinical Officer
Partners Behavioral Health Management
For Consumers For Providers For Managed Care Organizations For Government Payers (County, State and
Federal) Accrediting Organizations
Better Care Must Be the End Game
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Escalating costs
Shrinking Revenue
Calls for accountability
Pressures from stakeholders (patients, providers, payers, etc.)
Health care reform offers the opportunity to build from local strengths to meet the challenges
Health Homes and Accountable Care Organizations are tools permitted to
achieve the goals
Health Care Reform: Understanding the Context
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1. As parity and national healthcare reform are implemented, more people than ever before will have access to treatment for mental health and addiction services through expanded public and private insurance coverage.
2. Specialty behavioral healthcare organizations must expand capacity to meet increased demand and offer measurable, high-performing prevention, early intervention, recovery, and wellness services and supports.
3. We must also be ready to work with the expanded Medicaid systems and be able to bill through the new health insurance exchanges, Accountable Care Organizations (ACOs), Primary Care Medical Homes, Person-Centered Medical Homes and other funding sources.
4. “Medical Homes” and “Health Homes” are becoming the primary focus of integration of care – connecting the head back to the body…
5. Significant movement to “One Stop Shops” integrated healthcare service delivery models.
Why A System Redesign? Improved Access, Better Care, Potentially Reduced Costs
Access Services earlier on
No show management
Same day access
Reduced time from first call to treatment
Outcomes Same day access
Engagement strategies
New models of care (integration, coordinated care, ACOs, Specialty care, health homes)
Costs Value based purchasing (pay for performance, episodes of care)
Rates
Collaborative documentation
Maximizing capacity
Global Policies and Strategies to Improve Behavioral Healthcare
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1. Prevention and Wellness Focused
2. Managed Care (2012 Version)
3. Integrated “Horizontal” Care Delivery System
4. New Integrated Management Entities for Medicaid and Medicare Funding:
Accountable Care Organizations - Medical Center and Primary Care Practice Partners with specialty providers under contract for service delivery
Health Homes, Health Home Neighbors - Population-based integrated care model targeting consumers with chronic conditions, which coordinate medical and behavioral health care, and community and social supports
Primary Care Medical Homes - Coordinated care model focused on acute care for all populations
Care Coordination to improve care
Key Policy Drivers of a “Reformed” Healthcare System To Address Outcomes, Access and Costs
Payment Reform – Primarily shared risk models with incentive payments to providers for meeting quality outcome indicators
Technology (EHR, Meaningful Use, Telemonitoring, Telemedicine)
Key Policy Drivers of a “Reformed” Healthcare System To Address Outcomes, Access and Costs
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SAMHSA’s Proposed Nine Domains and Continuum of Services
• A modern mental health and addiction system should have prevention, treatment and recovery support services available both on a stand-alone and integrated basis with primary care and should be provided by appropriate organizations and in other relevant community settings. SAMHSA’s proposed continuum includes nine domains, including:
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SAMHSA’s Nine Domains for a Modern Addictions and Mental Health Service System
1. Health Homes
2. Prevention and Wellness Services
3. Engagement Services
4. Outpatient and Medication Assisted Treatment
5. Community Supports and Recovery Services
6. Intensive Support Services
7. Other Living Supports
8. Out of Home Residential Services
9. Acute Intensive Services
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SAMHSA’s Eleven Services Comprising a Modern Mental Health and Addiction Service System Includes:
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1 2 3 4 5
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6 7 8 9 10 11
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Improved Outcomes - Better Care
SU disorders are prevalent in primary care
SU disorders add to overall healthcare costs, especially for Medicaid
SU disorders can cause or exacerbate other chronic health conditions
SU interventions can reduce healthcare utilization and costs
Substance Use Disorders are Relevant in Primary Care
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Recovery Oriented Systems of Care and Integration
Emphasizes recovery as a process which is person-centered, self-directed and positively affects families and communities.
The goals are:
To intervene earlier with individuals with substance use problems;
To improve treatment outcomes; and
To support long-term recovery for those with substance use disorders.
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A Bi-Directional Approach Is Needed
We need to implement this model
bi-directionally—to identify people in primary care with SU conditions and serve them there unless they need specialty care, and to identify people in SU care that need basic primary care and step them to a full scope medical home for more complex care.
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Disproportionate burden of health conditions and risks among those with poor mental health
Source: NYC DOHMH Community Health Survey, 2009, http://nyc.gov/health/epiquery
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Low Rates of Accessing Medical Care
Source: NYC DOHMH Community Health Survey, 2009, http://nyc.gov/health/epiquery
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Was there a time in the past 12 months when you needed medical care but did NOT get it?
Includes doctor visits, tests, procedures, prescription medication and hospitalizations
Co-occurring disorders among Medicaid beneficiaries with substance use disorders
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Models of Behavioral and Primary Care The Case for Integrated Care
Coordinated – services exist in different settings, separate records, treatment plans, minimal contact between providers.
Co-located – both services provided in the same location, may share records but different treatment plans and minimal to moderate contact between providers
Integrated – services have medical and behavioral health (and possibly other) components within one treatment plan for a specific patient or population of patients, share record, coordinate treatment plans, frequent contact
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Why Integrated Care?
Increase patient satisfaction
Improve access to mental health services
Improve quality of care – increase patient functioning and productivity
Lower cost of service especially for highest utilizing patients
Incorporates a biopsychosocial model
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Integrated Care Works Practices demonstrate the following:
More effective medication treatment
Reduced depression severity
Improved general health status
Decreased disability
Better occupational function
Improved patient satisfaction
Cost-effectiveness
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Snapshot: An Integrated Care Program
Minimum Behavioral Health Services Integrated with Primary Care:
Screening
Assessment
Brief Supportive Counseling
Therapy
Case Management
Medication Monitoring
Coordinated team care
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Integrated Healthcare Delivery Settings 1. Accountable Care Organizations (ACOs) Model of Service Delivery
2. Primary Care Practice Medical Homes – Integration of primary care, and behavioral health needs available through and coordinated by the PCP
3. CBHO Health Homes/ Person-Centered Medical Homes - Integration of primary care, and behavioral health needs available through and coordinated by the CBHO
4. Federally Qualified Health Centers (FQHCs) - Integration of primary care, oral health, and behavioral health needs)
5. Multi Agency Health Homes – Integrates medical, behavioral, social services, etc.
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Medicaid Managed Care Systems
Certain types of Medicaid Managed Care waivers are designed to manage the growth of Medicaid funding while, at the same time, maintaining high quality behavioral healthcare benefit plans.
The objective is not to limit services for individuals, but to manage a system so that a person is guided to the appropriate level of care.
35 States currently operating Managed Care Waivers
Medicaid managed care to control costs and to expand the use of disease and care management programs and patient-centered medical homes to coordinate care for high cost and high need populations
Medicaid 1915 B and C Waiver – Prepaid Inpatient Health Plans
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Controlling the selection of the professionals and provider organizations in a particular delivery system
Setting service payment rates and methodologies
Setting clinical best practice policies
Establishing the framework for the measurement of clinical quality and performance
Medicaid Managed Care – MCO Responsibility
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1.3 M Medicaid enrollees, 80% are enrolled in the CCNC Medical Home program.
$984 M in savings between 2007 and 2010.
Cost for persons “aged, blind or disabled” remained constant over the 4 years.
Care is focused on enrollees with complex health problems.
Care Coordination function at Health Home and Care Management at Systems level is used to improve care and reduce cost.
Care Coordination for behavioral health began in 2010
Community Care North Carolina
Where Policy and Strategy Delivered Better Access, Better Outcomes and Reductions in Cost
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Accountable Care Organizations
“Almost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were re-hospitalized within 30 days…We estimate that the cost to Medicare of unplanned re-hospitalizations in 2004 was $17.4 billion” •Source: NEJM 2009;360:1418-28
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Coastal Carolina Quality Care, Inc. (CCQC), Accountable Care Coalition of Caldwell County, LLC, and Accountable Care Coalition of Eastern North Carolina, LLC, who were recently selected by the Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare Shared Savings Program as an Accountable Care Organization (ACO) beginning April 1, 2012.
Cigna, as a private health care insurer, is also expanding its collaborative accountable care program by adding 10 new initiatives with physician groups in seven states, including North Carolina’s Cornerstone Health Care and Key Physicians (Key IPA).
Accountable Care Organizations in North Carolina
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1. What is the time between first call to treatment?
2. We have 454 behavioral health (200 + with Substance Use Disorder) patients assigned to our ACO, how much time will it take them to all get in and receive care?
Accountable Care Organization Key Questions for Behavioral Healthcare
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The ACO Concept for Success
Accountable – 32 Performance Measures
Innovative Care Redesign and Cost Effectiveness
Built Around Consumer
Team-Based Care – Integrated Care
Aligned Incentives to achieve the Triple Aim
Requires relevant, timely data
Shared savings between the ACO and Medicare Trust Fund
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CMS approved the 32 rules for ACO’s
Shared savings based on Four Domains of Quality:
Quality of patient experience
Care Coordination and patient safety
Preventive health
At-risk populations
Accountable Care Organizations
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Medical Homes and Health Homes –The Pathway to Quality Care
Integrated Healthcare “Values” Needed
Under an Accountable Care Organization Model the Value of Behavioral Health Services will depend upon our ability to:
1. Be Accessible (Fast Access to all Needed Services) 2. Be Efficient (Provide high Quality Services at Lowest Possible Cost) 3. Electronic Health Record capacity to connect with other providers 4. Focus on Episodic Care Needs/Bundled Payments 5. Produce Outcomes!
• Engaged Clients and Natural Support Network • Help Clients Self Manage Their Wellness and Recovery • Greatly Reduce Need for Disruptive/ High Cost Services
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A medical home is a coordinated care model focused on acute care for all populations.
Medical Homes
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Lowers health costs; Increases quality; Reduces health
disparities; Achieves better
outcomes; Lowers utilization
rates; and, Improves compliance
with recommended care.
Medical Home Outcomes:
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Health homes are a population-based integrated care model targeting consumers with chronic conditions, which coordinate medical and behavioral health care, and community and social supports.
Health care reform legislation (Section 2703) established health homes as a new state Medicaid option for service delivery specifically for enrollees with chronic conditions.
Health Homes - Policy
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From cost perspective, the member populations are split 5% with multiple chronic conditions and 95% with less complex conditions
This 5% accounts for half (49%) of health care spending.
Strategy: For the 95% with less complex conditions, access to better medications, internet-based services, integrated and coordinated care
Health Home Strategy
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Policy Rationale: Rigorous prior authorization and reduction of provider rates cannot produce the savings and improve the care for the 5% of population with chronic conditions.
Strategy: For the 5%, bi-directional care drives the “wellness” of this population with chronic health conditions (physical, substance use and mental) and their social support needs.
Health Homes: Seeking Better Care to Achieve Additional Savings
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State Option to Provide Health Homes for Enrollees with Chronic Conditions.
Health homes qualify for 90% Federal medical assistance percentage (FMAP) rate for first eight fiscal quarters.
CMSs overarching approach (also know as “The Triple Aim”) to improve health care by:
Better Healthcare for Individuals
Improving the Health of Populations
Reducing the Per Capita Costs of Health Care
Section 2703 of the Affordable Care Act
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Overview: Integrated Healthcare Opportunities and Challenges 1. Low level of internal referrals from MH/SU clinical
staff to primary care services is qualitative concern due to the historical level of physical health service needs for persons with mental illness/substance use disorders.
2. Clinical focus/formulation within the behaviorally trained clinical team seems to be primarily focused on identifying and addressing the signs and symptoms of mental and substance use disorders that does not adequately expand the assessment to identify and address the physical health needs of the same clients.
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Overview: Integrated Healthcare Opportunities and Challenges
1. Need to assist historically training behavioral health staff to embrace the importance of and participate in a fully integrated clinical team to address all of the wellness needs (physical and behavioral) that prevent the client from fully functioning in daily living activities.
2. The Access to Treatment workflows need to incorporate processes that will help ensure that the wellness needs of each client (MH/SU and physical health) are addressed and appropriate treatment plans/referrals are made to support the wellness needs assessed.
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Overview: HealthCare Reform Opportunities and Challenges
CBHO Healthcare Homes - Two Types of Involvement
Participation in development and deployment of bi-directional integrated care projects
Become a health neighbor to a health home as a high performing specialty MH/SU provider organization
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Levels of Systematic Collaboration /Integration
Level One – Minimal Collaboration
Level Two – Basic Collaboration at a Distance
Level Three – Basic Collaboration On-Site with Minimal Integration
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Levels of Systematic Collaboration /Integration
Level Four – Close Collaboration On-Site in a Partly Integrated System
Level Five – Close Collaboration Approaching a Fully Integrated System
Level Six – Full Collaboration in a Transformed Fully Integrated Healthcare System
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Quality Improvement
Healthcare Effectiveness Data Information Set (HEDIS) used by 90% of health plans.
New Medicaid HEDIS performance measures for behavioral health.
The seven new measures fall into three categories – medication adherence, hospital follow up, and physical health management (specifically around cardiovascular screenings, diabetes screenings, cervical cancer screenings, and follow-up after hospitalization) to be added in 2013.
Quality Improvement Policy
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National Quality Forum (NQF) performance measures for consumers with chronic complex conditions.
Optimizing patient function, maintaining function, or preventing further decline in function.
Seamless transitions between multiple provider organizations and care sites.
Access to a usual source of care.
Shared accountability across patients, families, and provider organizations.
Patient clinical outcomes in terms of morbidity and mortality. Avoidance of inappropriate, non-beneficial end-of-life care.
Cost transparency.
Shared decision-making.
Quality Improvement
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Integrated Care
Horizontal Integration within and between programs
Assessments & Protocols designed to identify healthcare risk
Self help programs to promote well care and healthy living
Vertical Integration within and between provider
agencies
Coordination and integration of care across disciplines and providers
HIT alert system for crises occurrences
Horizontal and Vertical Integration: Opportunities for Collaboration
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Simply put, it's a coordinated system that combines medical and behavioral services to address the whole person, not just one aspect of his or her condition.
Medical and mental health providers partner to coordinate the detection, treatment, and follow•]up of both mental and physical conditions.
Combining this care allows consumers to feel that, for almost any problem, they• have come to the right place.
Integrated Care
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So How does the Behavioral Health Delivery System Fit into the new
Healthcare Ecosystem?
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Enhanced Access, Increased Results from Care, Cost Management
North Carolina Provider Readiness Assessment to Measure CBHOs “Value” as a Partner to Improve Care
1. Access to treatment processes and costs and level of redundant collection of information and process variances
2. Centralized Schedule Management with clinic/program wide and individual clinician “Back Fill” management using the “Will Call” procedure
3. No Show/Cancellation management principles and practices using an Engagement Specialist to provide qualitative support
4. Re-engagement/transition procedures for current cases not actively in treatment
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North Carolina Provider Readiness Assessment to Measure CBHOs “Value” as a Partner to Improve Care
5. Internal levels of care/benefit package designs to support appropriate utilization levels for all consumers
6. Outcome Assessment Capacity (i.e., PHQ-9, DLA-20, 10 X 10 Wellness Indicators, etc.).
7. Level of key performance indicators for all staff including cost-based direct service standards and ability to measure Key Performance Indicators
8. Use of Collaborative Concurrent Documentation
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North Carolina Provider Readiness Assessment to Measure CBHOs “Value” as a Partner to Improve Care
9. Current level of internal utilization management functions including: Pre-Certs, authorizations and re-authorizations Referrals to clinicians credentialed on the appropriate third
party/ACO panels Co-Pay Collections Timely/accurate claim submission to support payment for
services provided 10. Payer mix enhancements including third party payers
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North Carolina Provider Readiness Assessment to Measure CBHOs “Value” as a Partner to Improve
11. Revenue Cycle Management including co-pay collection processes
12. Public information and collaboration with medical providers in the community through an Image Building and Customer Service plan
13. Integrated physical and behavioral healthcare service delivery capacity
14. Change management history on time to change and effective implementation
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Value Based Purchasing
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“Value-Based Purchasing” Model
1. Payment Reform is moving from “paying for volume to paying for value/quality”
2. VBP requires integration of clinical, quality and financial information and the ability to track and analyze costs by consumer, provider, team, program, and payor and can operate effectively under fee for service, case rate, and sub-capitation payment models in order to succeed under a variety of Pay for Performance (P4) bonus arrangements.
3. Medicare Case Study:
October 2011 – Medicare will launch VBP for hospitals - +1% to – 1% rate adjustment based on quality measures
In 2017 = +2% to – 2% Medicare rate adjustment based on benchmarks that getter higher each year – “race to the top” in hospital quality
Most health care funding will be through "payers" (rather than 'safety net' sorts of grant funding) and most payer models will be based on managed care and ACO model – with reimbursement focused on "total cost of care" and "pay for performance."
There will be three big "macro" shifts in allocation of funding by payers:
Dollars will move from hospitals, institutional care to community-based
From specialists to primary care
From face-to-face services to tech-enabled services and other technologies
Behavioral Health Funding Policy
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Payment Reform: Specialty Care moving to Case Rate Payment Models
Linkages to Hospitals, Long
Term Care Facilities &
Supported Housing serving
persons with MH/SU
Disorders; Bundled
Payments, Case Rates and
Bonus Sharing
Arrangements for
management of Total Health
Expenditures and minimize
Error Rates
Payment Models to cover
the Medical and Behavioral
Health Prevention, Primary
Care and Chronic Disease
Management including
Dedicated Funding for
Uninsured; Bonus
Structure for managing
Total Health Expenditures
CBHO with
links to
multiple
Medical
Homes
Medical/BH
Health Care
Home
Partner-
ship
Linkages to High
Performing Specialists that
can support the
management of Total Health
Expenditures and minimize
Error Rates; Case Rates
with a Bonus Structure
Food Mart
CBHOs working with Health
Care Homes through
Partnerships or Linkages
Food Mart
Other Specialty CBHOs
Fully
Integrated
Medical/BH
Health
Care Home
Clinic
Clinic
U.S. Population with Serious Mental Health and Substance Use Disorders
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Value-Based Purchasing Attainment Levels:
1. We have educated ourselves and our members about the new payment models that will be unfolding under the rubric of Value-Based Purchasing and understand that payment reform is moving from “paying for volume to paying for value”.
2. Leveraging the integration of our clinical, quality and financial information, they are able to determine, in near real-time, the cost of each service provided in their organization.
3. Member centers have the ability to track and analyze costs by consumer, provider, team, program, and payor and can operate effectively under fee for service, case rate, and sub-capitation payment models.
4. Member centers are able to integrate clinical and financial data to succeed under a variety of Pay for Performance (P4) bonus arrangements.
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Value-Based Purchasing Model Core Elements
1. Know cost per service/staff type
2. Identify clinically recommended service mix,
frequency and duration per level of
care/intensity of need (i.e., ICD-10 CM) to
support determination of costs of
bundled/episodic care needs
3. Provide outcomes to demonstrate reduction
of high/disruptive cost services (i.e.,
reduction in ER visits)
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Section 2703 of The Affordable Care Act permits States to structure a tiered payment methodology that accounts for the severity of each individual’s chronic condition and the “capabilities” of the designated provider, or the team of health professionals.
Flexibility is afforded to States to
propose alternative models of payment not limited to a PM/PM.
Health Home Payment Methodology
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Fee for Service is headed towards extinction Health Care Home models will begin with a 3-layer funding design with the
goal of the FFS layer shrinking over time Being replaced with case rate or capitation with a pay for performance
layer
Medical Homes: Value-Based Purchasing
Case Rate
Fee for Service/
PPS
Bonus
· Prevention, Early Intervention, Care
Management for Chronic Medical Conditions
· Per Service Payment
· Prospective Payment System (PPS)
Settlement (FQHC model) to cover shortfalls
· Share in Savings from Reduced Total
Healthcare Expenditures (bending the
curve)
Person
Centered
Medical
Homes
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Integrating Primary Care into Mental Health and Substance Use Services
• Many individuals served in specialty MH/SU have no PCP
• Health evaluation and linkage to healthcare can improve MH/SU status
• On-site services are better than referral to services due to coordination opportunities and improved adherence
• Person-centered healthcare homes can be developed through partnerships between MH/SU providers and primary care providers
• Care management is a part of MH/SU specialty treatment and the healthcare home
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How Can Substance Use Providers Develop Integrated Systems?
For SU providers envisioning a future role as person-centered healthcare homes, there are two pathways to follow:
1. Providers who want to become full scope person-centered healthcare homes for people with SU conditions should seek to serve a broader community population as well as those receiving SU services
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How Can Substance Use Providers Develop Integrated Systems?
2. SU providers who want to partner with full scope primary care organizations to create person-centered healthcare homes for individuals with SU conditions should organize on-site NP/PCP, collaborative care, care management, a designated PCP consultant, outcome measurement, and stepped care for primary care needs in SU settings
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The Person Centered Healthcare Home for Persons with Serious Behavioral Health Disorders
Assure regular screening and registry tracking/outcome measurement at the time of psychiatric visits for all BH consumers receiving psychotropic medications
Locate medical nurse practitioners/PCPs in BH clinics—provide routine primary care services in the BH setting via staff out-stationed under the auspices of a full scope person-centered healthcare home
Identify a primary care supervising physician within the full scope healthcare home to provide consultation on complex health issues
Assign nurse care managers to support individuals with elevated levels of glucose, lipids, blood pressure, and/or weight/BMI
Use evidence based practices developed to improve the health status of all individuals with chronic health conditions, adapting these practices for use in the BH system.
Create Wellness Programs
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Key Delivery Challenges to the Integration of Behavioral Health Care into Primary Health Care
1. What Model of integration – continuum from co-located primary care to full health care home?
2. What Partnerships with other health care providers for a wider array of coordinated health care services?
3. How to use the Four Quadrant Model of Integration?
4. How to prioritize clients for primary care? – e.g. chronic conditions
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Key Delivery Challenges to the Integration of Behavioral Health Care into Primary Health Care
5. What primary care services will be provided in the integrated setting? e.g. screening for chronic conditions for all persons on psychotropic medications or persons with chronic addictions.
6. What office and support structures need to be in place for effective integration of primary and behavioral health care.
7. How will you address medical records integration and access?
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Key Delivery Challenges to the Integration of Behavioral Health Care into Primary Health Care
8. What billing and code changes will need to be made to sustain the integrated primary care?
9. How will care management and care coordination be provided for persons receiving primary and behavioral health care?
10. How will you integrate wellness and disease prevention and management into the integrated model?
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Creating the Care Team
Create patient identification and flow processes.
Office set-up
Collaboration among team
Practice Models
More integrated care metrics
Screening and tools
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Integration of Primary Care into Specialty Behavioral Healthcare: Roles of Primary Care Practitioner
Creating the Person-Centered Healthcare Home Assure regular screening and registry tracking/outcome
measurement for consumers
Provide routine primary care services to the MH/SU population
Identify a primary care supervision MD if using a NP to provide consultation on complex health conditions
Assign nurse care managers to support person with elevated levels of glucose, lipids, blood pressure, and/or chronic medical conditions
Use EB preventive care practices (immunizations, cancer screening, etc)
Create wellness programs (using peer specialists is a great way to do this)
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How do we design and implement these systems of integrated care?
Practice culture of primary care requires: Consultative BH interventions Fast pace brief interventions High volumes of persons seen Immediate access, availability and
visibility where interruptions are ok New vocabulary Different documentation and tracking
systems Open access/same day scheduling
Integrated Practice Culture
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Behavioral Health Consultation in Primary Care
• Not long-term therapy
• Goal is to answer the QUESTION in primary care
• Brief and focused services
• Behavioral health consultation mirrors primary care more than psychotherapy – variety, episodic care
• Psychiatrist as consultant
• Telemedicine consultation
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Integration of Behavioral Healthcare into Primary Care
Integrated Care Program Behavioral Health Services integrated within Primary Health Care:
• Screening
• Assessment
• Brief supportive counseling
• Therapy
• Case management
• Medication monitoring
• Coordinated team care
Nurse screens clients at
establish care and
annual appointments
Physician sees client and validates screening
Physician introduces client and therapist
Physician and therapist provide team approach
for coordinated care
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Consideration for PCP referral for Behavioral Health Consultation Services
Mental Health Conditions
• Diagnostic clarification and intervention planning
• Facilitate consultation with psychiatry regarding psychotropic medications
• Behavior and mood management
• Suicidal/homicidal risk assessment
• Substance abuse assessment and intervention
• Panic/Anxiety management
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Consideration for PCP referral for Behavioral Health Consultation Services
Health Behavior/Disease Management
• Medication adherence
• Weight management
• Chronic pain management
• Smoking cessation
• Insomnia/sleep
• Psychosocial and behavioral aspects of chronic disease
• Any health behavioral change
• Management of high medical utilization
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The Behavioral Health Consultant in Primary Care: Characteristics, Skills and Orientation to Practice
Characteristics • Flexible, high energy level, match primary care pace and style
• Team player – visible and available
• Interest in health and wellness
Skills • Finely honed clinical assessment and communication skills
• Behavioral medicine knowledge base
• Cognitive behavioral intervention skills
Orientation to Practice • Action-oriented, directive, focus on patient functioning
• Emphasis on prevention and building resiliency
• Utilizes clinical protocols and pathways
• Invested in educating patients
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The Behavioral Health Consultant in Primary Care: Roles, Interventions and Goals
Team Focus • Provides real time patient assessments and interventions • Consult with team on behavior change strategies • Follow up as indicated
Patient Focus • Support patient self-management • Monitor adherence • Provide targeted behavioral interventions
Population Focus • Utilization management • Reduce health risk behaviors in the population • Monitor and improve patient outcomes
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• Perform mental health assessments for the following purposes:
• Assessing psychosocial functioning
• Determining appropriateness of psychotherapy or other psychosocial interventions to address anxiety, depression, other mental illness, or situational concerns
• Provide individual therapy with emphasis on brief interventions (e.g., Cognitive-Behavioral Therapy or Motivational Interviewing)
• Provide short-term family therapy (e.g., Solution-Focused) when appropriate
• Provide group therapy if appropriate to population
• Track progress of therapy patients (e.g., through use of brief monitoring instruments)
Typical Role for a Behavioral Health Professional
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Additional Roles for an Integrated Mental Health Professional
• Oversee mental health screening and referral process • Triage patients in crisis for psychiatric referral • Provide consultation to physicians on mental health issues of
patients as needed Including guidance, based on assessment, to physicians in
considering medication options for treating mental health conditions
• Develop and maintain links with the LME and various community MH/DD/SA providers (agencies and independent practitioners)
• Assist patients in understanding and accessing enhanced mental health or substance abuse services as needed
• Collaborate with billing specialists to insure maximum reimbursement for services, insuring that preauthorization of care is obtained in a timely manner.
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Questions and Feedback Questions?
Feedback?
Next Steps?
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