presenters: susan blue, acsw, community services group carmen klingensmith, community services group...
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Making the Affordable Care Act Affordable
Presenters:Susan Blue, ACSW, Community Services Group
Carmen Klingensmith, Community Services GroupClaire Hornberger, LCSW, TrueNorth Wellness Services
Mary McGrath, MSW, TrueNorth Wellness ServicesBarbara Terrill-Kettering, Psy.D., Community Services Group
• Brief overview of “models” and toolkits that
will help BH providers survive and thrive in this ACA environment.
• Identify and apply strategies your organization may adopt and polish.
• Understand the “packaging” your organization can maximize.
Learning Objectives
Integrated care
TrueNorth Wellness Services – efforts in working with primary care providers
Community Services Group – efforts of wellness initiatives with employees
Introduction
“Obamacare” Passed March 23, 2010 Most significant regulatory change for the US
healthcare system since Medicaid and Medicare Goals:
Increasing quality and affordability of health insurance
Lowering the uninsured rate by expanding public and private insurance coverage
Reducing the costs of healthcare coverage for individuals and government
The Affordable Care Act (Patient Protection and Affordable Care Act)
Has forced a conversation about change, new
service models, and controlling costs Health Homes Accountable Care Organizations Patient Centered Medical Homes Focused conversation on integration of
behavioral health and general medicine Small number of individuals account for largest
percentage of costs Behavioral health conditions – present in other high
cost, chronic health conditions
Affordable Care Act
Sea change for behavioral health providers Craft a role with integration – value added
Consumer/Patient experience – behavior change Financial bottom line – reduction of ED visits
and hospital admissions and readmissions Expand the reach of general healthcare beyond
the doctor’s office and hospital into consumer/patient’s home and community
Integration
Behavioral Health Providers have expertise in
approaches that are valuable and necessary to: A partnership with general medicine in order to improve
the health of our consumers/patients Patient Centered Care and Patient Engagement Community partnerships Evidenced based care that changes behavior and reduces
utilization of services while improving health outcomes: Motivational interviewing Trauma focused therapy Cognitive behavioral therapy Dialectical behavioral therapy
Expertise of Behavioral Health Providers
Helping people change their behavior is fundamental
to achieving better and more cost effective outcomes Jeffrey Brenner - MacArthur Genius and primary care
physician explained that his model relied heavily on the work of behavioral health pioneers when he said, “Actually behavioral health is 30 years ahead of us. I hope primary care can learn from behavioral health. When psychiatric care was deinstitutionalized, behavioral health did heroic work to figure out how to deliver better care at lower cost and evolved some creative models.”
Clearly we have expertise to offer
Goal of Integrated Care – Population Health
We must focus on Mental as well as Physical Wellness
to fully integrate healthcare Our workshop will review several strategies for BH
providers to include in their tool kit as they prepare to enter the world of integrated healthcare in whatever service model exists in their community. TrueNorth Wellness Services – clinical services focus
IMPACT model Lifestyle Management
Community Services Group – employee focus Trauma Informed Care principles and therapy Technology – My Strength
Full Integration
Research indicates early exposure to trauma can
be correlated to behavioral health and substance abuse/addiction issues
Organizations that fail to understand the relevance of trauma on health issues are not likely to experience positive outcomes with individuals they serve and will have difficulty maintaining a healthy workforce
There are various options available to providers for addressing trauma with individuals in service and with a workforce
Trauma Informed Care
10% of patients in primary care experience
depression People with depression have 50-100% higher health
care costs Only 50% of people with depression are treated Many people prefer treatment by their PCP and PCPs
prescribe the majority of antidepressants Treating both physical and behavioral health
achieves better results Many physical symptoms that send patients to their
PCP have behavioral health roots
Integrated Health – Why Behavioral Health Fits into
Primary Care
Stepped program
Assessment and education Behavioral activation/pleasant events
scheduling AND
Antidepressant medication OR problem-solving treatment
Maintenance and relapse prevention plan for patients in remission
IMPACT model – Improving Mood Promoting Access to Collaborative Treatment
Initial treatments are rarely sufficient PHQ-9 used at every visit Outreach to patients who do not attend Can be adapted to and effective in a wide range of health
care settings Effective teamwork is essential Behavioral health staff need the following skills
Strong engagement skills, solution focused, behavioral activation, ability to not engage in intensive therapy, motivational interviewing, problem solving
IMPACT implementation center http://impact-uw.org/about/implementation.html
IMPACT Model
Primary care, mental health, social services,
community based services – we all operate in silos
Working under the same roof is not enough Effective collaboration takes a lot of work Successful integration requires:
Clinical, operational, and financial integration A shared workflow and shared, measurable
goals
Collaboration is Not a Natural State!
A supportive PCP who “owns” the program and
is able to “sell” it to the patient A private workspace for behavioral health staff Clearly defined workflows Everyone in the clinic needs to know about the
program and be able to sell it Effective communication!
Needed to Succeed:
We are guests in their house We must learn their culture We must speak their language Allow for “local” leadership PCP and support staff champions are critical Behavioral health needs to establish TRUST
with the PCP BH personality is as important as credentials Review the finances first!
Lessons learned one year in:
The “magic ingredient” of helping patients make
positive behavioral changes to support better health There are 4 principles of MI:
Express empathy, avoid arguing Develop discrepancy Roll with resistance Support self sufficiency
The basic process: Look for signs of readiness for change Strengthen commitment to change Develop and negotiate a change plan Proceed at the person or organization’s pace
Motivational Interviewing
Motivational Interviewing: Following the basic process
Motivational interviewing is NOT what you were already doing.
When you hear yourself or your staff reflecting “we already do that”. This is nothing new, be wary.
We are all CHANGE AVERSE!
Use EARS as a clinical and administrative skill:
ElaborateAffirm
ReflectSummarize
Or, forge ahead as an organization! May involve recruiting new & different people who share your vision of change or starting a new “division” of your organization
Motivational Interviewing:
Health care costs continue to increase
Focusing on work place wellness with a trauma informed perspective supports health behavior change and impacts health care costs
Workplace Wellness
In an attempt to improve health literacy and normalize accessing BH
services, CSG has crafted an internal EAP program with an updated menu of services within a trauma informed focus
Trauma Informed education and certification is a focus for EAP clinicians
Non-therapists are being identified and trained in crisis management skills to provide emergency response
CSG has made the confidential online resource and screening tool “My Strength” available to all staff to use as needed
CSG provides Mental Health First Aid classes to educate non-clinician participants about managing crisis or someone’s developing behavioral health issue
Other strategies include tobacco cessation and a workplace wellness initiative to encourage healthful eating and increased physical activity
CSG strategies for employees’ physical and
behavioral health
Nimble staff and organization Strengths focused Flexible Results oriented Solution focused
THRIVING IN THE ACA ENVIRONMENT “THE HOW TO’s”:
Important Characteristics to Nurture:
Engagement System perspective System and street “savvy” with non-compliant
patients Motivational interviewing Navigating through obstacles Trauma informed care
Skills/Expertise
Evidence based practices Become indispensable to the physical health providers Demonstrate cost structure advantage Demonstrate positive patient outcomes Solve their system issues/challenges Focus on what works Translate patient communications and behaviors to
physical health providers Join with physical health providers but differentiate
ourselves Embrace continuing education
Must Do
Population health management Real outcomes that translate into healthier
population at lower cost Aging demographic and growing health care
needs of aging populations How to meet these demands without
increased costs?
Future Considerations
Susan emphasized that we can navigate the “sea change”
that accompanies the ACA from a provider and employer perspective.
Carmen enlightened us about the power of adopting trauma informed care as a bedrock philosophy of all we do.
Barbara described CSG’s robust workplace wellness services and how they incorporate trauma informed care to improve employee health & reduce healthcare costs.
Claire shared the IMPACT model for depression care in a primary care setting as well as the “system savvy” BH providers must demonstrate to make these collaborations successful.
WRAP UPTo tie together the major points/learning from this
presentation:
I highlighted Motivational interviewing as a key
skill to master to create behavior change in the clinical work of integrated care and lifestyle management as well as a central component of the organizational redesign and rebranding BH providers must do to thrive in this ACA world.
Hopefully, we have met the learning objectives for this workshop and shared the philosophies, skill sets and adaptive characteristics each of our organizations must embrace to go beyond “surviving” to THRIVE in an ACA environment.
Wrap Up (cont.)
Adverse Childhood Experience (ACE Study/1995-1997 )
Collaborative effort between the Centers for Disease Control and Prevention and the Kaiser Permanente’s Health Appraisal Clinic, San Diego, California
Resources to acknowledge: National Council’s learning communities SAMHSA SAMHSA-HRSA (Health Resources and Services
Administration) Center for Integrated Health Solutions (CIHS)
Sara Collins, PH.D, The Commonwealth Fund
References & Resources
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