physical & behavioral health integration (bhi): …...depression screening workflow 11 safety...
TRANSCRIPT
![Page 1: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/1.jpg)
March 23, 2017
Physical & Behavioral
Health Integration (BHI):
Strategies to Overcome
Implementation Barriers
0
A Department of Social Services
PCMH Presentation Hosted by
Community Health Network of CT, Inc.
![Page 2: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/2.jpg)
Learning Objectives
1
Explain why behavioral health is an important element to
incorporate in the Person-Centered Medical Home (PCMH)
Define common integration barriers
Understand your current level of integration between physical
and behavioral health
Gain insight into applying strategies to overcome barriers and
sustain BHI
Identify available resources to support BHI in your practice
![Page 3: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/3.jpg)
Triple Aim
2
“[Pursuing the Triple Aim: The First 7 Years]. Cambridge, Massachusetts:
Institute for Healthcare Improvement; [2015]. (Available on www.IHI.org)”
“[System-Minded Design: Optimizing the Microsystem for Workforce
Development]. Cambridge, Massachusetts: Institute for Healthcare
Improvement; [2015]. (Available on www.IHI.org)”
![Page 4: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/4.jpg)
NCQA Standards
Identify high-risk patients who may benefit from care management
through a comprehensive health assessment, and use evidence-
based guidelines to plan and manage their care
Social determinants of health
Behavioral health conditions
High cost/utilization
Poorly controlled or complex conditions
Maintain agreements with and incorporate behavioral health care
providers within the practice site
Improve clinical quality of care, efficiency, and patient experience
for vulnerable patients
3
![Page 5: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/5.jpg)
BHI Models
Consultative Model • Psychiatrists and other behavioral health
clinicians see patients for consultations in their offices – away from primary care
Co-located Model • Psychiatrist and behavioral health clinicians see
patients in primary care settings
Collaborative Model • Psychiatrist and other behavioral health
clinicians work closely in providing caseload consultation with Primary Care Providers (PCPs)
4
![Page 6: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/6.jpg)
Consult, Coordinate, Collaborate
5
Integrating Behavioral Health and Primary
Care: Consulting, Coordinating and Collaborating
Among Professionals; Cohen, et al.,
doi: 10.3122/jabfm.2015.S1.150042
![Page 7: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/7.jpg)
Health Insurance Portability and
Accountability Act (HIPAA)
6
HIPAA Privacy Rule
Assures protection of an individual’s health information
Facilitates sharing of health information needed to provide and
promote the highest quality of care
Protects the public’s health and well-being
Is flexible and comprehensive in covering the disclosures that
need to be addressed
Exception
Stricter state laws or rules for substance abuse treatment
facilities (42 CFR Part 2)
![Page 8: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/8.jpg)
Common Integration Barriers at the
Practice Level
7
![Page 9: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/9.jpg)
Understand Your
Current Level of BHI
8
![Page 10: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/10.jpg)
Gap Analysis
9
SAMHSA-HRSA Center for Integrated Health Solutions:
Behavioral Health Integration and the Patient-Centered Medical
Home
![Page 11: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/11.jpg)
GROW Pathway to Integration Tool
10
Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care
Supplement: Behavioral Health Integration. Phillips KE, Holt BS, eds. Seattle, WA:
Qualis Health, MacColl Center for Health Care Innovation at the Group Health
Research Institute, and the University of Washington’s AIMS Center; 2014.
![Page 12: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/12.jpg)
Depression Screening Workflow
11
Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care
Supplement: Behavioral Health Integration. Phillips KE, Holt BS, eds. Seattle, WA:
Qualis Health, MacColl Center for Health Care Innovation at the Group Health
Research Institute, and the University of Washington’s AIMS Center; 2014.
![Page 13: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/13.jpg)
Ongoing Quality Improvement
(QI) Process
Evaluate behavioral health measures based on data/reports
Choose and define QI project
Assess workflows for potential improvements
Choose realistic, attainable, and measurable goals
Establish timeline for implementation and achievement
of each goal
Complete QI project to implement improvement
Assess for goal achievement
Sustain improvement
The QI process is continuous and cyclical,
never stagnant
Enhancing Outcomes with QI Webinar
12
![Page 14: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/14.jpg)
CareMedica - Primary
Care __________________________________________________________________________________
Feedback From an Integrated Practice
13
![Page 15: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/15.jpg)
Common Integration Barriers at the
Practice Level
14
![Page 16: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/16.jpg)
Care Team Staffing
Care team structure and schedules
Patient involvement
State licensing
15
![Page 17: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/17.jpg)
Clinical Skill Set
Training new staff and existing staff
Communicating effectively
Documentation requirements
16
![Page 18: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/18.jpg)
Medication Management
Medication management protocol
Strategies for optimizing adherence
Care team roles in supporting medication therapy
17
![Page 19: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/19.jpg)
Patient Population Stratification
Identifying patients with behavioral health conditions
Risk stratification
Utilization data from insurer or other source
18
![Page 20: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/20.jpg)
Referral Resources
Identify community resources
Consider population needs
Assess usefulness of community resources
19
![Page 21: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/21.jpg)
Space Availability
Patient encounter suitability
Professional proximity
Private working space
20
![Page 22: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/22.jpg)
Financial Resources
Identify funding sources to implement and sustain BHI
Financial benefits to BHI
Identify billable codes in your state
21
![Page 23: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/23.jpg)
Workflow Processes
BHI workflow processes
Ongoing QI process
Consider patient and family feedback
22
![Page 24: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/24.jpg)
BHI Key Success Factors
Allocate appropriate time to plan
Transform practice culture
Train staff to implement and sustain integration
Assess and manage capacity realistically
Identify internal champions and external stakeholders
Utilize available and free resources
23
![Page 25: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/25.jpg)
Resources
24
By email: [email protected]
By phone: 203.949.4194
Online: www.huskyhealthct.org/providers/pcmh.html
CT Behavioral Health Partnership (CT BHP): www.ctbhp.com
All PCMH webinars located on the HUSKY Health
website page “Pathway to PCMH Webinar Recordings
and Presentation Materials”
![Page 26: Physical & Behavioral Health Integration (BHI): …...Depression Screening Workflow 11 Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral](https://reader033.vdocuments.mx/reader033/viewer/2022050420/5f8f580499585e36ae282a62/html5/thumbnails/26.jpg)
Questions?
25