BEHAVIORAL HEALTH INTEGRATION INTO

PRIMARY CARE SETTING

Marlene Putman, Administrator, Tillamook County Health & Human Services

Frank Hanna-Williams, Executive Director, Tillamook Family Counseling Center

Barbara Weathersby, LCSWBehavioral Health Provider, TFCC & TCH&HS

May 16, 2013

Welcome & Introduction

• Overview• What is Integration?• Workshop participants • Agenda

Tillamook County Integration Project:OUR JOURNEY

•When & How we started•Our Process•Our Partnership and Funding•Work Underway

Time Spent

Inte

grati

on E

ffort

s

Great Idea!!How we started

Making It Work!!

Partnerships & Funding

The Journey

Now What?!!

Our Process

Readiness Exercise(Readiness Assessment in Folder)

Behavioral Health Integration:What it looks like On The Ground• Recruitment, Job

Description & Role

• Shadowing, Care Teams, Interaction

• What’s in a Name?– Provider?– Consultant?– Specialist?

Behavioral Health Integration:What it looks like On The Ground

• Shadowing – Providers, clinical & Front desk

• Care Teams – Huddles & Hand-offs • Interaction – Hallways & Always

• Triage – Phone & Front

Patient-Centered Medical Home Care Teams

• Principles: Patient-Centered Medical Home –Personal Provider - Primary Care

Provider –Whole Person Orientation–Care is coordinated or integrated– Focus on Quality and Safety

Patient-Centered Medical Home Care Teams

BLUE TEAM

Provider

Marty Caudle, PAKathy, MADr. Anne ZimmermanBrianna, MADr. Paul BetlinskiAutumn, RNBarb Weathersby, LCSW

Clinical Support

Nurse-------------------------JeannetteCase Manager---------------Emily

RED TEAM

Provider

Dr. John ZimmermanRose, MADonna Jose, ANPOmar, MAErin Oldenkamp, PNPAndi, MABarb Weathersby, LCSW

Clinical Support

Nurse-------------------------KatieCase Manager---------------Jessica

Behavioral Health Integration:What it looks like On The Ground

• What’s in a Name?–Provider?–Consultant?– Specialist?

Sooo…what does integration REALLY look like…

IN THE BEGINNING…

• Research & Learn about Integrated Care• Identify & Engage Leadership• Develop Staff & Partner Buy-in EARLY• Develop Goals and Timeline • Clarify Model, Relationships & Finances• Identify & Develop Agreements• Determine Training Needs & Issues & Details

Lesson Learned:Build Buy-in from the START

BUY-IN = OWNERSHIP & PARTNERSHIP

Learning and working together :

(1) develops your Vision of Integration(2) Provides for regular communication(3) Provides shared experiences(4) Identifies barriers & challenges

LEARN ABOUT INTEGRATED CARE

• Research Models & Context • Talk with Others• Attend training and/or join Collaboratives• Visit Sites• Talk with your staff• Use what you learn to create your model

BUILDING BUY-IN THROUGH LEADERSHIP

• Admin. & Leadership –Vision• Identify key leaders on staff• Identify Other Support Needed• Have a Basic Plan of Action (timelines)

BUILDING BUY-IN – BUILD YOUR CASE

• Use local needs assessments & Plans• Use the research & law• Talk with local Medical providers/staff• Build the business case –cost saving &

patient health• Give examples of effective models

BUILD BUY-IN – BUILD YOUR CASE

• The Business Case for Integration: - Best use of Clinician time - Projections for billable time (10-13PPD) - Staff Support & Retention - Triage- resource & referral

BUILDING BUY-IN – SOME CHALLENGES

• Cultural• Physical• Political• Administrative• Financial• Philosophical – PCMH Model

BUILDING BUY-IN – SOME OPPORTUNITIES

• Screening – PHQ9• Screening – SBIRT• Common measures• Common Clients• Shared staff costs• Community Health Outreach

Buy-InExercise

Question: What will you do next to build Buy-In?

Behavioral Health Integration Start-up: Nuts & Bolts • Developing Infrastructure

1. Preparation for Practice Staff2. Contract for Services3. Billing4. Hire/Identify Mental Health Professional

Behavioral Health Integration: Preparation for Practice Staff

– Clinical/practice staff agree on role – Identify Clinic Champion– Identify Introductions & Training– Include support staff, billing, clinical

& front desk–Define daily workspace, EMR,

training needs, transition time

Behavioral Health Integration: Agreements for Services– Describe model– Describe staff role/job descrip.– Describe funding & Billing–Worksite, equipment, etc.– Hiring & Supervision–Monitoring, Evaluation, &

Communication– Exchange of Information– EMR sytemsContract for Services

Lesson Learned:Billing is confusing- talk with people that have been through it, confer with State, test it, keep learning.

Behavioral Health Integration: Tackling Billing Issues– Differentiate Mental Health and

Behavioral Health–Be clear about diagnosis type–Warm-hand off not billable on

same visit as medical (typically)–All staff have to understand and

document.–Different Insurances= Different

pay

Behavioral Health Integration: Billing Challenges– Different EMRs

–Different terminology

–Different expectations

–Diagnosis & Coding

Behavioral Health Integration: Identify/Recruit/Hire Staff– Recruitment/Ads Describe Role

– Screening of Applicants

– Specific Interview Questions with “Scenarios”

– Flexiblity/Adaptability KEY

Miracles Do Happen!

DiscussionAs time allows

•What would you do next to prepare for Behavioral Health Integration?

Integration from our Client’s Perspective….

Who’s Who

Lead Contact informationMarlene Putman mputman@co.tillamook.or.us

Frank Hanna-Williams

frankhw@tfcc.org

Barbara Weathersby

bweather@co.tillamook.or.us