Post on 21-Jan-2016
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Integrating Behavioral & Physical Health: Building “Whole Person” Health
Presented by:Peter Currie, PH.D
Senior Director of Clinical Transformation & Integration
Inland Empire Health Plan
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IEHP Membership
2015
1,100,000
2009
400,000
2016
1,300,000(Projected)
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Carve Out Of Behavioral Health: Unintended Consequences
County Behavioral
Health
Drug Medi-Cal
Health Plan
Regional Center CCS
Why IEHP Integrated BH:
Physical Health and Behavioral Health (BH) care were Separate and Disconnected
Outpatient Mental Health Services Under Utilized & Substance Abuse Treatment was Nil
IEHP had no influence over the BH Network Coordination of Care – PCPs describe referring into the “Black
Hole” High Cost of BH Administrative Services:
50% of BH dollars reached the MBHO’s Providers (2009)Context – 95% of Tax Payer Dollars
paid to IEHP reach IEHP Medical Providers
The BH Integration Plan
Fully Integrated BH Program – “In House” Streamline the coordination of physical and mental
health benefitsRedirect MBHO Admin/Profit (50%)to fund Expanded
BH ServicesDirectly Contracted BH Network – Identify and
Support Best PracticesEliminate Reliance on Vendors (MBHOs) for all BH
Expertise including NCQA Compliance
BH Integration within the Health Plan: Results in the First Two Years
Increased access to BH services – Cost Neutral to Plan Medical Cost-Offsets for high-risk/high-cost populations Improve coordination of physical & behavioral healthcare
through Web: Access to Health Record for BH Providers & BH Treatment Reports through IEHP Portal for PCPs
IEHP’s Directly Contracted BH network - Private Sector, FQHCs, County Mental Health & CBOs
Met 100% of NCQA requirements for BH in 2012 & 2015
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BH Integration within the Health Plan: Foundation for Practice Transformation
PCP
PsychiatristCounty Mental Health
Intensive Outpatient Program
Member
Therapist
1-800 Number
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Identifying the Complex Target Population by Adding a BH Lens
Riverside County Specialty Mental Health Mortality Study (Jan 2007- May 2010)
RCDMH41.8 years
Natural Causes46.8 years
Unnatural/Unexpected38.8 years
US AverageLife Expectancy
77.7 years
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Lessons from Riverside County Co-Location Pilot
• Patients arrive to health care providers “fully integrated” with physical and BH needs intertwined
• Health care providers in the IE operate mostly in silos which limits their impact on overall health status
• Blaine Street County Mental Health and Rubidoux Public Health Clinic bi-directional Co-location pilot Learning People seek care where they are welcomed and
comfortable Rather than refer out to the “black hole” bring the
missing/needed care to where the population is getting care
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Chronic health condition + SMI condition = high costs
Medi-Cal FFS No SMI
Medi-Cal FFS SMI
Medi-Cal FFS Enrollees 1,413,654 166,786 11% SMI % of TotalMedi-Cal FFS Costs $3,790,393,322 $2,395,938,298 39% SMI % of TotalMedi-Cal FFS Cost/Enrollee $2,681 $14,365 5.4 SMI/Non-Ratio
Diabetes 3.2% 11.0% 3.5 SMI/Total-RatioIschemic Heart Disease 1.5% 6.0% 3.9Cerebrovascular Disease 0.8% 3.0% 3.9Chronic Respiratory Disease 4.1% 13.0% 3.2Arthritis 1.4% 7.0% 5.0Health Failure 0.8% 3.0% 3.9
Inpatient Episodes/1,000 77 293 3.8 SMI/Total-RatioER Visits/1,000 239 1,167 4.9Inpatient Acute Days/1,000 434 2,094 4.8Primary CareVisits/1,000 85 492 5.8Specialist Visits/1,000 639 6,058 9.5
California Fee for Service Medi-Cal Analysis - 2007
Metric
Data from JEN Associates, Cambridge, MA
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Health Care10%
Environment 19%
Human Bi-ology20%
Lifestyle51%
Traditional Health Care is NOT the Primary Determinate of Health Status
Schroeder, NEJM 357; 12
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Social Determinants: Drivers of Population Health and Patient Experience
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Pressure on Health Plans to Integrate Physical & Behavioral Health
• Download of BH Benefits into the Health Plans January 1, 2014 Medicaid Expansion of Mental Health April 1, 2014 Dual Eligible Pilot September 15, 2014 EPSDT Benefit for Autism
• State Direction & Lessons from IEHP’s recent CMS Audit Expectation that Health Plans have a Care Plan for members
that includes BH provider Treatment Plans Expectation that BH providers participate in Interdisciplinary
Care Teams
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Strategy for Change
Develop an array of Health Homes that are tailored to support practice transformation and:
“Integrated care” Integrated care “results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.”(Safety Net Medical Home Initiative, 2014)
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IEHP Strategy: BH Integration as Platform for Population Healthcare
Primary Care
FQHCSUD
Specialty Clinic Long Term Care Facility
Whole health care that is person-centered, cost effective, and results in
improved health and wellness
BHI-I Themes: Patient/Provider
Experience Team Based Care Care CoordinationSelf-Management Population Health
Shared Areas of Improvement: Access to Care
Integration of Care Coordinated Care
Plan of Action Site Based Planning
CIN/PTI Themes: Electronic Health
Record ConversionPatient
Management Complex Care Management
Disease Management
BHI-I and CIN/PTI Shared Areas of Improvement
PROVIDE FUNDING FOR INFRASTRUCTURE DEVELOPMENT
IEHP invests $20,000,000 over 2 years in 13 health care orgs
a) Build individual health homes tailored to their target population AND ALSO
b) Work collectively to improve the Inland Empire local health care system
SUPPORT PRACTICE TRANSFORMATION WITH COACHING
JCC Coaching Team Practice Improvement Areasa) Improve
patient and provider team experience
b) Provide team-based care and treat-to-target
c) Coordinate care
d) Manage population health
e) Promote self-management
SUPPORT CULTURE CHANGE FROM VOLUME TO VALUE WITH QI FRAMEWORK
The Behavioral Health Integration Initiative (BHI-I) Approach
BHI-I Aim:
Improve the whole
health and
wellness of all
individuals in the Inland
Empire by creating an array
of population-based, integrated health homes
©2015 Jen Clancy Consulting Team. Copying and distribution permitted with citation to JCC Team
BHI-I Coaching Principles1. “Bottom-Up” Approach to Building Population-Specific
Health Homes2. Relationship Based and Accessible to Ensure
Accountability3. Promote Learning and Improvement4. Use of Qualitative and Quantitative Data5. Peer to Peer & Health System to Health System
Relationship Building
Inland Empire’s Thirteen (13) BHI-I Pilot Health Care Learning Organizations
1. Riverside University Health System2. Riverside County Department of Ambulatory
Care3. Riverside County Department of Behavioral
Health4. Borrego Community Health5. Desert Clinic Pain Institute6. My Family Inc. Recovery Center7. Arrowhead Regional Medical Center Family
Medicine Clinics8. San Bernardino County Public Health9. San Bernardino County Behavioral Health10.Social Action Community Health System
Clinic11.Orchid Court, Inc.12.San Bernardino Adult Day Healthcare Center13.Telecare Corporation
Key BHI-I Goals1. Improve access to primary care and behavioral health
providers for adults and pediatric patients, and meet NCQA practice standards.
2. Health and wellness is tracked (using appropriate clinical measurement tools and data) to continuously increase the effectiveness of the treatment team to improve the health status of the target population.
3. Increase whole health screening & systematic follow ups to positive screens
4. Increase the percentage of individuals with self-selected “Total Health and Wellness Goals” that are shared between key providers
5. Improve medication reconciliation6. Improve patients & provider team’s experience of care7. Reduce avoidable emergency room utilization8. Reduce inappropriate hospital admissions9. Reduce 30 day hospital readmissions rate
©2015 Jen Clancy Consulting Team. Copying and distribution permitted with citation to JCC Team)
Behavioral Health Integration:Platform for Population Healthcare
Build & Support Health Home Array with “BH Inside”Supporting Provider Partners who are already integrating
care to build out & refine what they have already begunLinking best integration practices to achieve shared care
plans that live and breath and reflect the whole person Support New Trans Disciplinary Treatment Models for
Complex Populations:E.g. Combining Pain Management, Mental Health and Substance Abuse (SUD) to create a new Pain/Narcotic Misuse Treatment Center
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Why Behavioral Health Homes ?
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All Healthcare is Local
Emerging Designs
Fully Integrated Systems of Care that Align Service
Delivery, Management Structures and Financing
for Medical Care and Behavioral Health
Services in Support of Full Clinical Integration
Historical Designs
Managed Care Organizations (MCOs)
for Health Care of TANF
Fee for Service Health Care Services for Aged,
Blind, Disabled
Mental Health Carve-Out
Fee for Service Drug & Alcohol
Emerging Designs
Managed Care Organizations (MCOs)
for all Health Care
Behavioral Health Carve-Out
Clinical Integration Activities
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Achieving the Triple Aim by Integrating the Social and Behavioral Determinants of Health into Health
Care Payment and Delivery Systems