Post on 03-Jan-2016
Safety Net or Death Trap?
Improving Behavioral Health & Primary Care for the
Most VulnerableWayne P. Law, MSW
Administrator, Hawaii Dept. of Health - Adult Mental Health Division - Community Mental Health Center System Administration
C. Kimo Alameda, PhD.Director, Hawaii Dept. of Health - Office of Health Equity & Multicultural Services
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Behavioral Health Safety-Net
The Problem:
The Stigma of Mental Illness Still Exists: Thus, some ethnic (or geographic) groups with mild-moderate mental illness prefer going through the “primary care door” rather than the “mental health door”, and by the time they get into the “mental health door”, they have SMPI.
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Behavioral Health Safety Net
How will it be better addressed?:
At the front -- catching mental illness at the onset (in primary care) with people who tend not to use mental health services so they can obtain treatment earlier.
At the back – catching chronic disease earlier with the SMPI population so they can live longer.
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Behavioral Health Safety-Net
The Problem…cont.:
People with SMPI die on an average of 25 years earlier than those without SMPI. This high mortality is largely due to preventable conditions: Smoking Obesity, Diabetes and Metabolic Syndrome Alcohol and Substance Abuse Infectious Diseases (HIV, TB)
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Behavioral Health Safety Net
The Idea:
A Person-Centered Integrated Health Care Home where one’s behavioral health and primary care needs can be addressed earlier -- in a holistic, culturally appropriate, and non-stigmatizing way.
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Hawaii’s Safety-Net
Health Care Home---Why Else?
Financial Incentives via ACA
A. “Medical Home” $9-$1 federal match for the first 2 years.
State plan amendment available to all eligible providers state wide.
Short Term
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Hawaii’s Safety-Net Health Care Home---Why Else?
B. Continuum of care reduces health disparities for patients with multiple chronic diseases like diabetes, hypertension, and depression, which are aggressive drivers of costs$$$.
2. Already Happening: The majority of “behavioral health care” in the US is delivered in primary care settings -- 65% of all behavioral health medications are given through the primary health care system.
Long Term
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Financially, how is it now?
“It's carved-in for QUEST,
carved-out for QExA (with members getting care through AMHD or CCS) and then other underinsured/uninsured
served by AMHD.”
Quest Expanded Access for the ABD--Aged,
Blind, or Disabled
Under Age 65 and not ABD--Aged,
Blind, or Disabled
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Big Island Project
…consideringworking with the FQHC’s,
Participating PCPs, the Health Plans, and the Beacon Grant
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Who are the Partners?
Dept. of Health-Behavioral HealthObjectives:
• All mental health and behavioral health consumers will have a PCP (or will be incentivized to have a PCP) who participates in a health home.• The “home” could be the nearest FQHC (or participating
PCP health home) or the Mental Health Center / Family Guidance Center if primary care is brought in.
• Pharmacy and Dental will be connected.
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Who are the Partners?
FQHCs and/or Participating PCPsObjectives:
• All patients with suspected severe mental illness will be screened for AMHD/CAMHD eligibility.
• FQHCs/PCPs will have Electronic Health Records.• Health Plans will provide incentives to the FQHCs
and PCPs to allow for such a move.• Base payment per client per month for being a Health
Home?• Bonus payment for improved outcomes?• A Care Coordinator / Patient Navigator
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Who are the Funders?
Dept. of Human Services—MedicaidObjectives:
• The possibility of utilizing the $9-1 ACA federal match.• Hawaii’s State Plan Amendment includes behavioral
health services as part of the Health Home definition and in addition to FQHCs, may allow PCPs, and Mental Health Centers to qualify for this incentive.
• Other?
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Who are the Funders?
Beacon Grant (Big Island) Objectives:
• Beacon will zero-in their efforts on the Medicaid population to ensure all have an Electronic Health Record (HER).
• Beacon will offer funding for the navigator role in the FQHC and for PCPs participating as a health home.
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Kalihi-Palama Project
Oahu
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Using the ACA Incentive?
A. “Medical Home” $9-$1 federal match for the first 2 years.
Hawaii’s State Plan Amendment includes behavioral health services as part of the Health Home definition and in addition to FQHCs, may allow PCPs, and Mental Health Centers to qualify for this incentive.
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Kalihi Palama Community Mental Health Center is looking at….
Bi-Directional Integrated
Health Care Approach
By Partnering with Kalihi Community Health Center, a FQHC, and using
the Medicaid Match
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
NCCBH Four Quadrant Model:
A Conceptual UnderstandingMental
Health
Needs
HIGH
QII:MH is Locus of CareCoordinate with PCP
QIV:MH and/or PC is Locus of
CareCombined Care
LOW
QI:PC is Locus of CareProvide MH by PC?
QIII:PC is Locus of CareProvide MH by PC
Low High
Physical Health Needs
Note: We are targeting Quadrant II and Quadrant IV populations
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
What Are We Talking About?
Consumer/Patient
AMHD Health Center
BH Staff
PC StaffServic
es as Usual
+Some
Primary Care
Services as Usual
+Behavio
ral Health
Package
Funding Opportuniti
es
Adding Staff?
Integrated Team?Coordination of Care via Patient Navigator?Electronic Record?Standardized Screening Tools / Assessment?Cross-agency Forms and Procedures?Cross Training?MOA with other Partners
Cross AssessmentCross Screening Funding
Opportunities
Adding Staff?
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Some Barriers & Potential Solutions We Are Working Through….
Barrier of not knowing Reimbursement Issues such as:
What do we know about who pays for what?. What are the billing rules by payer (eg., billing
primary care visit same day as behavioral health visit, number of visit limits, auth/preauthorization's, etc.?
What do we know about the Medicaid requirements for billing?.
Solution: Work with Medicaid and get involved with the SPA.
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Inability of the Mental Health Centers to be a provider for QUEST patients. Many of KP-CHC’s patients are QUEST insured and will need a higher level of behavioral health intervention.
Solution: Revisit DOH’s current policy established by the previous administration toward restoring the CMHC’s contractual relationship with QUEST Health Plans.
Some Barriers & Potential Solutions We Are Working Through….
9/12/11 Wayne P. Law & C. Kimo Alameda -- Hawaii Department of Health
Thank You
Mahalo!!
Hilo Bay Front