Linkedin Power point

110
SYNCHRONIZATION

Transcript of Linkedin Power point

Page 1: Linkedin Power point

SYNCHRONIZATION

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ASystemic Integration

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ofBehavioral Health

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into the Medical Continuum

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T. C. O S N E R & A S S O C I A C A T E S

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I didn’t pick my illnesses

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To my endocrinologist,I’m a diabetic

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To my PCP,I have Crohn’s

Disease

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To my OB-GYN,It’s a recurring

infection

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To my Oncologist,I have breast CA

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To my Hospitalist,I’m someone to

stabilize

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To the ED doc,I’ve got panic attacks

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What’s the one thing they

all have to deal with?

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The reason I have to see them

more than I should ?

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My Depression . . .

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My Depression . . .

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. . . my socialstressors . . .

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. . . and my addiction

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Behavioral health issues . . .

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. . . the pervasive co-morbidity

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By now, we’ve all seen the stats

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But we still suffer from . . .

STEREOTYPES

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“Will someonePlease get thisPsych patient

outof my ED?”

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A partial solution . . .

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. . . adding much needed serves

Behavioral health in Oncology

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. . . Creating medical homes

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But it’s a systems problem . . .

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Behavioral Health Integration,

like the rest of Healthcare,

has been stitchedtogether into a

Monster

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An arm here . . . . . . a leg there . . .

and last – The Brain

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Developing in silos . . .

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Independent

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Uncoordinated

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Uncooperative

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disconnected

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duplicative

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protective

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“MyProgram”

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A philosophy of integration . . .

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. . . based on new assumptions

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Behavioral Health is inclusive of promoting well-being . . .

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. . . preventing and intervening in harmful behaviors . . .

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. . . and the treatment of mental health and addictions disorders

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It is a primary service firstand a specialty service second

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It engages all behavioral healthmatters regardless of location

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Treatment occurs at the siteof the most frequent medical

utilization

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Treatment is synchronizedacross the medical continuum

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The systems engages with the patient rather than patients having to engage with

departments

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Behavioral heath integrationIs defined on three levels

Substance abuseand mental health

Internal integrationof core services

External integrationinto the medical continuum

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Realigning and repurposing resources

to be FTE neutral

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How to build an integrated service: From primary to specialty care

Assessment & ReferralAnchor Service(licensed SW/Registrar/Hybrid ClinicianCall Center/Database-EMR/Inter-departmental)

From routine to acute

Embedded Hybrid PracticesIn Primary Care

Embedded Hybrid Practicesin Specialty Care(cardiology, oncology, endocrinology, etc.)

Reprogramming of BHUandRealignment of psychiatry

Realignment of existingHospital-base outpatientinto hybrid MH/CD programs

Hospital-based Behavioral Health

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All integration effortsboth in internal and externalbegin with the developmentof the Hybrid Clinician

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Creating . . .

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Creating . . .

E T H O S

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As every Marine is a rifleman . . .

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. .. every clinician is a Hybrid

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Hybrid Clinician profile

• Licensed Masters – level Clinician in social work, psychology or marriage/family

• Licensed or Certified Alcohol/Drug Counselor

• Conceptual/systems thinker

• Flexible team player

• Strong diagnostic skills

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Hybrid Clinician profile

• Experienced in different levels of care

• Entrepreneurial

• Desire to be more than just “a therapist”

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Hybrid Clinician skillset

• Knows the entire system

• Functions at any level of care

• Interventionist: CBT/SFBT/MI

• High Risk case management

• Utilization management

• Registrar

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Hybrid Clinician skillset

• Versed in Lean Principles

• Certified in Primary Behavioral Health Care

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Financial sustainability is achieved

through existing payment mechanisms

and creative partnershipswith payers

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Creating an organic system .

Embed infrastructure

rather than a service

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Creating an organic system .

Embed infrastructure

rather than a service

Hybrid skillsets –

No Wrong Front Door

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Creating an organic system .

Hybrid skillsets –No Wrong Front Door

Treatment is synchronizedand flows through

the system

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Creating an organic system .

Treatment is

synchronizedand flows through

the system

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

Single Hospital System

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

Single Hospital System

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

SpeciallyTrainedHybrid

Clinicians

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

Single Hospital System

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

PreviouslyUnidentified

Psych Drivers

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

Single Hospital System

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

PreviouslyUnidentified

Psych Drivers

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

Single Hospital System

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Integrate intoSystemPCPs &

Specialties

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

Single Hospital System

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Integrate intoSystemPCPs &

Specialties

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Challenges & Hurdles

“You can’t do that”

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Challenges & Hurdles “Our system is too big”

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Challenges & Hurdles “You can’t do it all at

once”

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Challenges & Hurdles “What about HIPAA”

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Challenges & Hurdles

“We can’t afford additional FTES”

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F

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Fi

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Fir

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Firs

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First

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First S

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First St

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First Ste

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First Step

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First Steps

Diagnose the System

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First Steps

Diagnose the System

“If you want to truly understand something (like your organization), try to change it”

Kurt Lewin

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First Steps

Diagnose the System

• the Infrastructure

• the Culture

• the Continuum connectivity

• its nimbleness

• current employee fit

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Diagnose the System

• the Infrastructure

• the Culture

• the Continuum connectivity

• its nimbleness

• current employee fit

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Identify administrator

and physician Champions!

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Identify administrator

and physician Champions!

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Train 1st generation Hybrids and their leader.

(Hybrid boot camp)

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Educate Payers regarding the model

and haveHybrids credentialed

on all panels

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Engage Finance for all Proper Support

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Engage IT for all Proper Support

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Identify PCP/SpecialtyBeta Sites

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Then . . .

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Tell the story

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Tell the story

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Tell the story

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First Steps are bothsequential and simultaneous

efforts

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Playing in old Yankee Stadiumwhile building

New Yankee Stadium

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Single Hospital System

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Single Hospital SystemOne

Department

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Single Hospital SystemOne

DepartmentOne Identity

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Single Hospital SystemOne

DepartmentOne IdentityMultifaceted

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Single Hospital SystemOne

DepartmentOne IdentityMultifaceted

Revenue generating

Across the

Continuum of Care

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Single Hospital SystemOne

DepartmentOne IdentityMultifaceted

Revenue generating

NoWrongDoor

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ICU

PCP PCP

PCPPCP

PCPPCP

SpecSpec

SpecSpec

Spec Spec

SPECIALTYMED/SURG

EDBHU

SpecialtyMentalHealth

SpecialtyMentalHealth

A&RC.C.

Supplemented by billable

Web-basedCBT

Web-basedCBT

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What it is and what it does . . .

• Embeds infrastructure, not just a service

• Coordinates systems rather than clinicians

• Delivers treatment where the patients are

• Reduces stigma and impacts compliance

• Impacts costs

• Not the typical Hub & Spoke system