SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Program Grantees: Part 2

Transcription

1 SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Program Grantees: Part 2 Ken Bachrach, Ph.D., Clinical Director Jim Sorg, Ph.D., Director of Care Integration and IT Tarzana Treatment Centers ILC Meeting #39 November 19,

2 SAMHSA PBHCI Program The SAMHSA PBHCI program provided grants to promote the integration of primary care services for adults with serious mental illness (SMI) in community-based behavioral health settings. The PBHCI program s purpose is to increase access to health care for individuals with SMI and improve their overall health status through better coordination of care. 2

3 SAMHSA Primary Care Behavioral Health Integration (PBHCI) To integrate primary care with MH/SUD services for patients with a chronic physical health condition and a serious mental illness Grant 1: Improve Care Integration at Tarzana Treatment Centers (TTC) Grant 2: Improve Care Integration by embedding TTC primary care in LA County Department of Mental Health San Fernando Mental Health Center

4 Outline of Presentation Why Integrate Care? Integrated Care at Tarzana Treatment Centers Integrated Care for Chronic Somatic, SUD, & MH Conditions Using HIT as a Care Integration Driver

5 Tarzana Treatment Centers Mission Statement To provide high quality, integrated healthcare that improves the quality of life and health of patients regardless of financial resources, and contributes to a reduction in the total cost of care. 5

6 Reducing ER & Hospital Admissions and Readmissions

7 Impact of Mental Illness & Substance Use Disorders on Cost and Hospitalization for People with Diabetes $40, Per Capita Cost Per Year $30, $20, $10, Per Capita Hospitalization Per Year $- Diabetes Only Diabetes + MI Diabetes + SUD Diabetes + MI + SUD 0 Beneficiaries with Diabetes Per Capita Cost Per Year Per Capita Hospitalization Per Year SOURCE: C. Boyd et al. Faces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services. Center for Health Care Strategies, December 2010.

8 Reducing Hospital Admissions for Ambulatory Care Sensitive Conditions Persons with mental illness 2.3 times more likely to be admitted to hospital for ACSC based on New York State hospital discharge data for Li Y, Glance LG, Cai X, Mukamel DB Mental illness and hospitalization for ambulatory care sensitive medical conditions Med Care Dec;46(12): Short and long-term diabetes complications Uncontrolled diabetes Lower extremity amputation among diabetic patients Perforated appendix Pediatric asthma Adult asthma Chronic Obstructive Pulmonary Disease Pediatric gastroenteritis Hypertension Angina without procedure Congestive heart failure Low birth weight Dehydration Bacterial pneumonia Urinary Tract Infection

9 Drivers for future care integration SAMHSA PBHCI Grant Program Medicaid Section 2703 Medicaid Health Homes/AB 361 Joint Commission & CARF Behavioral Health Home Certification Certified Community Behavioral Health Clinics

10 Section 2703 Medicaid Health Homes Section 2703 Health Homes are for people with Medicaid who: Have 2 or more chronic conditions Have one chronic condition and are at risk for a second Have one serious and persistent mental health condition

11 Section 2703 Medicaid Health Homes Chronic conditions listed in ACA Section 2703 include: Mental health Substance abuse Asthma Diabetes Heart disease Being overweight Additional chronic conditions, such as HIV/AIDS, may be considered by CMS for approval

12 AB-361 Health Homes for Medi-Cal Enrollees Enacted and signed in 2013 Authorizes DHCS to submit Medicaid State Plan Amendment and 1115 Waiver to implement

13 Behavioral Health Home Certification Joint Commission BHH Certification: Optional certification available to any organization accredited under the Joint Commission Behavioral Health Care program. Requirements emphasize the need for the behavioral health home to coordinate and integrate care. Through strong focus on coordination and integration of care, treatment, or services expected to be effective in decreasing the high rates of morbidity and mortality of individuals with serious mental illness and other behavioral health conditions.

14 Certified Community Behavioral Health Clinics Protecting Access to Medicare Act of 2014 Authorizes $25M for planning grants to 8 states Authorizes guidelines for creation of prospective payment system Requires coordination with primary care

15 Integrated Care at Tarzana Treatment Centers

16 16 Demographics Persons served in Calendar 2013: Primary care = 11,041 persons Substance use disorder specialty care = 4,687 HIV/AIDS specialty care = 1,072 Mental health specialty care = 1,059

17 Primary Care Five Primary Care Clinics Integrated with Other Services 8 Providers (MD, NP, PA) All primary care patients assigned to a Care Team 17

18 Specialty Care Substance Use Disorder Treatment Mental Health Disorder Treatment HIV / Medical Care and related services Housing Assessment and Referral Services in Hospital EDs In Home Services 18

19 Acute Psychiatric Hospital 60 bed unit staffed 24 / 7 by psychiatrists and other medical staff Referral Sources Step downs from Acute Hospitals - Medicare Contracts with LA County Department of Public Health Kaiser and other Managed Care Organizations Average Length of Stay Insurance funded - 3 days Block Grant funded 7 days

20 Specialty HIV/AIDS Care HIV/AIDS Medical Clinics Palmdale Reseda Prevention and Testing Case Management Jail In-Reach MH/SU Disorder Treatment Transitional Housing Home Heath Care 20

21 Joint Commission Certification Certified under: Hospital Standards Behavioral Health Standards Opioid Treatment Standards Triennial survey in November 2014 sought: Patient Centered Medical Home Behavioral Health Home 21

22 SAMHSA - Primary Care Behavioral Health Integration To integrate primary care with MH/SUD services for patients with a chronic physical health condition and a serious mental illness Grant 1: Improve Care Integration at Tarzana Treatment Centers (TTC) Grant 2: Improve Care Integration by embedding TTC primary care in LA County Department of Mental Health San Fernando Mental Health Center

23 Department of Mental Health Integrated Service Model Individuals not currently seen by MH System Engagement in non-traditional health settings (e.g. faith based institutions) Focus on Latinos who are monolingual Patient enrolled in TTC s primary medical care services Wellness classes, group education, MH therapy, psychiatric services, nontraditional services (curandero, sobador, botanica) and integrated case management

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25 What Does Integrated Care for Chronic Somatic Condition, SUD, and MH Look Like? All conditions are addressed by all staff and are: Included in the problem list Included in the treatment plan Included in the Integrated Summary Addressed with motivational interviewing to improve compliance with monitoring, treatment interventions and lifestyle changes

26 Behavioral Health Homes (BHH) For patients with severe mental health and SUDs, make the home in behavioral health rather than in primary care Bring primary care in-house or link them to a primary care provider Patients may feel more comfortable in a BH setting Coordinate and integrate care as would be done in primary care The psychiatrist or behavioral health clinician may be the lead rather than the primary care physician

27 Care Teams Primary Care May include some or all of the following: Lead: Physician, Nurse Practitioner or Physician Assistant Nurse, Behavioral Health Clinician, Case Manager, Medical Assistant, Psychiatrist, Pharmacist Behavioral Health May include some or all of the following: Lead: Behavioral Health Clinician/Supervisor Psychiatrist, Addiction Counselor, Case Manager, Nurse, Nurse Practitioner or Physician Assistant, Primary Care Physician

28 Tarzana Treatment Centers, Inc. Integrating Chronic Disease Management into Behavioral Health Homes Self-Medical History Review chronic diseases Review medications Assess if patient is receiving medical care of chronic diseases ASI/Mental Health Assessment Note Chronic Diseases identified in Self- Medical History form Identify how these chronic diseases impact SUD and MH issues Integrated Summary Treatment Plan Capture chronic disease information from ASI-plan is for it to drop into Integrated Summary for SUD programs MH programs may not use this form Add chronic disease as a problem Add problem page for chronic disease with goals, objectives and interventions Treatment Address chronic diseases as part of your overall care with the patient Follow the objectives and interventions on the treatment plan and document progress in the medical record Reinforce medical provider orders and recommended treatment Case/Care Management Communicate with the primary care provider Monitor and assess if patient is seeing the medical provider and following the medical provider's care plan Coordinate care as needed with primary care provider Whole Person Care Emphasize that managing chronic diseases is similar to managing addiction and mental health disorders Point out the similarities in terms of how taking better care of oneself promotes recovery and improved health

29 arzana Treatment Centers Integrated Continuum of Care Integrated Services and Care Coordination SUD Services Mental Health Primary Care HIV Services IT/EHR/A VATAR Assessment / Case Management Detoxification Residential Rehabilitation Partial Hospitalization/ Day Treatment IOP/ Outpatient Maintenance/ MAT Housing Acute Psych Hospital/Sta bilization Intensive Outpatient Outpatient Housing 3 General Clinics 2 Specialty HIV Medical Clinics Prevention & Testing Case Management Jail In- Reach Mental Health SUD Services Integrated Treatment Plan Care Coordination Electronic Prescribing Telemedicine Community Assessment Service Centers Case Management in Hospital EDs Home Health Care Housing

30 Using Health IT as a Driver for Care Integration

31 i P a d w i t h D S M D i a g n o s i s

32 i P a d w i t h S U D / M H P r o g r e s s N o t e s

33 P r i m a r y C a r e C o n s o l e V i e w

34 Problem List with all Conditions

35 T r e a t m e n t P l a n

36 Integrated Medical and MH/SUD Diagnoses

37 Patient Registries Diabetic Patients with SUD Diagnoses

38 QUESTIONS? 38

39 Ken Bachrach, Ph.D., Clinical Director Jim Sorg, Ph.D. Director of Care Integration and IT Tarzana Treatment Centers