Webinar 1-DLF Learning Collaborative. Liz Stallings, RN, BSN: Behavioral Health Consultant June 24, :30 PT

Transcription

1 Webinar 1-DLF Learning Collaborative Liz Stallings, RN, BSN: Behavioral Health Consultant June 24, :30 PT

2 Introductions Liz Stallings RN, BSN Director Behavioral Health Services, HFS Consultants

3 Introductions Sherreta Lane, VP Finance Policy District Hospital Leadership Forum

4 Today s Agenda Goals of the Learning Collaborative - Liz Stallings Review of DSRIP Incentive Program for District Hospitals - Sherreta Lane No Room for the Mentally Ill-What is the Problem? - Liz Stallings

5 Agenda Continued Current and Future State Model for Emergency Psychiatric Care - Liz Stallings DSRIP Plan Mountains Community - Charlie Harrison CEO DSRIP Plan Sierra View- Melissa Fuentes, LCSW, Director of Social Services Upcoming Webinars: July 16, 1pm - 2:30pm PT August 13, 1pm - 2:30pm PT

6 Goals of the Learning Collaborative Increase understanding of DSRIP program available to District Hospitals Increase understanding of clinical issues surrounding behavioral health patient care Encourage collaboration and dissemination of ideas and best practices Educate participants as to issues affecting Behavioral Health planning for DSRIP

7 Objectives At the completion of the BH Learning Collaborative (3 sessions) participants will: Identify at least one viable clinical initiative to consider/submit for DSRIP funding Understand the requirements for submission of a DSRIP proposal Identify others with whom to collaborate regarding similar initiatives and success factors Understand the problems and opportunities related to behavioral health patient care improvements.

8 Non-Designated Public Hospitals & Public Safety Net Transformation and Improvement Project (aka DSRIP) Sherreta Lane, VP Finance Policy District Healthcare Leadership Forum

9 NDPHs and Public Safety Net Transformation & Improvement Project A primary focus of DHLF since its inception was inclusion in the state s 1115 waivers 2015 Medi-Cal 1115 Waiver, Medi-Cal 2020 includes district/municipal hospitals via the Public Safety Net Transformation and Improvement Project Application submitted by DHCS to CMS in March 2015 Negotiations between DHCS (and stakeholders) and CMS to occur over next few months

10 Medi-Cal 2020 New 5-year waiver to be implemented November 1, 2015* Waiver application includes $17 billion in federal funds and includes: Workforce Shelter Changes to county/uc DSH/safety net care pool funding Managed care incentives Whole person care

11 Public Safety Net Transformation & Improvement Project Build upon DSRIP 1.0 and work done/lessons learned by county/uc hospitals DSRIP type programs in other states Need for hospital stretch goals emphasized Proposed domains: Delivery System Transformation Care Coordination for High-Risk, High-Utilizing Populations Resource Utilization Efficiency Prevention Patient Safety

12 District/Municipal Hospital Provisions Included in the application: Tiering of projects among district/municipal hospitals due to the diversity of hospitals Up to one year of a funded planning period Target funding amount - $100 million annually net in aggregate Funded via intergovernmental transfers (IGTs) Standardized reporting, and metrics tied to national standards required

13 Behavioral Health Half of DHLF proposals include projects related to behavioral health. Examples: Telemedicine Crisis stabilization/intervention centers OP clinic Expanded IP services Chronic behavioral health care management Full continuum Integration of physical and behavioral health Psychiatric consultation liaison Community and patient primary care/bh integration

14 Questions about your DSRIP Initiatives How and why was this project identified for participation in DSRIP? What results/outcomes would demonstrate project goals and initiatives? Is there research, literature searches or other evidence based knowledge considered in identification of goals for the project? What is the target population?

15 Questions (cont.) Potential internal and external stakeholders? How will data analysis be built into project processes and outcomes? Describe how project development and implementation is envisioned over a five year period?

16 Acute Psychiatric Emergency Care

17 Overcrowding of ED with psychiatric patients Symptom or Problem Root causes Availability of psychiatrists and other BH personnel Availability of a network of options for psych disposition Relationship with county mental health Regional interpretation of 5150 regulations

18 Root Causes Relationship with local police and ambulance service Reduction in inpatient beds Desire to divert psychiatric patients based on historical carve out philosophy Anywhere but here

19 Prevalence of Mental Health Issues 1 in 4 adults experience mental illness in a given year 1 in 17 experience a severe mental illness such as schizophrenia, bipolar disorder and major depression 20% of youth ages experience a severe mental disorder in a given year 13% of 8-15 year olds experience mental disorders

20 Prevalence Average wait times for patients awaiting a psych bed in CA is 15 hours and can be days Suicide is the 10 th leading cause of death in the U.S. and the 3 rd leading cause of transitional age youth years Emergency Medicine International found that the financial impact of psychiatric boarding costs EDs $2,264/patient and wait 3.2 times longer than non psychiatric patients-2012

21 Regulatory Changes AB232 ACA Mental Health Parity Accountable Care Organizations Population Management AB1300 The Joint Commission All lead to increasing demand for behavioral health resources, which will continue far into the future

22 Defining the Problem Presentation of psychiatric patients to non psychiatric EDs has been occurring for decades Issue has increased with Mental health parity, ACA reform, increased regulations and ambiguity about the regulations As beds have declined, population has increased, and covered lives have increased

23 Declining Psychiatric Resources in CA

24 Declining Psychiatric Resources in CA

25 Adult Inpatient Psychiatric Beds In CA 26 counties have NO inpatient psychiatric services OF ANY KIND.

26 Child/Adolescent Psych Beds In CA Child beds and adolescent beds are not interchangeable. A hospital may have a dozen adolescent beds, but zero child beds. There is no state definition regarding age ranges for child vs. adolescent beds. The definitions are hospitalspecific, i.e., one facility may consider adolescent to mean ages 11 to 17, while another may consider it to be However, because child and adolescent together are a single-license category, OSHPD data does not reflect differences between them.

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43 DSRIP Proposal-Mountains Community Charlie Harrison-CEO

44 Summarize Today and Next Steps Today s webinar - What is the problem? July 16 webinar - Why should we care about this problem? August 13 webinar - How can we solve this problem?

45 Thank You Questions Complete webinar evaluations Provide input as to future agenda items for webinars

46 Thank You HFS Consultants 505 Fourteenth Street, Fifth Floor Oakland, CA Liz Stallings RN, BSN Office: Cell: BRANCH OFFICES: Oakland Fresno Orange County Redding Milwaukee Area Maryland Area Phoenix, AZ Portland, OR