Social Innovation Fund (SIF)
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1 Welcome & Social Innovation Fund (SIF) Pre-Launch Training John A. Hartford Foundation Seattle, Washington September 14-15, 2013 Welcome & Implementing IMPACT University of Washington AIMS Center 1. Lay the Foundation 2. Plan For Clinical 3. Train Your 4. Launch 5. Ongoing Practice Clinical Team Your Care Maintenance Change Today Facility, Agenda & Materials Review Talaris Facility Trainers & Staff Agenda Review Materials Review SIF Initiative i i Overview CNCS SIF GRANTEE Corporation for National and Community Service Social Innovation Fund John A. Hartford Foundation Subcontractor: University of Washington AIMS Center SUB- GRANTEE WWAMI Primary Care Clinics 1
2 Public-Private Private Partnership Funding SIF $1 JAHF $1 Award $2 Subgrant ee Award $2 Subgrant eematch $2 Total Investment $4 Eligible ibl Clinics i Non-profit community primary care organization Located in a rural WWAMI county or serve a significant proportion of rural dwelling patients Service area designated as medically underserved and/or a health professional shortage area Serve at least 1,500 unique patients each year Patient population at least 50% uninsured or Medicaid id Selected Sites 8 applied 5 selected 3 replication 2 expansion IMPACT Principles i 1. Collaborative Care Team: PCP, Care Manager, Psychiatric Consultant, other team members 2. Population Focus Registry: no one falls through the cracks 3. Treatment to Target Measurement: adjust treatment until depression improves 4. Evidence-based Medications and / or evidence-based psychotherapy 5. Accountable Tracking caseloads over time Collaborative Team Approach Washington State MHIP (Mental Health Integration Program) Patient PCP Care Manager New Roles Core Program Psychiatric Consultant Other Behavioral Health Clinicians Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources Community Health Plan of Washington 2
3 MHIP Common Client Diagnoses Diagnoses % Depression 71% Anxiety (GAD, Panic) 48% Posttraumatic Stress 17% Disorder (PTSD) Alcohol / Substance Abuse 17%* Bipolar Disorder 15% Thoughts of Suicide 45% plus acute and chronic medical problems, chronic pain, substance use, prescription p narcotic misuse, homelessness, unemployment, poverty,. MHIP Depression Outcomes Clinically Significant Improvement 5 point decrease in PHQ-9 Average: 46% (range: 29% - 71%) Treatment Response 50 % or greater improvement in PHQ-9 and a score less than 10 Average: 44% (range: 27% - 61%) Community Health Center of Central WY FQHC established ,000+ unique patients in 2012 Locations Casper, WY Riverton, WY Dubois, WY 35.7% Medicaid 17.9% Medicare 33% Third Party 13.2% Private Pay Program Type and Goal Replication 550 patients Clinical Social Worker Additional Behavioral Health Services Clinical Social Worker Support Staff Referral Coordinator, Case Manager Psychiatric Nurse Practitioner 3
4 Day 1: Welcome & 9/14/13 M S Health Mat-Su H l h SServices, i IInc. P Program Type T and dg Goall CMHC established in 1977 FQHC established in ,214 unique patients Mar-Dec 2012 Location Replication 300 patients per year Wasilla, AK 50% Medicaid 19% Third Party 17% Medicare 14% Private Pay SIF Clinical Cli i l Team T T i i Training Attendees A d Paraprofessional (medical asst. or similar) 1.5 FTE Psychotherapy LCSW s as Behavioral Health Consultants 0.8 FTE Support S t Staff St ff Project Manager 1.0 FTE, Medical Assistants, Registered Nurses, Specialty Providers, Screening Case Manager, Open Access Screeners In-house Psychiatrist 0.25 FTE Primary Care Providers Physician Ph i i FTE, FTE Family F il Nurse N Practitioners P titi FTE P Partnership hi Health H l h Center C Implementation Plan for IMPACT Model at PHC, Missoula Established in 1989 FQHC established in ,092 unique patients in 2012 Location Missoula, MT 62% Self-pay 11% Medicaid 19% Medicare 9% Private Pay 4
5 IMPACT Team: 3.0 FTE Licensed Clinical Social Worker / Counselor 3.0 FTE Community Health Specialist Registered Nurse Care Manager, Quality Assurance Psychiatric Nurse Practitioner Ancillary Behavioral Health at PHC: Three specialty behavioral health providers/lcsw/lacs / C Groups support: sobriety, anxiety, corrections, opioid exit strategy group Mindfulness library Relapse prevention study Pending state t grant request, 4th IMPACT team Peninsula Community Health Services Established in 1989 FQHC since ,934 unduplicated patients in 2012 Locations Bremerton, WA (2 clinics) Port Orchard, WA Poulsbo, WA 57% Uninsured 28% Medicaid 6% Medicare 9% Third Party Peninsula Community Health Services Challenges Access to comprehensive behavioral health services for the uninsured (Psychiatric i consultant, Counseling, Medication Management) Care Coordination of Behavioral Health Issues Substance abuse screening and services for uninsured and underinsured d Strengths Experience with MHIP Capacity to expand behavioral health services Transformation to Patient Centered Medical Home Program Type and Goal Expansion (currently part of MHIP) MHIP Patients Treated to Date 565 At least 350 new patients Behavioral Health Practitioners 2.0 FTE Support Staff Health System Specialist 0.10 FTE Hiring 0.25 FTE 5
6 Valley View Health Center FQHC established in ,095 patients served in 2012 Locations Chehalis, WA Centralia, WA Winlock, WA Toledo, WA Onalaska, WA Morton, WA Raymond, WA PeEll, WA 41% Uninsured 34% Medicaid Program Type and Goal Expansion (currently part of MHIP) MHIP Patients Treated to Date 411 At least 400 new patients Master s s Level Behavioral Health Providers 2.0 FTE Support Staff Behavioral Health Support Coordinator 1.0 FTE Consulting Psychiatrist, UW 0.2 FTE Key Components of Collaborative Care Rita Haverkamp Anna Ratzliff 6
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