Health Forum, San Diego July 28, 2017

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1 Health Forum, San Diego July 28, 2017 TYLER NORRIS, MDIV Chief Executive, Well Being Trust ROBIN HENDERSON, PSYD Chief Executive, Behavioral Health, Providence Medical Group, Oregon ARPAN WAGHRAY, MD Medical Director, Behavioral Health Services, Providence St Joseph Health, Washington

Our nation is facing tremendous need Depression is

health and substance use has become the most pressing

39% of admissions are either for or co-morbid with

Mental health issues drive $400B in direct cost of

2 Our nation is facing tremendous need Depression is the leading cause of disability worldwide, and mental health and substance use has become the most pressing health crisis in the U.S. 39% of admissions are either for or co-morbid with mental health and/or substance use. Mental health issues drive $400B in direct cost of care and loss of productivity to our economy and society. Mental Health affects all of us we are all either directly impacted or one degree away. Mental health and wellness is the most pressing health crisis in the nation touching every one of us directly or indirectly, costing our economy and society over $400B annually. 2

Well Being Trust believes all people have the opportunity to realize their fullest

3 Our North Star We exist to advance the mental, social and spiritual health of the nation. Well Being Trust believes all people have the opportunity to realize their fullest potential for well-being significantly reducing the personal, familial, social, and economic costs of mental illness and substance abuse. OUR MISSION OUR VISION OUR BHAG 3

view. Loving-kindness and Compassion We aim to cultivate a boundary-crossing, distributed force of leaders in a wellbeing field of

4 Our vision: human flourishing across the lifespan in healthy communities. We know we can t achieve this alone. Building a social movement Our guiding principles: Our steadfast values: We embrace a whole-person, whole-community, wholesystems view. Loving-kindness and Compassion We aim to cultivate a boundary-crossing, distributed force of leaders in a wellbeing field of fields. Radical Inclusion and Equity of Opportunity Our mantra is: Do what we do best, partner for the rest. Dignity and Respect Social Justice for All

Our purpose / foci / goal areas Ease access to care and to the determinants of wellbeing Build resilience in children, teens and families Ease Access Reduce suffering from depression, anxiety and

5 Our purpose / foci / goal areas Ease access to care and to the determinants of wellbeing Build resilience in children, teens and families Ease Access Reduce suffering from depression, anxiety and social isolation Decrease addiction and substance use, while promoting recovery Create hope for people and families living with serious and persistent mental illness Create Hope Create Healthy, Equitable Communities Build Resilience Eliminate stigma everywhere, and grow a culture of wellbeing in healthy, equitable, resilient communities Decrease Addiction Reduce Suffering 5

6 Well-being across the lifespan Across our focus areas, we support people throughout their key stages when and how it s needed most. Prenatal End of Life Age groups Attachment & Resilience Identity, Autonomy & Self Awareness Workplace Well-being & Productivity Healthy Maturation & Generatively 6

Well-being across the spectrum We work with partners to

Inpatient Emergency Department Primary Care/Clinic

Skilled Nursing Urgent Immediate Care Employer School

7 Well-being across the spectrum We work with partners to meet people where they are from care to community Acute/ Inpatient Emergency Department Primary Care/Clinic Community Home Self Transitional Care Rehabilitation Skilled Nursing Urgent Immediate Care Employer School Work School Incarceration Family Assisted Living Foster care Anywhere 7

8 Levers to advance our foci / goals ENGAGE To change the national conversation around mental health and wellbeing, and to mobilize distributed action everywhere. DISCOVER To grow the efficacy of the field of fields upstream from whole person wellbeing. LEVERS ADVOCATE To drive large-scale investments that can produce highdose impact and assure sustainability. INVEST To build agency and capacity, transform care, and grow equitable, healthy places and cultures. CATALYZE To implement together what none of us can do alone. 8

CONVENINGS POLICY & INVESTMENT COMMUNICATION RESEARCH &

9 Applying social movement praxis to drive outcomes at scale CLINICAL TRANSFORMATION COMMUNITY TRANSFORMATION CONVENINGS POLICY & INVESTMENT COMMUNICATION RESEARCH & TRANSLATION DATA & METRICS CAPACITY BUILDING Strength in Numbers 9

10 2017 Impact Portfolio: Partnerships and Investments Arpan Waghray, MD WBT Medical Director & Co-Chair, Full Spectrum Integration Leadership Team (FSIT) Clinical Practice Group ED&UP! (Emergency Department and Upstream) Emotional Wellbeing Initiative Impact Investment Advisory Group #BeWell #BeHeard Policy Landscape and Messaging Healthy Communities Youth Social Engagement Movement & Platform Healthy Community Agenda Integrated Data Platform Learning & Evaluation Skill and Capacity Development

We are putting structures in place to: Monitoring Evaluate Selectively Monitor Comprehensively

11 Outcomes and learning methodology The WBT is beginning formative evaluation design, and will focus on defining measures and metrics in We are putting structures in place to: Monitoring Evaluate Selectively Monitor Comprehensively Learn Continuously Evaluation to support continuous improvement and collaborative learning with programs, partners, grantees, advisors, and the field. Learning

12 Thank you.

13 Providence Oregon: Behavioral Health Strategic Plan ROBIN HENDERSON, PSYD Chief Executive, Behavioral Health, Providence Medical Group, Oregon

AIM PRIMARY DRIVERS Ease Access SECONDARY DRIVERS 80% of BH

Alternative Payment Models Grounded in our mission, we will

Providence Health Plan as a fully integrated health plan across

Build Resilience Ease Suffering Decrease Addiction Create Hope

Child/Adolescent BH Services Strengthen Acute BH Care Continuum

14 AIM PRIMARY DRIVERS Ease Access SECONDARY DRIVERS 80% of BH Conditions addressed by Primary Care X% of business in Alternative Payment Models Grounded in our mission, we will embrace whole person health, with all doors open to our customers. We will focus on prevention and early intervention with Providence Health Plan as a fully integrated health plan across all lines of service. Build Resilience Ease Suffering Decrease Addiction Create Hope 24/7 Centralized Intake/Referral Team State-wide Leader in Child/Adolescent BH Services Strengthen Acute BH Care Continuum Strengthen Outpatient BH Care Continuum Strengthen Acute BH Care Continuum Strengthen Outpatient BH Care Continuum Trauma Informed Care in All Ministries Healthy Communities Advocacy Community Partnerships

15 PRIMARY DRIVER SECONDARY DRIVERS 80% of BH needs met in Primary Care TACTICS BHP Standardization and Optimization Psychologist Prescribing Privileges Development of Care Pathways Ease Access X% Alternative Payment Methodology BH in ED Standardization and Optimization Collaborative Engagement Team (CET) Behavioral Health Integration Team (BHIT) Pilots to take risk for PHP BH Lives 24/7 Intake/ Referral PCPCH Finance Pilots (SB 231, CPC+) Develop Access & Triage Service

with Youth Villages Psychiatric Emergency Service at PWF CAPU Reorganization Development of Opx

16 PRIMARY DRIVER SECONDARY DRIVER TACTICS Partnership with Trillium Family Services 24/7 State-wide Intake/Referral Build Resilience State-wide Leader in Child/ Adolescent BH Services PSV Pilot with Youth Villages Psychiatric Emergency Service at PWF CAPU Reorganization Development of Opx continuum of care including Partial Integrated pediatric psychiatry at SW Peds Perinatal BH development

PRIMARY DRIVER SECONDARY DRIVERS TACTICS

17 PRIMARY DRIVER SECONDARY DRIVERS TACTICS Acute Care Gap Analysis/ Work Plan Ease Suffering Strengthen Acute BH Care Continuum Strengthen Outpatient BH Care Continuum PES Units-PPMC and PSVMC Expansion of ED Bob project Outpatient Gap Analysis/Work Plan Bridge Program Electroconvulsive Therapy (PMH) Physical Plant Assessment & Capitol Plan

18 PRIMARY DRIVER SECONDARY DRIVERS TACTICS Decrease Addiction Strengthen Acute BH Care Continuum Strengthen Outpatient BH Care Continuum Acute Detox Model Change Gap Analysis & Work Plan Medication Assisted Treatment Opiate/Pain Management Program

PRIMARY DRIVER SECONDARY DRIVERS TACTICS Staff Training plan 2018-2021 Create

BH/Spiritual Care Connection OHA BH Collaborative BH Policy Agenda

19 PRIMARY DRIVER SECONDARY DRIVERS TACTICS Staff Training plan Create Hope Trauma Informed Care in All Ministries Advocacy Stigma Reduction efforts BH/Spiritual Care Connection OHA BH Collaborative BH Policy Agenda Acute/Subacute Children s MH Collaborative OAHHS BH Technical Advisory Council USDOJ Advisory Team

20 PRIMARY DRIVER SECONDARY DRIVER TACTICS Healthy Communities Community Partnerships Cascadia Garlington Center Gladstone School District pilot EDIE/OHLC Collaborative Cascadia PreManage pilot Unity Transitional Advisory Council

21 Clinical Practice Group ARPAN WAGHRAY, MD Medical Director, Behavioral Health Services, Providence St Joseph Health, Washington

23 Initial Exploratory Concepts Anti-Stigma Campaign Trauma Informed Care Training Behavioral Health access in Primary Care Community Based Prevention IHI ED and UP care collaborative PROM Collection with value analytics Caregiver Concierge Program Improving Mental Health Care 23

24 Behavioral Health Clinical Practice Group Optimize PSJH s internal ability to provide best of class care across an integrated full spectrum continuum -- inclusive of inpatient, ambulatory, community and self/home. Better Together Synergy: Many parts of the overall PSJH organization are working toward care improvements in MH&W. Our goal is to truly move the best care design and outcomes forwards together. 24

Full Spectrum Behavioral Health Integration CORE PRINCIPLES Patient/Family centered Population Health Clinical Program Services Focus on

Investment Practice Group- BH Health Plan Early life engagement and prevention across the lifespan No wrong door for care or meeting social

25 Full Spectrum Behavioral Health Integration CORE PRINCIPLES Patient/Family centered Population Health Clinical Program Services Focus on Well-being and Resilience Integration across the spectrum of care and community Trauma-Informed approach Clinical Providence Community Investment Practice Group- BH Health Plan Early life engagement and prevention across the lifespan No wrong door for care or meeting social needs Community Partnerships Healthcare Intelligence Data Support Community partnerships Focus on destigmatizing mental health and celebrating neurodiversity 25

26 Leading together! A Learning Community to Integrate Behavioral Health in the ED in collaboration with IHI Mental Health services for our Caregivers Support the care continuum: No wrong door for care Regional representation Focused groups to guide compassionate care Monitor Clinical Outcomes 26

27 System Clinical Depression Pathway

How Can Emergency Departments Improve Care for Patients with Mental Health Issues?

D1/E1 These presenters have nothing to disclose How Can Emergency Departments Improve Care for Patients with Mental Health Issues? Robin Henderson, PsyD Mara Laderman, MSPH Arpan Waghray, MD December 13,