Social Innovation Fund (SIF) Training Seattle, Washington September 27-28 Welcome & Introductions John A. Hartford Foundation Welcome & Introductions University of Washington AIMS Center 1
Implementing IMPACT 1. Lay the Foundation 2. Plan for Clinical Practice Change 3. Train Your Clinical Team 4. Launch Your Care 5. Ongoing Maintenance Today Facility, Agenda & Materials Review Talaris Facility Trainers & Staff Agenda Review Materials Review SIF Initiative Overview CNCS Corporation for National and Community Service SIF Social Innovation Fund GRANTEE John A. Hartford Foundation Subcontractor: University of Washington AIMS Center SUB-GRANTEE WWAMI Primary Care Clinics 2
Eligible Clinics 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 Selected Sites Cohort 1 Community Health Center of Central Wyoming FQHC established in 2000 10,000+ unique patients in 2012 14,000+ unique patients in 2013 Locations Casper, WY Riverton, WY Dubois, WY 24% Medicaid 12% Medicare 38% Third Party 26% Private Pay 3
Program Type and Goal SIF Program Type Replication Care Manager Structure All-in-One SIF Goal 550 patients Clinical Team Care Manager Role Certified Social Worker, Licensed Clinical Social Worker and Bachelors Social Worker Family Practice MD, PA, NP, 3 RNs, 4 MAs and 2 reception Quick Care 3 PAs, 3 MAs and 2 reception OB/GYN and Pulmonology 2 MDs, 1 DO, 3 RNs, 2 MAs and 2 reception Psychiatric Consultant Psychiatric Nurse Practitioner Mat-Su Health Services, Inc. CMHC established in 1977 FQHC established in 2005 2,309 unique patients in 2013 Location Wasilla, AK 35% Medicaid 20% Medicare 26% Third Party 19% Private Pay 4
Program Type and Goal SIF Program Type Replication Care Manager Structure Shared SIF Goal At least 375 patients by end of three years Clinical Team Care Manager Role Paraprofessional (medical asst. or similar) 1.5 FTE Psychotherapy LCSW s as Behavioral Health Consultants 0.35 FTE Support Staff Project Manager 1.0 FTE, Medical Assistants, Registered Nurses, Specialty Providers, Screening Case Manager, Open Access Screeners Psychiatric Consultant In-house Psychiatrist 0.25 FTE Primary Care Providers Physician 1.0 FTE, FNP 1.0 FTE, PA-C 1.0 FTE Partnership Health Center Established in 1989 FQHC established in 1992 13,092 unique patients in 2012 Location Missoula, MT 62% Self-pay 19% Medicare 11% Medicaid 9% Private Pay 5
Welcome and IMPACT Principles and Tasks 9/27/14 CURRENT IMPLEMENTATION OF IMPACT MODEL AT PHC, MISSOULA Clinical Team IMPACT TEAM: 2.25 FTE Licensed Clinical Social Worker/Counselor 3.0 FTE Community Health Specialist Psychiatric Nurse Practitioner ANCILLARY BEHAVIORAL HEALTH at PHC : Three specialty behavioral health providers/lcsw/lacs Groups support: sobriety, anxiety, corrections, opioid exit strategy group Mindfulness library Relapse prevention study State grant funded, 4th IMPACT team Peninsula Community Health Services Established in 1989; FQHC since 1993 23,069 unduplicated patients in 2013 Locations Bremerton, WA (2 clinics) Port Orchard, WA Poulsbo, WA 32 % Uninsured in 2013 and 5% in 2014 42% Medicaid 10% Medicare 16% Third Party 6
Peninsula Community Health Services Challenges Access to comprehensive behavioral health services for the uninsured (Psychiatric consultant, Counseling, Medication Management) Care Coordination of Behavioral Health Issues Substance abuse screening and services for uninsured and underinsured Strengths Experience with MHIP Capacity to expand behavioral health services Transformation to Patient Centered Medical Home Program Type and Goal SIF Program Type Expansion (currently part of MHIP) Care Manager Structure All-in-One MHIP Treated to Date 565 SIF Goal At least 350 new patients Expansion Clinical Staff Care Manager Role Behavioral Health Practitioners 2.0 FTE Support Staff Health System Specialist 0.10 FTE Psychiatric Consultant Hiring 0.25 FTE 7
Valley View Health Center FQHC established in 2004 19,095 patients served in 2012 Locations Chehalis, WA Winlock, WA Onalaska, WA Raymond, WA Centralia, WA Toledo, WA Morton, WA PeEll, WA 41% Uninsured 34% Medicaid Selected Sites Cohorts 1 & 2 13 applied 8 selected 6 replication 2 expansion Selected Sites Cohorts 1 & 2 8
Bighorn Valley Health Center FQHC established in 2012 Serving 2,000+ patients Location Hardin, MT Medicaid 28.2% Uninsured 28% Medicare 9.9% Private insurance 33.8% Program Type and Goal SIF Program Type Replication Care Manager Structure Shared SIF Goal At least 300 patients over 3 years Clinical Team Care Managers Nate Church Becky Longwarrior Psychiatric Consultant Hillary Corson Primary Care Champion Paul Murter Project Lead Earl Sutherland 9
Kodiak Area Native Association Established in 1966 2,756 unique patients/yr Location Kodiak, AK 50% Uninsured 29% Medicaid Program Type and Goal SIF Program Type Replication Care Manager Structure Shared SIF Goal 375-450 patients over 3 years Clinical Team Care Manager Role Masters level Behavioral Health Professional (1 FTE) PA-C/MPH (0.5 FTE) Medical Staff Primary Care Providers (0.3 FTE), Registered Nurses & Certified Medical Assistants (0.2 FTE) Support Staff Project lead (0.25 FTE), Financial Staff (0.15 FTE), Administrative staff (0.2 FTE), Evaluation Staff (0.1 FTE) Psychiatric Consultant Consulting Psychiatrist 10
Southwest Montana Community Health Center FQHC established 1986 Serves 16,000+ unique patients/year Locations Butte, MT Dillon, MT Sheridan, MT (Pharmacy) 25% Medicaid 12% Medicare 34% Uninsured 28% Private Insurance Program Type and Goal SIF Program Type Replication Care Manager Structure Shared SIF Goal 800 patients over 3 years Clinical Team Care Manager Role Care Manager Additional Behavioral Health Services 2 Clinical Social Workers Support Staff Behavioral Health Director Psychiatric Consultant Psychiatric Nurse Practitioner 11
Welcome and IMPACT Principles and Tasks 9/27/14 Introduction to IMPACT: Daniel s Story http://aims.uw.edu/daniels-story-introductioncollaborative-care Principle 1: Patient Centered Team Care PCP Core Program New Roles Patient Care Manager Psychotherapist Psychiatric Consultant Additional Clinic Resources Principle 2: Population Based Treatment 12
Principle 3: Measurement Based Treatment To Target Principle 4: Evidence-Based Treatment Principle 5: Accountable Care 13
Discussion What was your first impression of IMPACT? What is familiar? What is new? What is still confusing? Which principles will be easiest to implement? Which principles will be hardest to implement? IMPACT Clinical Workflow: Delivering Care as a Team Identify & Engage Establish a Diagnosis Initiate Treatment Follow-up Care & Treat to Target Complete Treatment & Relapse Prevention System Level Supports Break Out to Clinic Groups 14