Presentation on theme: "Behavioral Health Integration: A Key Step towards the Triple Aim"— Presentation transcript:
1 Behavioral Health Integration: A Key Step towards the Triple Aim Session # C4aOctober 18, 2014Behavioral Health Integration: A Key Step towards the Triple AimMara Laderman, MSPHSenior Research AssociateInstitute for Healthcare ImprovementBenjamin Miller, PsyDDirector of Health PolicyUniversity of Colorado - DenverPlease insert the assigned session number (letter and number), i.e., A2aPlease insert the assigned DAY and DATE of your presentation, i.e., Friday, October 17, 2014 or Saturday, October 18, 2014Please insert the TITLE of your presentation.List each PRESENTER who will attend the CFHA Conference to make this presentation. You may acknowledge other authors in subsequent slides.Collaborative Family Healthcare Association 16th Annual ConferenceOctober 16-18, Washington, DC U.S.A.Collaborative Family Healthcare Association 12th Annual Conference
2 Faculty DisclosureWe have not had any relevant financial relationships during the past 12 months.CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest.Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.Collaborative Family Healthcare Association 12th Annual Conference
3 Learning Objectives At the conclusion of this session, the participant will be able to: Learn about the Triple Aim benefits of primary care-behavioral health integration.Use analyses of health plan and outcomes data to make the case for integration at their organization.Describe IHI's approach to behavioral health integration.Include the behavioral learning objectives for this sessionCollaborative Family Healthcare Association 12th Annual Conference
4 Bibliography / Reference IHI 90-Day R&D Project Final Summary Report: Integrating Behavioral Health and Primary Care. Cambridge, MA: Institute for Healthcare Improvement; March 2014.Laderman M, Mate K. Integrating Behavioral Health into Primary Care. Healthcare Executive Mar/Apr;29(2):74-77.Academy for Integrating Behavioral Health and Primary Care, Agency for Healthcare Research and Quality (AHRQ). Lexicon for Behavioral Health and Primary Care Integration. Available at:Mental Health, Substance Abuse and Health Behavior Services in Patient-Centered Medical Homes. Kessler, R., Miller, B.F., Kelly, M., Graham, D. Kennedy, A., Littenberg, B., Maclean, C., van Eeghen, Scholle, S., Tirodkar, M., Morton, S., & Pace, W. The Journal of the American Board of Family Medicine, 27(5),The Working Party Group on Integrated Behavioral Healthcare, Baird, M., Blount, A., Brungardt, S., Dickinson, P., Dietrich, A., Epperly, T., Green, L., Henley, D., Kessler, R., Korsen, N., McDaniel, S., Miller, B., Pugno, P, Roberts, R., Schirmer, J., Seymour, D., & deGruy, F. (2014). Joint Principles: Integration Behavioral Health Care into the Patient-Centered Medical Home. The Annals of Family Medicine, 12(2),NEW!Continuing education approval now requires that presenters include five references within the last 5 years.Please list at least FIVE (5) references for this presentation that are no older than 5 years.Without these references, your session may NOT be approved for CE credit.Collaborative Family Healthcare Association 12th Annual Conference
5 Learning Assessment A learning assessment is required for CE credit. A question and answer period will be conducted at the end of this presentation.Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.Collaborative Family Healthcare Association 12th Annual Conference
6 Today’s Agenda Making the case: Integration and the Triple Aim Overview of IHIIHI’s research on behavioral health integrationFive-step sequence to integrate BHFuture directions for IHI’s workBehavioral Health Integration Capacity Assessment (BHICA)
7 Today’s Agenda Making the case: Integration and the Triple Aim Overview of IHIIHI’s research on behavioral health integrationFive-step sequence to integrate BHFuture directions for IHI’s workBehavioral Health Integration Capacity Assessment (BHICA)
8 DefinitionThe care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health, substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, ineffective patterns of health care utilization.Value of Integration:Physical/Behavioral Integration is good health policy and good for health.For consistencies sake, here again is the DEFINITION we are using when we talk about integration. Interestingly enough, this definition also foreshadows our discussion today. You see, for integration to be successful and having the biggest bang for the buck, it has to be about allowing the providers, both behavioral health and primary care, to work together on a range of issues. Integration is about offering up comprehensive team based services to a community who often presents with multiple chronic conditions and not just a single disease.But you already knew that.Let’s drill down into how we got to where we are and set some context.Peek, C. J., National Integration Academy Council. (2013). Lexicon for Behavioral Health and Primary Care Integration: Concepts and Definitions Developed by Expert Consensus. In Agency for Healthcare Research and Quality (Ed.), AHRQ Publication No.13-IP001-EF.
10 Confusion. You want confusion Confusion? You want confusion? Try to figure out how to change policy with a movement that is so spread as collaborative care.
11 In service to Improving outcomes Decreasing cost Enhancing the patient experience
12 Drucker’s Big Seven (for innovative opportunity) The unexpected success, failure or outside eventThe incongruity – between reality as it actually is and reality as it is assumed to beInnovation based on process needChanges in industry or market structureDemographicsChanges in perception, mood and meaningNew knowledge – scientific and nonscientific
13 Those who say it can’t be done are usually interrupted by others doing it James Baldwin
14 Today’s Agenda Making the case: Integration and the Triple Aim Overview of IHIIHI’s research on behavioral health integrationFive-step sequence to integrate BHFuture directions for IHI’s workBehavioral Health Integration Capacity Assessment (BHICA)
15 Our Mission: To improve health and health care worldwide The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization.We were founded just about 25 years ago with a mission to improve health and healthcare worldwide and since that time, we have grown to become a leading innovator in health and health care improvement.People understood that the science of improvement was working in other industries, and our founders realized that this same science could be applied to health care.We are headquartered in Cambridge, Massachusetts but work around the world on six continents. Though our organization is small with just over 120 people, we realize enormous leverage from our more than 200 talented faculty who are proven leaders in their fields, strategic partners responsible for remarkable transformations in their own systems and a connected and committed community of individuals and organizations who come together year after year at our trainings, seminars, conferences and other large meetings to exchange best practices, co-create new tools and soak in the best of health care improvement from around the world.
16 IHI’s Work: Five Key Areas IHI along with our partners and community are focusing on five core areas of work:
17 Triple Aim for Populations Our Goal: Drive the Triple Aim, simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per capita cost of care for the benefit of communities.The Triple Aim for Populations which strives to simultaneously improve the health of the population, enhance the experience and outcomes for patients, and reduces the per capita cost of care for the benefit of communities.
18 Proven Methodology: Science of Improvement W. Edwards DemingAPI’s Model for ImprovementIHI works with organizations using the science of improvement.Originally goes back to Deming who taught that with certain principles of management, “organizations can increase quality and simultaneously reduce costs (by reducing waste, rework, staff attrition, and litigation while increasing customer loyalty). The key is to practice continual improvement and think of manufacturing as a system, not as bits and pieces.“ –In 2009, the Model for Improvement was created by Associates for Process Improvement (API) based on Deming’s work and as a tool for the front lines. The Model asks 3 questions and then uses PDSA cycles for small, rapid-cycle tests of change.
19 Today’s Agenda Making the case: Integration and the Triple Aim Overview of IHIIHI’s research on behavioral health integrationFive-step sequence to integrate BHFuture directions for IHI’s workBehavioral Health Integration Capacity Assessment (BHICA)
20 What drives IHI’s interest in integration? Poor outcomes and high costs for patients with medical + behavioral comorbidities.Getting to the Triple Aim will require addressing behavioral health!Changing incentives will facilitate this.
21 Research Project AimsUnderstand the core principles underlying successful approaches to integration of behavioral health services into primary care.Develop IHI’s approach to integration.Identify how IHI can support organizations to integrate behavioral health and primary care.
22 Research MethodsReviewed peer-reviewed and grey literature and materials from existing models.NameOrganizationGary BelkinNYC HHC / NYUBenjamin MillerUniversity of Colorado – DenverMary RainwaterIntegration Consultant, formerly with IBHPLaurie AlexanderIntegration Consultant, formerly with AIMS CenterAlexander BlountUMass Medical Center, Center for Integrated CareParinda KhatriCherokee Health SystemsJurgen UnutzerIMPACT / AIMS Center, University of WashingtonBrenda Reiss-BrennanIntermountain Health CareRobin HendersonSt. Charles Health SystemRussell PhillipsHarvard Medical School, Center for Primary CareIleana WelteBig White WallBrady ColeU.S. Department of Veteran’s Affairs12
23 Key Research FindingsPerception is that there are many different ways to implement integration; we found that the commonalities are much greater than the differences.Collaborative care principles; strong evidence base.Five-step sequence to integrate BHBiggest challenges are business case and operationalizing components into workflows.Improvement approach is currently lacking.Lack of integration outside of clinic visit.Preview 5 steps
24 Innovation: Full Spectrum Integration Layer of ServiceFrequency of InteractionWhere service is providedWho provides service1 – Acute CareContinuous (during hospitalization)HospitalPhysicianCost2 –Clinic CareQuarterlyClinicPCP; behavioral health provider. Could include group visits3 – Community CareWeekly; more than once a week initiallyHome, workplace, community organizationCommunity health workers; mobile clinics. Could include group visits4 – Family Engagement in CareDailyHomeFamily members5 – Self-carePatients6 - Policy and Financial Considerations
25 Which states and why?Variability in financial environment between states to support behavioral health integration.Some states may be more interested than others due to: Medicaid waivers, Medicaid BH carve out, Medicaid expansion / expected growth in Medicaid population, # of ACOs & pushes for global payments.We compiled a list of states with favorable markets for integration.Favorable States: AZ, AR, CA,CO, IL, KY, MD, MI, NV, NJ, NM, OH, OR, and VT.
26 Today’s Agenda Making the case: Integration and the Triple Aim Overview of IHIIHI’s research on behavioral health integrationFive-step sequence to integrate BHFuture directions for IHI’s workBehavioral Health Integration Capacity Assessment (BHICA)
27 Five Step Sequence Assess readiness for integration. Develop reliable operations and processes to support integrated care.Develop the business case for integration.Re-design care delivery using collaborative care principles for integration.Operationalize changes into clinical workflows.
28 1. Assess readiness for integration Assess readiness based on:Patient needsClinic characteristicsPolicy & financial environmentExisting data & measurement system1. AssessReadiness
29 2. Processes to Support Integration 2. Develop Reliable Operations and Processes to Support Integrated CareLeadership and cultureAccess and workflowsTechnology considerationsWorkforce: recruitment, hiring, onboarding, and oversight of staffWorkflowsSeamless information sharing & communicationTracking patients and using dataContinuous quality improvement and outcomes monitoringSpace and supplies to support BH care1. AssessReadiness2. Processes to Support Integration
30 3. The Business Case for Integration Fee-for-service workaroundsNegotiate case rates with payersConsider global funding strategies and blended payment systemsIdentify federal and state incentives to support integrated careTrain staff to optimize use of existing revenue sources to provide cost efficient, medically necessary care.1. AssessReadiness2. Processes to Support Integration3. Make theBusiness Case
31 4. Re-design Care Delivery Using Collaborative Care Principles Develop interdisciplinary care teamPromote self-care support and family engagementTreatment to targetStepped careSystematic caseload review, consultation & referralAdoption of evidence-based guidelinesBH providers support healthy behavior change in addition to screening, diagnosis, and treatment for BH conditions1. AssessReadiness2. Processes to Support Integration3. Make theBusiness Case4. RedesignCare Delivery
32 5. Operationalize Changes in Clinical Workflows Fully implement operational infrastructureSample change ideas to operationalize collaborative care principles:Interdisciplinary care team proactively manages a panel and chronic health conditions and participates in care planningCoordinate care inside and outside of org. including tracking referralsTechnological solutions when BH providers are not available in person1. AssessReadiness2. Processes to Support Integration3. Make theBusiness Case4. RedesignCare Delivery5. Operationalize Changes in Workflows
33 Today’s Agenda Making the case: Integration and the Triple Aim Overview of IHIIHI’s research on behavioral health integrationFive-step sequence to integrate BHFuture directions for IHI’s workBehavioral Health Integration Capacity Assessment (BHICA)
34 Where IHI can add valueFocus on how to make specific changes and on addressing operational and organizational issues that need to be in place to facilitate implementation of integrated care.Bring improvement science to integration.Sense-making across different models.Focus on leaders and systems.Measurement of system-level integration outcomes.
35 New Collaborative Program Optimize Primary Care Teams to Meet Patients’ Medical AND Behavioral NeedsPartnering with the MacColl Center for Health Care InnovationLaunches in February, 2015
36 Areas for future innovation work Integration in high-risk specialty clinics.Scaling to communities, regions, states and solving related structural challenges.Costs (and ROI) of integration, alternative payment methods, and financial models.Behavioral health providers performing other functions on the care team, such as supporting behavior change for patients with chronic disease.Building out other layers of full spectrum integration.
37 Today’s Agenda Making the case: Integration and the Triple Aim Overview of IHIIHI’s research on behavioral health integrationFive-step sequence to integrate BHFuture directions for IHI’s workBehavioral Health Integration Capacity Assessment (BHICA)
38 Behavioral Health Integration Capacity Assessment Tool (BHICA) Resource for organizations to assess their readiness to integrate behavioral health and primary care.Consider potential approaches to integration;Understand the current infrastructure to support greater integration;Assess the organization’s strengths and challenges in undertaking different approaches to integration;Set and prioritize goals for integration efforts.https://www.resourcesforintegratedcare.com/tool/bhica
39 Five Sections of BHICA 1. Understanding Your Population 2. Assessing Your Infrastructure3. Identifying the Population and Matching Care4. Assessing the Optimal Integration Approach for Your Organization5. Financing Integration
40 Evaluation Framework Linked to Organization Processes, Impact, and Resources
42 Session EvaluationPlease complete and return the evaluation form to the classroom monitor before leaving this session.Thank you!This should be the last slide of your presentationCollaborative Family Healthcare Association 12th Annual Conference