1. A penny saved is a penny earned: Pharmacy and behavioral health cost savings in pediatric IPC clinics Paul Kettlewell, Ph.D. Tawnya J. Meadows, Ph.D. Shelley J. Hosterman, Ph.D. Vanessa Pressimone, Ph.D. Collaborative Family Healthcare Association 16 th Annual Conference October 16-18, 2014 Washington, DC U.S.A. Session F 1 c Friday October 17, 2014

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Learning Objectives At the conclusion of this session, the participant will be able to: Identify data collection procedures to measure outcomes on cost offset. Describe pharmacy savings found. List two plausible reasons why behavioral health costs were found to be relatively cheaper per member per month in integrated primary care clinics versus standard primary care clinics.

4. Bibliography / Reference Cummings, N.A., O'Donohue, W.T., & Cummings, J.L. (2009). The financial dimension of integrated behavioral/primary care. Journal of Clinical Psychology in Medical Settings, 16, 31-39. doi:10.1007/s10880-008-9139-2 Felleman, B.I., Athenour, D.R., Ta, M.T., & Stewart, D.G. (2013). Behavioral health services influence medical treatment utilization among primary care patients with comorbid sustance use and depression. Journal of Clinical Psychology in Medical Settings, 20, 415-426. doi:10.1007/s10880-013-9367-y Monson, S.P., Sheldon, J.C., Ivey, L.C., Kinman, C.R., & Beacham, A.O. (2012). Working toward financial sustainability of integrated behavioral health services in a public health care system. Families, Systems, & Health, 30, 181-186. doi:10.1037/a0028177 Wiley-Exley, E., Domino, M.E., Maxwell, J., & Levkoff, S.E. (2009). Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study. Journal of Mental Health Policy & Economics, 12, 205-213. Thielke, S. (2011). Health psychology in primary care: recent research and future directions. Psychology Research and Behavior Management, 4, 59-68. doi:10.2147/PRBM.S12996

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.

6. Pediatric IPC Model & Outcomes

7. Clinical Model & Services Three pilot sites Psychologist (4 days/week) Postdoc fellows (2-3 days/week) Behavioral health schedules 6-7 billable units a day Family, individual, group Gaps in schedule for integrated activities Always available

8. Clinical Model & Services Sites & staff Problem focused eval/treatment Family, individual, & group therapy Consults & hand-offs Crisis appointments Same day evaluations Screening tools Handouts Communication Psychiatry telemedicine PCP education Liaison to MH/school Clinic wide interventions | 8

9. Collaborative Care: Consults & Handoffs Add Value | 9

10. Reducing Hospitalization & Costs (ED Saves) | 10 n = 2 (2.1%)

11. GHP Data: Bending the Cost Curve IPCBook Average Total Behavioral Health Spend 12.0%22% UBH Claims 5%18.3% | 11 Average length of treatment in IPC (3.7 sessions) as compared to usual care (18.9 sessions). Able to serve more patients

12. Reduction in PMPM for Medications | 12 Allowed PMPM Time of IPC Implementation

13. GHP Data: Bending the Cost Curve IPCBook Average Total Pharmacy Spend 9.8%35.5% BH medication 35.6%55.8% Non BH medication -19.5%15.8% | 13

14. Reduced Costs: Treatment Costs Total revenue generated per session resulted in significant gains for IPC clinic vs. control clinic (*p<.01) Possible factors: Less staffing, higher show rates, lower drop out rates, shorter courses of treatment DBDAnxiety Depression ■ Control ■ IPC

15. Reduced Costs: Medication Utilization | 15 Prescription medications/month decreased by 3.25% after integration. Stimulant prescriptions decreased marginally. Levels & trends did not change among the control sites.

16. Implications Value-based payment Or Share in cost savings Or Payment based upon members Or Flat percentage more of payment due to value added | 16

17. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!