1. Integrated Behavioral Health Planning Meeting October 25, 2013 Debra Hurwitz, MBA, BSN, RN CSI Co-Director 1

2. Agenda CSI Strategic Plan for Integrated Behavioral Health Draft Integrated Behavioral Health Charter Understanding the landscape Who else should be at the meeting? Who else do we want to hear from/know? What might we want to pilot? Next Steps 2

3. CSI-RI Strategic Plan Mission: To lead the transformation of primary care in RI in the context of an integrated health system Charge: To lead, partner or participate with appropriate stakeholders to develop additional capabilities for PCMH. To align with EOHHS and HEALTH to leverage state resources to improve population health Timeline: 1/14-1/16 Draft Charter 3

4. Models of medical and BH services Coordinated: BH services by referral at separate location with formalized information exchange (little evidence yet of cost and clinical improvement) Co-located: BH services by referral in the primary care practice space (moderate cost and clinical evidence + staff and patient satisfaction) Integrated: BH services part of the “medical” treatment in primary care practice (abundant clinical and growing evidence and great satisfaction) (Blout, 2003) 4

5. Importance of relationship with primary care First contact: When you need to “go to the doctor,” come see us Continuous: Know the patient/family over time and in context; can address issues over time Comprehensive: “We have what you need” Coordinated: “If we don’t have it, we will find it” Care for “undifferentiated” patient: No matter what the problem, you are in right place (Blout, 2013) 5

6. Need and Access to Care Need: 1 in 5 people have a mental health or addiction program Identification: 2/3 of patients with BH/addiction problems seen in medical sector receive no treatment Patient Response: The vast majority of people will not accept a referral to specialty BH offered by a PCP. It is care with primary care or no treatment Kathol, RG el al (2005). General Medicine and pharmacy claims expenditures in users of behavioral health services. Journal of Internal Medicine 220 (2) 160-167 Regier, DA, et al. The de factor US mental and addictive disorder service system. Arch Gen Psychiatry. 1993 Feb; 50(2) 85- 94 6

7. BH problems seen in primary care PHQ 3000 Major Depression 10% Panic Disorder 6% Other Anxiety Disorders 7% Substance Use Disorders 14% Any Mental Health Dx 28% ( BH = MH, SA, and Health Behavioral Change Needs ) (Blout, 2013 ) 7

8. Smoking 25% Obesity 30% Sedentary lifestyle 50% Non-adherence 20-50% Blout, 2013) 8 Prevalence of unhealthy behaviors

9. Chronic conditions that with BH component in standards Asthma Diabetes CVD Irritable Bowel Syndrome Obesity Substance Abuse 9

10. 2014 Draft NCQA Standards The practice is responsible for coordinating care across multiple settings which include the scope of services available within the practice and how behavioral health needs are addressed Comprehensive assessment: depression screening using PHQ 2, PHQ 9 or other standardized tool; mental health/substance abuse history of patient and family; behaviors affecting health 10

11. 2014 Draft NCQA Standards (cont) The practice implements clinical decision support following evidence based guidelines for: A mental health or substance use disorder Conditions related to unhealthy behavior The practice has a written process for implementing and managing referrals with specialists including behavioral health providers 11

12. What is happening in RI? 2006 Inventory of Behavioral Health and Primary Care-what needs to be added? Providence Center Kent Center Other? Who else do we want to hear from? What are barriers that need to be considered? 12

13. What might we want to pilot? Compacts/referral system Co-location Integration Community health team integration Psychiatry telemedicine Funding sources Other? 13 Next Steps