Focus on Quality Depression Screening and QI Tools June 12, 2019 Indiana Primary Health Care Association

Welcome! Please keep phones muted while not speaking to eliminate background noise. If you are using your computer for audio, click the microphone button next to your name to mute. Do not place calls on hold, so we don’t hear hold music. Use the chat box features if you have any questions that come up during the presentation. Please complete the evaluation poll by the end of the meeting. Note, this meeting will be recorded and shared with peers.

Agenda Data Benchmarks- Depression Screening Depression Screening Workflows & SBIRT INSPECT integration & Workflows Peer Sharing on INSPECT Use Quality Improvement Tools- A3 Model PCMH & Behavioral Health Announcements and Events Jasmine introduce

Introductions If you only called in please state your name and health center If there are multiple people in the room, enter their names and email into the Chat Box. Carla

Welcome, Lolade Gabriella Oladele!!! Born 03/21/2019 Weight-7lbs 1oz Length- 20.25in

Clinical Quality Metrics Measures of Focus Colorectal Cancer Screening Cervical Cancer Screening Hypertension Control Childhood Immunization Diabetes Control Behavioral Health Screening Clinical Quality Metrics We have 6 measures of focus; this quarter we begin with a focus on Depression Screening and Behavioral Health

Today’s Objectives After this session I will be able to: Identify at least two workflows for depression screening and SBIRT Describe how to integrate INSPECT into workflows at the health center Use the A3 model as a quality improvement tool Indicate promising practices and describe lessons learned from peers

IPHCA’s 2019 Annual Conference: STOP Addictions Resources Available on IPHCA Website Some topics covered: Social determinants of health Harm reduction in needle exchange Oral health treatment Community partners SBIRT and Motivational interviewing concepts Care team’s role in SUD Didn’t have FoQ due to IPHCA Annual Conference

Depression Screening & Follow- up (NQF 0418) Percentage of patients aged 12 years and older screened for depression using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.

How Do You Follow-up if Positive Screen?? Follow-up within 1 day must include one or more of the following: Additional evaluation for depression, e.g PHQ-9 Suicide Risk Assessment Referral to a practitioner who is qualified to diagnose and treat depression Other interventions or follow-up for the diagnosis or treatment of depression Pharmacological interventions Measure specs from Azara DRVS

Focus on Quality Data Review- Indiana No HP 2020 Average Overall, not much improvement as a state from 2017 to 2018, however there has been a significant increase in the number of Look-Alikes during 2018 who reported during UDS 2018, so the denominators are significantly different from 2017.

Depression Screening & Follow up Indiana Indiana outperforms National average 2017!! Blue- 2017 Black- 2018

Depression Screening & Follow Up Improvers Health Center Name 2018 UDS Rate Percent Increase from 2017 Shalom Health Center 87% 6% Purdue- NCNC 84% 1% Family Health Center of Clark County 77% 12% NorthShore Health Centers 75% 10% Maple City Health Care Center 74% Neighborhood Health Clinics 71% 3% Jane Pauley CHC Southlake Communty Mental Health 69% 7% Aspire Health Center 11% Riggs CHC 67% 8% Windrose Health Network 60% 38% Meridian Health Services 58% 18% Greene County Health 55% 24% Valley Professionals CHC 49% Indiana Health Centers 46% Open Door Health Services 36% 2% Madison County CHC

Screening Rate Improvements 17 CHCs saw improvements on depression screening and follow up in 2018 15 CHCs surpassed the National Average of 60% from 2017 Several QI tools can be used to improve on this measure and other clinical measures

Today’s Guest Presenters Donna Vaughan, LMHC Director of Integrated Primary Care WindRose Health Networks Stephanie Jeffery & Nicole Hall Director of Quality & Risk Management Valley Professionals CHC Elkin Salinas HCCN Project Coordinator Community Clinic Association of LA County

PHQ-2 and SBIRT Depression Screening

Peer Sharing on Collecting Depression Screening and INSPECT How are you using INSPECT in your EHR workflow Current challenges and promising practices INSPECT integration: Eskenazi, Regional, HealthLinc, Community Healthnet, Riggs, NorthShore, VPCHC

Quality improvement tool A3 for PDSA Display- Elkin Salinas Quality improvement tool

Link to Website QI Toolkit

Behavioral Health and Patient Centered Medical Home Behavioral health is big component in a patient centered medical home. There is even an opportunity for health centers to strive for a distinction in behavioral health integration through the National Committee for Quality Assurance (NCQA). Concept: Team-Based Care and Practice Organization TC 08 (2 Credits) Behavioral Health Care Manager: has at least one care manager qualified to identify and coordinate behavioral health needs. Concept: Knowing and Managing Your Patients(KM) KM 01 (Core) Problem Lists: Documents an up-to-date problem list for each patient with current and active diagnoses. The patient’s active problem list or diagnoses should include acute nd chronic conditions, behavioral health diagnoses and oral health issues, as well as past diagnoses that are relevant to the patient’s current care. KM 02 (Core) Comprehensive Health Assessment: Comprehensive health assessment includes 9 items, including mental health/substance use history of patient and family and behaviors affecting health. KM 03 (Core) Behavioral Health Screening: Conducts behavioral health screenings and/or assessments using a standardized tool. (Implement 2 or more – Anxiety; Alcohol use disorder; Substance use disorder; Pediatric behavioral health screening; Post-traumatic stress disorder; Attention deficit/hyperactivity disorder; Postpartum depression.) Carla

BH and PCMH (Cont.) KM O4 (1 Credit) Behavioral Health Screenings: Conducts behavioral health screenings and/or assessments using a standardized tool. (Implement two or more) KM 20 (Core) Clinical Decision Support: Implements clinical decision support following evidence-based guidelines for care of - practice must demonstrate at least four criteria and mental health condition (depression is one example) can be one of the four. Concept: Care Management and Support (CM) CM 01 (Core) Identifying Patients for Care Management: Considers the following when establishing a systematic process and criteria for identifying patients who may benefit from care management – practice must include at least three in its criteria and behavioral health conditions is listed. CM 02 (core) Monitoring Patients for Care Management: Monitors the percentage of the total patient population identified through its process and criteria. If behavioral health conditions is selected from CM 01, then it must be included here. CM 04 (core) Person-Centered Care Plans: Establishes a person-centered care plan for patients identified for care management. Dependent on behavioral selection from CM 01. CM 05 (Core) Written Care Plans: Provides a written care plan to the patient/family/caregiver for patients identified for care management. Dependent on behavioral selection from CM 01. Carla

BH and PCMH (Cont.) CM 06, 07, 08. (1 credit each) all relate to the individual care plans and are dependent on the selection from CM 01. Concept: Care Coordination and Care Transitions (CC) CC 09 (2 credits) Behavioral Health Referral Expectations: Works with behavioral healthcare providers to whom the practice frequently refers to set expectations for information sharing and patient care. CC 10 (2 Credits) Behavioral Health Integration: Integrates behavioral healthcare providers into the care delivery system of the practice site Concept: Performance Measurement and Quality Improvement (QI) QI 01 (Core) Clinical Quality Measures: Monitors at least five clinical quality measures across the four categories (must monitor at least one measure of each type – behavioral health is one category. QI08 (Core) Goals and Actions to Improve Clinical Quality Measures: Sets goals and acts to improve upon at least three measures across at least three of the four categories (behavioral health is one category). Contact Carla Chance, Cchance@indianapca.org. for questions and more info

Evaluation Poll Please complete the brief evaluation before signing off.

Announcements & Events SBIRT Trainings $20 for Members, $40 non-members June 14th in Muncie June 17th in Indianapolis June 18th in Jeffersonville Project ECHO- Opioid Use Disorder for Prescribers and Dispensers Free Registration Open, began May 29th and continues for year More details in May CHC Digest Visit indianapca.org “Events” for more IPHCA events