New and Emerging Services and Primary Care, Behavioral (MH/SA) Health Initiative Presented by: Kathleen Reynolds, Director of CIHS

PBHCI – SAMHSA/HRSA Center for Integrated Health Solutions Grant Awarded to the National Council for Community Behavioral HealthCare Four years; $5.3 Million/year Target Audience SAMHSA Grantees HRSA Grantees General Public Services Training and Technical Assistance Knowledge Development Prevention and Wellness Workforce Development Health Reform Monitoring and Updates

National Steering Committee

Primary Behavioral Health Care Integration (PBHCI) Program - Grantees Program purpose To improve the physical health status of people with SMI by supporting communities to coordinate and integrate primary care services into publicly funded community-based behavioral health settings, including substance abuse service organizations Expected outcome Grantees will enter into partnerships to develop or expand their offering of primary healthcare services for people with SMI, resulting in improved health status Population of focus Those with SMI served in the public behavioral (MH/SA) health system

Top Ten Areas for Consideration in Developing and Supporting Patient Centered Health Care Homes State Level Leadership State Level Management Models/Strategies Culture Workforce Collaboration Confidentiality Finance Data Training

State Level Leadership Identify overarching vision and language for discussions Language (coming soon) Wagner Chronic Care Model Four Quadrant Model Doherty/Baird/Reynolds Continuum

Language Document – In Press – Available within 30 days

The Consumer and Staff Perspective/Experience

Wagner Chronic Care Model

Four Quadrant Clinical Integration Model

State Level Management Using overarching structure – What do you expect? This time we need “disruptive innovation” not paying for what we already do. What will be different and how will you know that changes are good change? How do you envision substance abuse services to be involved in the Health Home?

Models/Strategies – Bi-Directional Integration Behavioral Health –Disease Specific IMPACT RWJ MacArthur Foundation Diamond Project Hogg Foundation for Mental Health Primary Behavioral Healthcare Integration Grantees Behavioral Health - Systemic Approaches Cherokee Health System Washtenaw Community Health Organization American Association of Pediatrics - Toolkit Collaborative Health Care Association Health Navigator Training Physical Health TEAMcare Diabetes (American Diabetes Assoc) Heart Disease Integrated Behavioral Health Project – California – FQHCs Integration Maine Health Access Foundation – FQHC/CMHC Partnerships Virginia Healthcare Foundation – Pharmacy Management PCARE – Care Management Consumer Involvement HARP – Stanford Health and Wellness Screening – New Jersey (Peggy Swarbrick) Peer Support (Larry Fricks)

Models/Strategies for Involving/Integrating Substance Abuse Services Wisconsin and UCLA – SBIRT Program Baltimore – Two FQHC’s integrating co-occurring services into primary care Connecticut – Methadone Program became primary care site Philadelphia – Horizon House Medication Assisted Treatment Options

Projects by Region

Culture Acknowledge the differences between MH/SA/PC cultures Do not allow it to deter or delay implementation Address it through training On the job training Existing resources Joint grand rounds Webinars Train together and separately Provide support for moving forward

Workforce Existing Workforce Needs Reviewing and Credentialing standards Substance Abuse Professionals – Treatment and Prevention Mental Health Staff Who? Can do What? Where? Licensing Standards - Space Scope of Practice Standards Advanced Nurse Practitioners Future Work Force Linkages with training programs

Collaboration Does this come naturally in your state? Does your strategy support creating or breaking down silos? Does your strategy make use of the solid investments in existing systems and take advantage of their strengths? Will you system pay for or support collaboration for systems and for services now and in the future? How has MH/SA collaboration/integration gone in your state?

Confidentiality HIPAA allows for sharing information for Health Care Coordination 42CFR Part II Issues may impeded information sharing Does your state mental health code need revising?

Products at levels one, two, three, and four

Finance Existing Options series SBIRT codes Case Management Reimbursement Dear Medicaid Director 2005 Future Options Healthcare Home – expanded reimbursement options Include what we know works!

Data What existing data can you develop/share with pilots sites? Medicaid Data Based Integrated for MH, SA and PC? What are the costs per consumer? Is it available electronically? What will you want in the future? How will you know if you are successful? Do you have registry option for providers?

Training Keys to success Change management training Collaborative service provision – like professionals train like professionals Health Navigator Training BH staff (MH and SA) in primary care PC staff in mental health and substance abuse agencies

CIHS Services to Assist You Web-based Resource Center ( eSolutions Newsletter National Webinars Regional and State Based Learning Communities