A Behavioral Health Medical Home for Adults with Serious Mental Illness Aileen Wehren, EdD Vice President Systems Administration Porter-Starke Services, Inc. Beth Wrobel, BSME Chief Executive Officer HealthLinc, Inc. Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Session # G3a October 28, 2011

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

Need/Practice Gap & Supporting Resources In addition to the wealth of research regarding the effectiveness of integrated care, there is recent research (Alakeson, Frank and Katz, May 2010) that indicates that specialty behavioral health medical homes are a more effective method of meeting the unique health needs of individuals with serious mental illness Key factors for improving the health of individuals diagnosed with serious mental illness  Medical and behavioral health staff work as a team  Form a health Care Home where the patient feels at “home” and where other supportive services are avialable, usually the CMHC

Objectives Know how to achieve buy in from leadership and practitioners in implementing a medical home for individuals with a serious mental illness Understand the elements to successful integration of primary medical and behavioral health care for this group of individuals including identifying and overcoming barriers Know how to define and to achieve measurable healthcare outcomes Learn options to financially support behavioral health medical homes and integration of primary and behavioral healthcare

Expected Outcome Establishment of metrics that can be used to guide development of the care design and to determine effectiveness of the model Practical understanding of one design option

Our Design FQHC located a health clinic at the CMHC Staffed with a Healthcare Team: Nurse Practitioner, Nurse, Case Manager/Skills Trainer Started small with a hand selected group of consumers Grew the clinic after operational issues were resolved Medical appointments involve the entire Healthcare Team and the consumer Case Manager/Skills Trainer works with the consumer in-between appointments on actions identified in the healthcare/treatment plan Data Elements for evaluation: Exercise behavior, smoking behavior, PHQ9 scores, GAD scores, CAGE-AID scores, triglycerides, cholesterol levels, A1C levels, weight and BMI

Achieving and Maintaining Buy In Must have the confidence and support of the leadership, the practitioners and the individuals receiving the care. Everyone needs to understand the why and how of integrated health care Project design should include all staff that will have contact with the individuals Analyze finances to ensure that the project design can succeed financially Build evaluation into the project from the very start, both clinical (health and behavioral health) and financial Have regular meetings of the staff from involved providers to ensure effective management

Successful Integration of Care Behavioral health care is embedded in the primary healthcare clinic and framed in terms of overall health improvement and feeling better At medical appointments the individual, the primary healthcare staff and the behavioral health care staff are all present so that services are decided and agreed upon by all Healthcare/Treatment plans are jointly developed Review of current status and what are specific manageable steps to take until the next appointment

What Works Coordinated care between primary and behavioral health; providers work together toward common goals Health behavior coaching and skills training including initially participating with the individual to improve skills and motivation Focus on helping people improve/stabilize chronic physical/mental health conditions and to feel better about themselves Teaching illness management including physical and behavioral health and the intersection between them Helping to improve diet and exercise patterns Supporting consultation and joint treatment planning between primary care and psychiatry

What Might be a Barrier Lack of engaged and supportive leadership and/or staff Behavioral health carve outs within Medicaid programs Finances: Not determining what services can be billed, by which provider, at what rate, for what individuals (insurance status) Lack of staff training, initial and ongoing Lack of defined roles and responsibilities for staff as well as systems of communication Lack of engagement of the individuals receiving the care Psychiatric symptoms

Satisfaction with the Clinic

Success Stories Expansion recent so have only limited clinical outcomes Indiana Medicaid is interested in our results including financial impact Since October 2010 John has increased his weight (good), decreased his non-HDL cholesterol from 233 to 85, decreased LDL from 190 to 63 and decreased triglycerides from 215 to 158 Dale had his weight increase but his non HDL cholesterol decreased and he now wants to pursue employment Scott’s weight is decreasing, his PHQ9 decreased fro 14 to 5, his GAD from 7 to 2 and he has obtained a membership at the YWCA and is exercising regularly on his own Robert has lost 28 pounds and 3 inches off of his waist in the past four months. According to the Project RN, Callie, he is watching what he is eating and “feels so much better”

Some Preliminary Results

Learning Assessment Evaluation of a behavioral health medical home should include measurement of both physical and behavioral health indicators. Yes/No As long as the clinical team supports integrated service delivery the position and support of the leadership is irrelevant. Yes/No

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