1. Integration in Practice; Tracking the Transformation Perry Dickinson, MD Stephanie Kirchner, MSPH, RD Kyle Knierim, MD Collaborative Family Healthcare Association 16 th Annual Conference October 16-18, 2014 Washington, DC U.S.A. Session # G1B 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: Describe how ongoing quality improvement and change management are crucial in supporting behavioral health integration in a primary care setting. Identify how the Comprehensive Primary Care Monitor could be utilized in their own settings to supporting ongoing integration efforts. Discuss how elements of the Comprehensive Care Monitor align with essential practice transformation and support practice self-assessment.

4. Bibliography / Reference 1.Davis, M, Balasubramanian, BA, Waller, E, Miller, BF, Green, LA, Cohen, DJ. Integrating Behavioral and Physical Health Care in the Real World: Early Lessons from Advancing Care Together. Journal of the American Board of Family Medicine.2013;26(5): 588-602. 2.Peek, C.J. and the National Integration Academy Council (2013). Lexicon for behavioral health and primary care integration: Concepts and definitions developed by expert consensus. AHRQ Publication No.13-IP001-EF. Rockville, (MD), Agency for Healthcare Research and Quality. 3.Kathol, RG, deGruy, F, Rollman, BL. Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes. Annals of Family Medicine.2014;12(2): 172-175. 4.Fernald, DH, Deaner, N, O'Neill, C, Jortberg, BT, deGruy, F, Dickinson, P. Overcoming Early Barriers to PCMH Practice Improvement in Family Medicine Residencies. Family Medicine. 2011;43(7):503-509. 5.Daniel DM, Wagner EH, Coleman K, Schaefer JK, Austin BT, Abrams MK, Phillips KE, Sugarman JR. Assessing progress toward becoming a patient-centered medical home: an assessment tool for practice transformation. Health Services Research. 2013;48:1979-1897.

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. What is the PCMH Monitor? Originally developed for use in the Colorado Family Medicine Residency PCMH project, aimed at transforming their practices and programs into medical homes Intended to be a reflective tool for practices to assess and monitor their implementation of fairly concrete activities Can also be used for evaluation Used in multiple other projects across various types of practices

7. Why did we develop the Monitor? Facilitators needed a tool to measure progress and motivate practices PCMH principles are vague – difficult to conceptualize for implementation No tool existed to help practices evaluate progress toward goals Monitor has evolved over time to align with AHRQ Lexicon and incorporate behavioral health integration

8. Let’s give it a try! Please complete Section 11 (Behavioral Health Integration) of the Monitor: Questions to consider: ◦ Which area did you rank the highest & why? ◦ Which area needs the most work & why? ◦ Who do you need to complete the tool? ◦ How would you work to improve these areas?

9. Group Discussion Questions to consider: ◦ Which area did you rank the highest & why? ◦ Which area needs the most work & why? ◦ Who do you need to complete the tool? ◦ How would you work to improve these areas?

10. Team-based care We have the person, now what? How do we work together? How do we communicate with one another?

11. Professional Cultures Primary care and mental health professionals often have basic differences in how they view health care – may not understand each other very well ◦ Differences in basic approach to health and health care ◦ Differences in rhythm of practice, time with patients “I need my behavioral health people to speed up and my family medicine people to slow down” Lack of training in teamwork Need team meetings to figure out roles, work flow, how to work together

12. Looking at the Data Sum of scores for all items in each subscale normalized to number of points out of 100 total Practice and project level trends

13. Practice A: Overall Summary 13

14. Practice B: Summary by Item 14

15. Project 1: Change over time

16. Project 1: What changed

17. Project 2: Growth Over Time

18. Project 2: Quite a Range

19. Outcomes Monitor confirms from a practice perspective what we think is really going on (validates field notes, survey data) Highlights key areas of interest, progress, and difficulties Both the process of completing the Monitor and the results offer opportunities for reflection and prioritization.

20. Facilitating the Monitor Can be done in small bites Can open up conversations that lead to workflow redevelopment. Can make the concept of practice transformation “real” to staff. Can be used to benchmark progress over time. Takes some time – protect the time.

21. Questions?? Contact: Perry.Dickinson@ucdenver.edu Kyle.Knierim@ucdenver.edu Stephanie.Kirchner@ucdenver.edu

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