1. Integrating Behavioral Health and Physical Health Dr. Kimberly Gray, Chief Clinical Officer Advantage Behavioral Health

2. ACA

3. Percentages of Adults with Mental Disorders and/or Medical Conditions National Comorbidity Survey Replication, 2001-2003 3

4. Specialist or Major Contributor  ACA, parity, and a changing healthcare delivery system  Behavioral health conditions are being treated at a higher prevalence in primary care/general medical settings  People with co-morbid medical and behavioral health issues have greater overall health costs and poorer outcomes thus high Medicaid and Medicare costs  Evidence shows that aggressive attention to co-morbid behavioral issues improves both the behavioral and chronic medical condition  State SPA’s for Behavioral Health Homes treating whole person

5. Oh shoot! Was that today?

6. It Ain’t Pretty or Fun  Reviewed all of our integration strategy projects  SAMHSA Grants  SoC Grants  Serious FQHC status consideration  Co-location initiatives with FQHC’s and PCP’s  ACO Partnerships  Hospital Collaborations

7. Vision Quadrant II - Lo PH and Hi BHQuadrant IV - Hi PH and Hi BH Quadrant I - Lo PH and Lo BHQuadrant III - Hi PH and Lo BH

8. Parallel Processes  Need a Champion to Drive  Recognize Limitations – Unity Physician Partners  Capitalize on Current Successes – Care Management Entity  Establish Contracting Goals – change the conversation with MCO’s to help us both change payment methodology.

9. Unity Medical Clinics – Phase 1  Unity Medical Clinics (UMC) housed within 6 Centerstone outpatient clinics  Behavioral Health Specialist embedded within the UMC  Ease of referral and care coordination between UMC and Centerstone  Targeting high need clients without active primary care relationship  State Laws and additional legal limitations

10. Care Management Entity (CME) An organizational entity that serves as the “locus of accountability” for defined populations with complex challenges and their families Accountable for improving the quality and cost of care for historically high-cost/ poor outcome populations

11. CME Functions Evidenced Based Practices Clinical oversight Care Coordination & Transitional Care Care monitoring & review Provider network development & management (BH & PH) Utilization management & quality improvement Outcomes management Information management (Data Analytics, Setting System Goals for Scorecards, Population Health Information, Care Coordination Software) Training Paying Claims Utilize the CME mechanism for multi-disciplined, multi- provider team based care networks – (i.e. Health Homes)

12. Payer Partnerships A partnership is an arrangement in which parties agree to cooperate to advance their mutual interests. Fundamentally concerned about the VALUE of care provided so we have to pay attention to quality and costs.

13. Summary of Synergy  Recognize Internal Limitations – Unity Physician Partners  Build 6 clinics sites within Centerstone  Capitalize on Current Successes – Care Management Entity  Expanding into Care Management technology to be the HOST of One Care Plan with multiple EHR’s and specialists  Exchanging data with payers regarding hospital, ER use, HEDIS  Looking for partnerships to expand our reach and capabilities - new ideas in technology, payment structure and methodology, and keep it simple.  Establish Contracting Goals – New Payment Models  Bundled payments  P4P contracting  Team Incentives  Patient Incentives