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Integrated Behavioral and

Primary Care Services:

An Introduction

Integrated Behavioral and

Primary Care Services:

An Introduction

Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division Produced by the Alabama Department of Public Health Video Communications and Distance Learning Division Satellite Conference and Live Webcast

Tuesday, June 28, 2016 10:00 – 11:30 a.m. Central Time Satellite Conference and Live Webcast

Tuesday, June 28, 2016 10:00 – 11:30 a.m. Central Time

Faculty

Faculty

Jeff Capobianco, PhD, LLP

The National Council for Behavioral Health SAMHSA / HRSA Center for

Integrated Health Solutions Jeff Capobianco, PhD, LLP

The National Council for Behavioral Health SAMHSA / HRSA Center for

Integrated Health Solutions University of Michigan School of Social Work University of Michigan School of Social Work

Learning Objectives

Learning Objectives

• Participants will learn:

– What Market Forces Driving the

Need to Integrate Healthcare Services

• Participants will learn:

– What Market Forces Driving the

Need to Integrate Healthcare Services

– How the Ability to Integrate

Services is Affected by State, Regional, and Provider Factors

– How the Ability to Integrate

Services is Affected by State, Regional, and Provider Factors

Learning Objectives

Learning Objectives

– Clinical and Financial Outcomes

Associated with the Integration of Health Care Services

– The Six Levels of BH / PC Provider – Clinical and Financial Outcomes

Associated with the Integration of Health Care Services

– The Six Levels of BH / PC Provider

Integration

– Clinical and Administrative

Components Necessary for Successful Integration Integration

– Clinical and Administrative

Components Necessary for Successful Integration

Presentation Overview

Presentation Overview

1. Overview of Terms

2. What is Driving the Movement to Integrate

3 State Regional and Provider Level 1. Overview of Terms

2. What is Driving the Movement to Integrate

3 State Regional and Provider Level 3. State, Regional, and Provider Level

Approaches to Integration 4. Integration Outcomes

3. State, Regional, and Provider Level Approaches to Integration

4. Integration Outcomes

Presentation Overview

Presentation Overview

5. Business and Clinical Components of Successful Integration:

a) Organizational Change Management

b) Creating and Maintaining

5. Business and Clinical Components of Successful Integration:

a) Organizational Change Management

b) Creating and Maintaining b) Creating and Maintaining

Partnerships

c) Redesigning Administrative Work Flows and Clinical Care Pathways to Enhance Care Management and b) Creating and Maintaining

Partnerships

c) Redesigning Administrative Work Flows and Clinical Care Pathways to Enhance Care Management and

(2)

Presentation Overview

Presentation Overview

6. Ok, where do we begin…? 7. Questions / Discussion 6. Ok, where do we begin…? 7. Questions / Discussion

Defining Our Terms

Defining Our Terms

• How we define a “Term” determines

how we structure beliefs / mental models and ultimately our behavior

• Terms are at the core of how we think • How we define a “Term” determines

how we structure beliefs / mental models and ultimately our behavior

• Terms are at the core of how we think

and act

• If you / your staff are going to be

expected to change the way you think and act everyone must be working from the same set of terms

and act

• If you / your staff are going to be

expected to change the way you think and act everyone must be working from the same set of terms

Integration Terms

Integration Terms

• Some Integrated Health Term Sources: – Research Literature - ”Collaborative

Care”

– Policy - “Health Home”

• Some Integrated Health Term Sources: – Research Literature - ”Collaborative

Care”

– Policy - “Health Home” – Policy - Health Home

– Accrediting Bodies - “Patient

Centered Medical Home”

– Provider Agencies - “Patient

Centered Healthcare Home”

– Policy - Health Home

– Accrediting Bodies - “Patient

Centered Medical Home”

– Provider Agencies - “Patient

Centered Healthcare Home”

Terms Worth Spending the

Time to Define

Terms Worth Spending the

Time to Define

• Population Health Management and

Continuous Quality Improvement

• Care Management and Care

• Population Health Management and

Continuous Quality Improvement

• Care Management and Care g Coordination

• Team-base Care and

Interdisciplinary Team

• Scope of Work and Scope of Practice

g Coordination

• Team-base Care and

Interdisciplinary Team

• Scope of Work and Scope of Practice

Terms Worth Spending the

Time to Define

Terms Worth Spending the

Time to Define

• Value-based Purchasing and Episode

of Care

• Treat to Target and Stepped Care • Value-based Purchasing and Episode

of Care

• Treat to Target and Stepped Careg pp

• Etc.

g pp

• Etc.

Defining Integrated Health

Defining Integrated Health

• “At the simplest level, integrated

behavioral health care (i.e., mental health/substance use disorder) & physical health care occurs when

• “At the simplest level, integrated

behavioral health care (i.e., mental health/substance use disorder) & physical health care occurs when behavioral health specialty & primary care providers work together to address the physical & behavioral health needs of their patients” behavioral health specialty & primary care providers work together to address the physical & behavioral health needs of their patients”

(3)

Defining Integrated Health

Defining Integrated Health

• “Integration can be bi-directional:

either (1) specialty behavioral health care introduced into primary care settings, or (2) primary health care

• “Integration can be bi-directional:

either (1) specialty behavioral health care introduced into primary care settings, or (2) primary health care introduced into specialty behavioral health settings”

introduced into specialty behavioral health settings”

Integration is Essentially

Good Healthcare Delivery

Integration is Essentially

Good Healthcare Delivery

Superb Access to Care Patient Engage-ment in Care Clinical Infor-mation Systems Care Coor-dination Team Care Patient Feed-back Publicly Available Infor-mation Person

Person--Centered Centered Integrated CareIntegrated Care

Integration: A New Initiative?

Integration: A New Initiative?

“The Body must be treated as a whole and not just a series of parts”

--Hippocrates 300 BC “The Body must be treated as a whole and not just a series of parts”

--Hippocrates 300 BCpppp

The Triple Aim is… in Essence a

Call for Care Integration

The Triple Aim is… in Essence a

Call for Care Integration

•Targets identified by Don Berwick

(former director of the Center for Medicaid / care Services and Institute

f H lth I t) th t

•Targets identified by Don Berwick

(former director of the Center for Medicaid / care Services and Institute

f H lth I t) th t

for Healthcare Improvement) that new approaches to healthcare services provision should aim to achieve: for Healthcare Improvement) that new approaches to healthcare services provision should aim to achieve:

The Triple Aim is… in Essence a

Call for Care Integration

The Triple Aim is… in Essence a

Call for Care Integration

1. Improving the Health of

Populations of People 2. Bending the Cost Curve 1. Improving the Health of

Populations of People 2. Bending the Cost Curve 3. Improving the Patient’s

Experience / Quality of Care 3. Improving the Patient’s

Experience / Quality of Care

State Level Approaches

State Level Approaches

• Each state is a Health Care

Integration Experiment

• All are using one or more of the

following:

• Each state is a Health Care

Integration Experiment

• All are using one or more of the

following:g

– Medicaid Expansion – Medicaid 1115, 1915, and

2703(Health Home) Waivers g

– Medicaid Expansion – Medicaid 1115, 1915, and

(4)

State Level Approaches

State Level Approaches

– SAMHSA / HRSA Primary Behavioral

Health Care Integration; Certified Community Behavioral Health Center; HRSA; local / national

– SAMHSA / HRSA Primary Behavioral

Health Care Integration; Certified Community Behavioral Health Center; HRSA; local / national Foundation; and other Grants

• Some are bringing in / expanding use

of Medicaid Managed Care entities Foundation; and other Grants

• Some are bringing in / expanding use

of Medicaid Managed Care entities

State Level Approaches

State Level Approaches

• How State Government and Provider

Associations work together (or not) is important

• Accountable Care Organizations, • How State Government and Provider

Associations work together (or not) is important

• Accountable Care Organizations, g , Regional Care Organizations, Regional Integrated Care Organizations, etc. are all developing capacity to share data, coordinate care, and stratify cost

g ,

Regional Care Organizations, Regional Integrated Care Organizations, etc. are all developing capacity to share data, coordinate care, and stratify cost

Regional Level Approaches

Regional Level Approaches

• All Health Care is Local

• Frontier, Rural, and Urban areas have

different strengths / opportunities when it comes to integrating care

• All Health Care is Local

• Frontier, Rural, and Urban areas have

different strengths / opportunities when it comes to integrating careg g

• All providers must understand their

regional market:

– The health of the Population (zip

code level)

g g

• All providers must understand their

regional market:

– The health of the Population (zip

code level)

Regional Level Approaches

Regional Level Approaches

– How many service providers are

present (i.e., specialty health care, hospitals, independent physician groups, lab services, social services, and government svs courts / police /

– How many service providers are

present (i.e., specialty health care, hospitals, independent physician groups, lab services, social services, and government svs courts / police / and government svs-courts / police / parks rec / etc.) who do they serve, are they financially sound, do they

produce value, are you in competition, coopetition or are you strangers to these providers?

and government svs-courts / police / parks rec / etc.) who do they serve, are they financially sound, do they

produce value, are you in competition, coopetition or are you strangers to these providers?

IH Outcomes: Do People

Become Healthier with IH?

IH Outcomes: Do People

Become Healthier with IH?

• Integrated Care “Can improve mental

and physical outcomes for individuals with mental disorders across a wide

i t f tti d th

• Integrated Care “Can improve mental

and physical outcomes for individuals with mental disorders across a wide

i t f tti d th variety of care settings, and they provide a robust clinical and policy framework for care integration”

• Over 30 RCT’s showing IH improves

health outcomes

variety of care settings, and they provide a robust clinical and policy framework for care integration”

• Over 30 RCT’s showing IH improves

health outcomes

IH Outcomes: For People

with Severe Mental Illnesses

IH Outcomes: For People

with Severe Mental Illnesses

• “…Consumers treated at PBHCI clinics

had greater reductions in select

indicators of risk for metabolic syndrome and several physical health conditions

• “…Consumers treated at PBHCI clinics

had greater reductions in select

indicators of risk for metabolic syndrome and several physical health conditions and several physical health conditions, including hypertension, dyslipidemia, diabetes, and cardiovascular disease. No similar benefit of PBHCI was observed for other indicators, including

triglycerides, obesity, and smoking… and several physical health conditions, including hypertension, dyslipidemia, diabetes, and cardiovascular disease. No similar benefit of PBHCI was observed for other indicators, including

(5)

IH Outcomes: For People

with Severe Mental Illnesses

IH Outcomes: For People

with Severe Mental Illnesses

• … Consistent with other studies of

integrated care not directly targeting changes to BH service delivery…no reliable benefit of PBHCI on indicators of

• … Consistent with other studies of

integrated care not directly targeting changes to BH service delivery…no reliable benefit of PBHCI on indicators of reliable benefit of PBHCI on indicators of BH”

reliable benefit of PBHCI on indicators of BH”

IH Outcomes: For Youth

IH Outcomes: For Youth

• Benefits of IH were observed for

interventions that target MH problems

– Although there was variability in • Benefits of IH were observed for

interventions that target MH problems

– Although there was variability in g y effects across studies, these overall results enhance confidence that IH will lead to improved youth outcomes

g y

effects across studies, these overall results enhance confidence that IH will lead to improved youth outcomes

IH Outcomes: Does IH

Lower Cost?

IH Outcomes: Does IH

Lower Cost?

• Depression treatment in primary care for

those with diabetes correlated with an $896 lower total health care cost over 24

th

• Depression treatment in primary care for

those with diabetes correlated with an $896 lower total health care cost over 24

th months

• Medical use decreased 15.7% for those

receiving behavioral health treatment while controls who did not get behavioral health medical use increased 12.3% months

• Medical use decreased 15.7% for those

receiving behavioral health treatment while controls who did not get behavioral health medical use increased 12.3%

IH Outcomes: Does IH

Lower Cost?

IH Outcomes: Does IH

Lower Cost?

• Depression treatment in primary care

$3,300 lower total health care cost over 48 months

• Depression treatment in primary care

$3,300 lower total health care cost over 48 months

Initial Estimated Cost

Savings after 18 Months

Initial Estimated Cost

Savings after 18 Months

• Missouri Health Homes Total Saving

– 43,385 persons total served

C t D d b $51 75 PMPM

• Missouri Health Homes Total Saving – 43,385 persons total served

C t D d b $51 75 PMPM

– Cost Decreased by $51.75 PMPM – Total Cost Reduction $23.1M – Cost Decreased by $51.75 PMPM – Total Cost Reduction $23.1M

Importantly Consumers Like

IH Approaches

Importantly Consumers Like

IH Approaches

• For e.g. older adults reported greater

satisfaction with mental health services integrated in primary care

• For e.g. older adults reported greater

satisfaction with mental health services integrated in primary care settings than through enhanced referrals to specialty mental health and substance abuse clinics settings than through enhanced referrals to specialty mental health and substance abuse clinics

(6)

Importantly Consumers Like

IH Approaches

Importantly Consumers Like

IH Approaches

• Patient engagement helps to drive

health literacy and ultimately patient “ownership” / responsibility for

• Patient engagement helps to drive

health literacy and ultimately patient “ownership” / responsibility for health behavior change

• In the new marketplace the patient

has more choice about who to see so customer satisfaction matters

health behavior change

• In the new marketplace the patient

has more choice about who to see so customer satisfaction matters

Standard Framework for Integration Standard Framework for Integration

Referral Co-Located Integrated

Key Element: Communication Key Element: Physical Proximity Key Element: Practice Change Level 1 Minimal Collaboration Level 2 Basic Collaboration at a Distance Level 3 Basic Collaboration On-Site Level 4 Close Collaboration On-Site with Some System Integration Level 5 Close Collaboration Approaching an Integrated Practice Level 6 Full Collaboration in a Transformed/ Merged Integrated Integration Practice Integrated

Practice

Behavioral health, primary care and other healthcare providers work:

In separate facilities. In separate facilities. In same facility not necessarily same offices. In same space within the same facility. In same space within the same facility (some shared space). In same space within the same facility, sharing all practice space. Separate systems Communicate about

cases only rarely and under compelling

i t

Separate systems Communicate

periodically about shared patients

Separate systems Communicate regularly

about shared patients, by phone or e-mail Level 1 Minimal Collaboration Level 2 Basic Collaboration at a Distance Level 3 Basic Collaboration On-Site

Standard Framework for Integration Standard Framework for Integration

circumstances

Communicate, driven by

provider need

May never meet in

person

Have limited

understanding of each other’s roles

Communicate, driven by

specific patient issues

May meet as part of

larger community

Appreciate each other’s

roles as resources

Collaborate, driven by

need for each other’s services and more reliable referral

Meet occasionally to

discuss cases due to close proximity

Feel part of a larger yet

ill-defined team

Share some systems, like

scheduling or medical records

Communicate in person

as needed

Actively seek system

solutions together or develop work- a- rounds

Communicate frequently

in person

Have resolved most or all

system issues, functioning as one integrated system

Communicate

consistently at the system, team and individual levels

Level 4 Close Collaboration On-Site with Some System

Integration Level 5 Close Collaboration Approaching an Integrated Practice Level 6 Full Collaboration in a Transformed/ Merged Integrated Practice

Standard Framework for Integration Standard Framework for Integration

Collaborate, driven by

need for consultation and coordinated plans for difficult patients

Have regular face-to-face

interactions about some patients

Have a basic

understanding of roles and culture

Collaborate, driven by

desire to be a member of the care team

Have regular team

meetings to discuss overall patient care and specific patient issues

Have an in-depth

understanding of roles and culture

Collaborate, driven by

shared concept of team care

Have formal and informal

meetings to support integrated model of care

Have roles and cultures

that blur or blend

The Organizational Components

Impacted by Adoption of IH

The Organizational Components

Impacted by Adoption of IH

• Staffing • Building Design • Partnerships / Contracting • Staffing • Building Design • Partnerships / Contracting • Partnerships / Contracting • Financing • Clinical Practice

• Health Information Technology / Use

of Data

• Partnerships / Contracting • Financing

• Clinical Practice

• Health Information Technology / Use

of Data

The Organizational Components

Impacted by Adoption of IH

The Organizational Components

Impacted by Adoption of IH

• Quality Assurance and Improvement • Marketing

• Customer Service

• Quality Assurance and Improvement • Marketing

• Customer Service • Customer Service • Customer Service

(7)

Implementing IH Model

Components Vary in Difficulty

Implementing IH Model

Components Vary in Difficulty

• Implementing discrete model

components was easier than changing staff roles and work patterns

• Implementing discrete model

components was easier than changing staff roles and work patterns

• For example, many practices

implemented disease registries, but were unable to reconfigure work processes to use them effectively for population management

• For example, many practices

implemented disease registries, but were unable to reconfigure work processes to use them effectively for population management

Implementing IH Model

Components Vary in Difficulty

Implementing IH Model

Components Vary in Difficulty

• Same-day scheduling and

e-prescribing were far easier than developing care teams and

• Same-day scheduling and

e-prescribing were far easier than developing care teams and population management population management

Factors Influencing Model

Design and Adoption

Factors Influencing Model

Design and Adoption

1. The Organization’s Vision for Care Provision

2. Organizational Capacity to Change 1. The Organization’s Vision for

Care Provision

2. Organizational Capacity to Changeg p y g 3. Funding - Understanding cost of

care

g p y g

3. Funding - Understanding cost of care

Factors Influencing Model

Design and Adoption

Factors Influencing Model

Design and Adoption

4. Infrastructure and Staff Capacity to Capture, Manage and Share

Information - At both provider and 4. Infrastructure and Staff Capacity to

Capture, Manage and Share Information - At both provider and state levels

5. Provider Network - Who does what, who gets along with whom?

state levels

5. Provider Network - Who does what, who gets along with whom?

Let’s Dig a Little Deeper

Let’s Dig a Little Deeper

• Integration Components:

a) Organizational Change Management b) Creating and Maintaining Partnerships c) Redesigning Administrative Work • Integration Components:

a) Organizational Change Management b) Creating and Maintaining Partnerships c) Redesigning Administrative Work

Flows and Clinical Care Pathways to Enhance Care Management and Coordination

Flows and Clinical Care Pathways to Enhance Care Management and Coordination

Organization Change Management

Organization Change Management

1. Vision for the Organization (Why / What / How)

2. Use of a Change Management Technology

1. Vision for the Organization (Why / What / How)

2. Use of a Change Management Technologygy

3. Leadership Communication Plan 4. Clear Statement of Work / Charge 5. Work Plan Goals Detailing:

gy

3. Leadership Communication Plan 4. Clear Statement of Work / Charge 5. Work Plan Goals Detailing:

(8)

Organization Change Management

Organization Change Management

a. Action Steps b. Accountability c. Measures a. Action Steps b. Accountability c. Measures d. Timelines e. Resource Requirements

6. Continuous Quality Improvement to Sustain the Change

d. Timelines

e. Resource Requirements

6. Continuous Quality Improvement to Sustain the Change

Creating and Maintaining

Partnerships

Creating and Maintaining

Partnerships

• Map-out your provider network to

determine:

1. Provider Specialty

• Map-out your provider network to

determine:

1. Provider Specialtyp y 2. Location

3. If they share your consumers 4. Capacity to share data

p y

2. Location

3. If they share your consumers 4. Capacity to share data

Creating and Maintaining

Partnerships

Creating and Maintaining

Partnerships

5. Willingness to sign a Business Associates Agreement

6. Ability / willingness to share data 5. Willingness to sign a Business

Associates Agreement

6. Ability / willingness to share data y g and coordinate care

y g

and coordinate care

Creating and Maintaining

Partnerships

Creating and Maintaining

Partnerships

• Be clear about what you want and

know your costs and data requirements (i.e., business plan)

• Be clear about what you want and

know your costs and data requirements (i.e., business plan)

• Approach partners with whom most

of your consumers get their care

• Start with a discussion about your

potential partner’s wants / needs

• Approach partners with whom most

of your consumers get their care

• Start with a discussion about your

potential partner’s wants / needs

Creating and Maintaining

Partnerships

Creating and Maintaining

Partnerships

• Consider using an IH assessment

tool to learn where each other stands

• Develop a Business Associates • Consider using an IH assessment

tool to learn where each other stands

• Develop a Business Associates p Agreement (BBA) and focus on care coordination

p

Agreement (BBA) and focus on care coordination

Creating and Maintaining

Partnerships

Creating and Maintaining

Partnerships

• Once in a partnership make sure to have regular senior leadership discussions about progress being made / or not • Regularly discuss budget and care • Once in a partnership make sure to have

regular senior leadership discussions about progress being made / or not • Regularly discuss budget and care • Regularly discuss budget and care

coordination metrics to see if targets are being hit

• Make sure middle managers are executing a work plan that focuses on administrative workflow and clinical pathway alignment • Regularly discuss budget and care

coordination metrics to see if targets are being hit

• Make sure middle managers are executing a work plan that focuses on administrative workflow and clinical pathway alignment

(9)

Confidentiality

Confidentiality

• HIPAA permits sharing information

for coordination of care

• Nationally, with a Business

Associate Agreement consent is

• HIPAA permits sharing information

for coordination of care

• Nationally, with a Business

Associate Agreement consent is g not necessary g not necessary

Confidentiality

Confidentiality

• Exceptions: – HIV

– Substance abuse treatment – No • Exceptions:

– HIV

– Substance abuse treatment – No – Stricter local / state laws

• Don’t confuse legal advice with

court orders

– Stricter local / state laws • Don’t confuse legal advice with

court orders

Redesigning Administrative Work Flows and

Clinical Care Pathways to Enhance Care Redesigning Administrative Work Flows and

Clinical Care Pathways to Enhance Care Enhance Care Management and Coordination Enhance Care Management and Coordination

Redesigning Administrative Work Flows and Clinical Care Pathways to Enhance

Care Management and Coordination Redesigning Administrative Work Flows

and Clinical Care Pathways to Enhance Care Management and Coordination

• Administrative Work Flows Redesigns: – Collaborative / Concurrent

Documentation

• Administrative Work Flows Redesigns: – Collaborative / Concurrent

Documentation

– Same / Day Access and Just In Time Prescribing

– Team Based Care; Team Huddles – Data Sharing; Population Health

Management

– Same / Day Access and Just In Time Prescribing

– Team Based Care; Team Huddles – Data Sharing; Population Health

Management

Redesigning Administrative Work Flows and Clinical Care Pathways to Enhance

Care Management and Coordination Redesigning Administrative Work Flows

and Clinical Care Pathways to Enhance Care Management and Coordination

• Clinical Pathways Redesigns:

– Motivational Interviewing (level of care, activation)

• Clinical Pathways Redesigns:

– Motivational Interviewing (level of care, activation)

– Physical Health (Diabetes, Cardiovascular Disease, Obesity, Respiratory Disease, etc.) – Behavioral Health (Depression, Suicide,

etc.)

– Social Determinants of Health (poverty, – Physical Health (Diabetes, Cardiovascular

Disease, Obesity, Respiratory Disease, etc.) – Behavioral Health (Depression, Suicide,

etc.)

– Social Determinants of Health (poverty,

BH / PC Integration

BH / PC Integration

• Where on the path to integration is

your organization?

• What ground have you covered? • What barriers have you hit?

• Where on the path to integration is

your organization?

• What ground have you covered? • What barriers have you hit? • What barriers have you hit? • What questions remain? • What barriers have you hit? • What questions remain?

(10)

Let’s Discuss!

Let’s Discuss!

Jeff Capobianco Jeff Capobianco Jeffc@thenationalcouncil.org Jeffc@thenationalcouncil.org Jeff Capobianco Jeff Capobianco Jeffc@thenationalcouncil.org Jeffc@thenationalcouncil.org

Change Management

References Resources

Change Management

References Resources

•Managing Transitions: Making the Most of Change, 2nd

Edition (2003). William Bridges.

•The Advantage (2012). Patrick Lencioni.

•Our Iceberg is Melting: Changing & Succeeding Under

Any Conditions (2005) John P Kotter & Holger

•Managing Transitions: Making the Most of Change, 2nd

Edition (2003). William Bridges.

•The Advantage (2012). Patrick Lencioni.

•Our Iceberg is Melting: Changing & Succeeding Under

Any Conditions (2005) John P Kotter & Holger Any Conditions (2005). John P. Kotter & Holger Rathgeber.

•A Sense of Urgency (2008). John P. Kotter •The Heart of Change (2002). John. P. Kotter •Thinking for a Change. (2003). John C. Maxwell •Why Some Ideas Die and Other Stick: Made to Stick.

(2008). Chip & Dan Heath

Any Conditions (2005). John P. Kotter & Holger Rathgeber.

•A Sense of Urgency (2008). John P. Kotter •The Heart of Change (2002). John. P. Kotter •Thinking for a Change. (2003). John C. Maxwell •Why Some Ideas Die and Other Stick: Made to Stick.

(2008). Chip & Dan Heath

References

References

Defining Integrated Health Family Tree - From: Peek CJ and the National Integration Academy Council. Lexicon for Behavioral Health and Primary Care Integration: AHRQ Publication No.13-IP001-EF. Rockville, MD: Agency for Healthcare Research and Quality. 2013. Available at

http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf Defining Integrated Health - Source: Peek CJ and the National

Integration Academy Council. Lexicon for Behavioral Health and Defining Integrated Health Family Tree - From: Peek CJ and the

National Integration Academy Council. Lexicon for Behavioral Health and Primary Care Integration: AHRQ Publication No.13-IP001-EF. Rockville, MD: Agency for Healthcare Research and Quality. 2013. Available at

http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf Defining Integrated Health - Source: Peek CJ and the National

Integration Academy Council. 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. 2013. Available at: http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdfDefining Integrated Health - Source: Butler M, Kane RL, McAlpine D,

Kathol, RG, Fu SS, Hagedorn H, Wilt TJ. Integration of Mental Health/Substance Abuse and Primary Care No. 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 09- E003. Rockville, MD. Agency for Healthcare Research and Quality. October 2008.

Primary Care Integration: Concepts and Definitions Developed by Expert Consensus. AHRQ Publication No.13-IP001-EF. Rockville, MD: Agency for Healthcare Research and Quality. 2013. Available at: http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdfDefining Integrated Health - Source: Butler M, Kane RL, McAlpine D,

Kathol, RG, Fu SS, Hagedorn H, Wilt TJ. Integration of Mental Health/Substance Abuse and Primary Care No. 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 09- E003. Rockville, MD. Agency for Healthcare Research and Quality. October 2008.

References

References

Core Components of Integrated Models - Source: Adapted from Behavioral Health Homes for People with MH & SA, 2012.

http://www.integration.samhsa.gov/clinical-practice/CIHS_Health_Homes_Core_Clinical_Features.pdfTriple Aim – Source: Berwick, Nolan, & Whittington (2008). The Triple

Aim: Care, Health, And Cost. Health Affairs. vol. 27 no.3, 759-769.IH Outcomes – Source: Comparative Effectiveness of Collaborative

Chronic Care Models for Mental Health Conditions Across PrimaryCore Components of Integrated Models - Source: Adapted from

Behavioral Health Homes for People with MH & SA, 2012.

http://www.integration.samhsa.gov/clinical-practice/CIHS_Health_Homes_Core_Clinical_Features.pdfTriple Aim – Source: Berwick, Nolan, & Whittington (2008). The Triple

Aim: Care, Health, And Cost. Health Affairs. vol. 27 no.3, 759-769.IH Outcomes – Source: Comparative Effectiveness of Collaborative

Chronic Care Models for Mental Health Conditions Across Primary Chronic Care Models for Mental Health Conditions Across Primary, Specialty, & Behavioral Health Care Settings: Systematic Review and Meta-Analysis. Am J Psychiatry 2012;169:790-804.. / Blount: http://moo.pcpcc.net/files/organizing_the_evidence.pdfIH Outcomes - Source: RAND, 2013. Eval. SAMHSA Primary & Beh.

Health Care (PBHCI) Grant Program: Final Report.

IH Outcomes - Source: J. Asarnow, M. Rozenman, J. Wiblin, BA, L. Zeltzer. (2015).Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child & Adolescent Behavioral Health A Meta-analysis JAMA

Chronic Care Models for Mental Health Conditions Across Primary, Specialty, & Behavioral Health Care Settings: Systematic Review and Meta-Analysis. Am J Psychiatry 2012;169:790-804.. / Blount: http://moo.pcpcc.net/files/organizing_the_evidence.pdfIH Outcomes - Source: RAND, 2013. Eval. SAMHSA Primary & Beh.

Health Care (PBHCI) Grant Program: Final Report.

IH Outcomes - Source: J. Asarnow, M. Rozenman, J. Wiblin, BA, L. Zeltzer. (2015).Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child & Adolescent Behavioral Health A Meta-analysis JAMA

References

References

IH Outcomes - Sources: 1. Chiles et al.(1999). Clinical Psychology. ;6:204–220. 2. Katon et al.(2006). Diabetes Care. ;29:265-270. 3. Unützer et al. (2008)., American Journal of Managed Care 2008;14:95-100.Cost Savings After 18 months - Source: Parks, J

See:http://www.integration.samhsa.gov/Joe_Parks,_Envisioning_the_ Future_of_Primary_amd_Behavioral_Healthcare_Integration.pdf Cost Savings and ACO’s - Source: 8/25/15 CMS Report IH Outcomes - Sources: 1. Chiles et al.(1999). Clinical Psychology.

;6:204–220. 2. Katon et al.(2006). Diabetes Care. ;29:265-270. 3. Unützer et al. (2008)., American Journal of Managed Care 2008;14:95-100.Cost Savings After 18 months - Source: Parks, J

See:http://www.integration.samhsa.gov/Joe_Parks,_Envisioning_the_ Future_of_Primary_amd_Behavioral_Healthcare_Integration.pdf Cost Savings and ACO’s - Source: 8/25/15 CMS Report

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-08-25.html

Consumers Like IH Approaches - Source: Chen H, Coakley EH, Cheal K, et al. (2006). Satisfaction with mental health services in older primary care patients. Am J Geriatr Psychiatry. Apr;14(4):371-9.Components Vary in Difficulty - Source: Paul A. Nutting, see

http://www.slideserve.com/kobe/the-patient-centered-medical-home-implications-for-health-policy-and-workforce-development https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-08-25.html

Consumers Like IH Approaches - Source: Chen H, Coakley EH, Cheal K, et al. (2006). Satisfaction with mental health services in older primary care patients. Am J Geriatr Psychiatry. Apr;14(4):371-9.Components Vary in Difficulty - Source: Paul A. Nutting, see

http://www.slideserve.com/kobe/the-patient-centered-medical-home-implications-for-health-policy-and-workforce-development

Resources

Resources

• SAMHSA/HRSA Center for Integrated Health Solutions • http://www.integration.samhsa.gov/ (Great resource

on everything integration)

• Integrated Care Resource Center

http://www.integratedcareresourcecenter.com/

• SAMHSA/HRSA Center for Integrated Health Solutions • http://www.integration.samhsa.gov/ (Great resource

on everything integration)

• Integrated Care Resource Center

http://www.integratedcareresourcecenter.com/ (Website detailing what is happening with health reform in each state)

• Center for Healthcare Strategies http://www.chcs.org/

(Website focused on publicly funded healthcare and the transformations underway)

(Website detailing what is happening with health reform in each state)

• Center for Healthcare Strategies http://www.chcs.org/

(Website focused on publicly funded healthcare and the transformations underway)

(11)

Resources

Resources

• AHRQ Integration Academy

http://integrationacademy.ahrq.gov/atlas (1.Framework for understanding measurement of integrated care; 2. A list of existing measures relevant to integrated behavioral health care; & 3.Organizes measures by the framework and by user goals to facilitate selection of measures)

• AHRQ Integration Academy

http://integrationacademy.ahrq.gov/atlas (1.Framework for understanding measurement of integrated care; 2. A list of existing measures relevant to integrated behavioral health care; & 3.Organizes measures by the framework and by user goals to facilitate selection of measures)

measures).

• CMS Innovation Center: Health Care Payment Learning

& Action Network

http://innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/

• Partnering w/ Schools for MH: A Guidebook

https://www.omh.ny.gov/omhweb/Childservice/docs/sc hool-based-mhservices.pdf

measures).

• CMS Innovation Center: Health Care Payment Learning

& Action Network

http://innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/

• Partnering w/ Schools for MH: A Guidebook

https://www.omh.ny.gov/omhweb/Childservice/docs/sc hool-based-mhservices.pdf

References

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