Colorado Behavioral Healthcare Council How to Fix …...9/29/2012 1 Colorado Behavioral Healthcare...
Transcript of Colorado Behavioral Healthcare Council How to Fix …...9/29/2012 1 Colorado Behavioral Healthcare...
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Colorado Behavioral Healthcare Council
How to Fix the Healthcare System and Create Healthy Communities September 30, 2012
Dale Jarvis, CPA [email protected]
Overview: Advanced Publicity
• All health care is local!
• It’s becoming clear that there are a small number of pieces in a rather tight puzzle that describes how to fix the U.S. healthcare system.
• This session will provide information participants can take back to their community to lead or participate in discussions in their local approach to build a more healthy community.
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This Session: Clinically Driven Design
Clinical
Planning
Utilization
Planning
Cost
Planning
Financial
Modeling
System redesign should be clinically driven and then supported by financial design; not the other way around!
My Next Session: How to Get Paid for This Work.
My Working Assumption • Rather than
assuming that you know nothing about what I have to say…
• I see this session as an opportunity for you to assess how far you’ve already come.
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Agenda – Two Chapters
• The Big Picture – What is a Healthcare Neighborhood?
• Building the Health Neighborhood: The Puzzle Pieces and How they Connect
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Prologue: Have you heard about Type 3 Diabetes?
Mark Bittman, NY Times, 9/26/12 • The connection between poor diet and Alzheimer’s is
becoming more convincing. (“Food for Thought: What You Eat May Be Killing Your Brain” New Scientist).
• When the cells in your brain become insulin-resistant, you start to lose memory and become disoriented. You even might lose aspects of your personality.
• Let’s connect the dots: We know that the American diet is a fast track not only to obesity but to Type 2 diabetes.
• We also already know that people with diabetes are at least twice as likely to get Alzheimer’s, and that obesity alone increases the risk of impaired brain function.
• What’s new is the thought that while diabetes doesn’t “cause” Alzheimer’s, they have the same root: an over consumption of those “foods” that mess with insulin’s many roles.
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The Big Picture – What is a Healthcare Neighborhood?
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Last Year I Talked About Atlanta • Fulton County Georgia’s Objective: create
health neighborhoods that contain one-stop centers where people receive a holistic set of services under one roof that are customized to the needs of the neighborhood
• Neighborhood Union Primary Care Partnership was the first of four one-stops.
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What’s in the Health Neighborhood?
• The Fulton County Georgia (Atlanta area) Neighborhood Union Primary Care Partnership’s One Stop Shopping: – Well patient care – Sick-patient care – OB/GYN services – Travel immunization
services – Communicable disease
intervention – WIC/nutrition education – Oral health services – Behavioral health services
– Employment assistance – Disability and vocation
rehabilitation services – Foreclosure prevention
services – Housing assistance
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What’s in the Health Neighborhood? • The second one-stop, The
North Fulton Government Service Center has all of the above plus: – A day center for the children
of parents receiving services – A branch of the public
library – A reading room/information
center that offers ESL classes – An office where you can pay
your parking tickets and taxes
– A farmer’s market – A community garden – A walking trail
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People Around the Country are Running with the Concept
• My neighborhood community behavioral health center in West Seattle has just opened a one-stop with embedded primary care and other community partners.
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People Around the Country are Running with the Concept
• The Center for Human Development in La Grande Oregon has combined Primary Care, Public Health, Mental Health, Substance Abuse, Developmental Disabilities, Parenting, Rehabilitation and Veteran's Services.
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Hypothesis: Urban and Rural Communities will continue to organize Atlanta-like one stop shopping sites that aggregate and integrate
services that help community members move toward health.
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School
Assisted Living
Facility
Apartment Complex
Community Center
Behavioral Health Specialty Clinic
Mobile Team
Health Neighborhood One Stop Shopping Site
The Future is…
• Not in Plastics
• Not in Medical Homes
• But in One-Stop Health and Wellness Centers (virtual and physical)
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My Predictions • 80-90% of Behavioral Health Disorders will be
served in health and wellness oriented primary care clinic settings, with the number of one-stops growing
• Community Behavioral Health Organizations will: – Be part of one stop settings
– Have many staff working at many types of satellite clinics
– Have many staff working on community-based teams
• There will be very few freestanding behavioral health centers where this is the only service provided
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My Predictions (continued) • There will be two types of one stops:
– Geographic-based neighborhoods
– Population-based neighborhood (e.g. for Seniors and persons with Serious Mental Illness)
• This future fundamentally challenges the trajectory of how Community Behavioral Health Organizations have historically designed programs, campuses, where staff work, what technology is needed, and more
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Questions and Comments
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Building the Health Neighborhood: The Puzzle Pieces and How they
Connect
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The Current Ecosystem
Hospitals
Hospitals
Specialty
Clinics
Specialty
Clinics
Primary
Care Clinics
Primary
Care Clinics
Social Service Agencies
Dental Clinics Housing Providers
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The current ecosystem is not getting us what we need…
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The First Layer of the Puzzle: Maintain Health/Primary Prevention
• Primary Prevention: A program of activities directed at improving general well-being while also involving specific protection for selected diseases, such as immunization against measles. (Mosby's Medical Dictionary, 8th edition)
Prevention/Early Intervention
Initiatives to prevent health
conditions before they begin
to develop
Wellness Programs
Programs that engage
individuals, helping them
move toward health
Housing, Social Supports
Efforts to Address the Social
Determinants of Health
Public Health
Monitor, investigate,
educate, mobilize, assure the
health of the public
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Tip #1. Self care is one of the most important things for your baby and for yourself. Remember how the airline host directs you to put your oxygen mask on first, then your child’s? You must be able to care for yourself first, in order to care for your child.
Tip #2. The year following a child’s birth is recognized to be stressful for parents and their relationship. In fact, a leading marital therapist says that partner satisfaction plummets during this time, due to all the new demands. It is very important to know this is a NATURAL phase that parents go through, and men and women respond differently! What makes it work is TALKING to each other - and LISTENING! The same therapist says the #1 factor that impacts a marriage is whether the wife feels listened to. Husbands, this could make a huge difference in YOUR first year as well!
“New Parent” Brochure with ACE Material
Wow, a new baby!! If this
is your first baby, you may
be wondering, “Why didn’t
they include the training
manual with this model?”
“You mean this lasts for 18
years??!!” “Will I ever
sleep a full night again?”
“Help!!”
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Survival Mode Response
• Respond
• Learn or
• Process effectively
Allow time to de-escalate
Stressed
Can’t:
Brains
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Prevention/Early Intervention
• Are you leading the effort or partnering with others in your community to promote targeted prevention and early intervention activities?
• Mental Health First Aid
• Resilience Trumps Aces
• Senior Reach
• Etc.
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Other Primary Prevention • Wellness Programs: Do you have and promote
wellness programs for your clients, staff and member of the general community?
• Housing & Social Supports: Does your organization provide or partner at the hip with organizations that provide these services?
• Public Health: Do you have robust partnerships with your local public health authority, supporting each other’s efforts?
Wellness Programs
Programs that engage
individuals, helping them
move toward health
Housing, Social Supports
Efforts to Address the Social
Determinants of Health
Public Health
Monitor, investigate,
educate, mobilize, assure the
health of the public28
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The current ecosystem is not getting us what we need…
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The Second Layer of the Puzzle: Interrupt Health Problems/Secondary Prevention • Secondary Prevention: A program of activities directed at
diagnosing and treating existent condition in early stages before they cause significant morbidity. (US National Library of Medicine)
• Examples: Prevent high blood pressure from becoming hypertension; high blood sugar from becoming diabetes, disruptive behavioral in school from becoming SED, minor depression from becoming major depression.
Person-Centered
Healthcare Homes
Cradle to Grave Well Care
(Secondary Prevention) and
Sick Care
School-Based Clinics
Provide health, behavioral
health and a host of other
services to children at youth
onsite at schools
Employer Clinics
Healthcare Homes and
pharmacies embedded in the
workplace
Retail Clinics
NP/PA-run clinics in shopping
centers; no appointment; treat
40+ conditions; 98%
satisfaction rates
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Workflow 1 for Person with BH Disorders
New Patient’s first
Visit to PCP includes
behavioral health
screening
Possible
BH Issues?
Behavioral Health
Assessment by BH
Professional working
in primary care
Need BH
Svcs?
Clients with Low to Moderate
BH need enrolled in Level 1;
to be case managed and
served in primary care by PCP
and BH Care Coordinator with
support from Consulting
Psychiatrist and other clinic-
based Mental Health Providers
Clients with Hi Moderate to
High need referred to Level 2
specialty care; PCP continues
to provide medical services
and BH Care Coordinator
maintains linkage; this is a
time-limited referral with
expectation that care will be
stepped back to primary care
YES
YES
Referrals to other needed services and supports (e.g. Social Services, Vocational Rehabilitation)
Clients with Hi Moderate to
High need transferred to Level
3 BH specialty care; takes over
ensuring that whole health
needs of clients are met
including primary care through
integration or partnership
model.
Integration Door #1
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New Patient’s first
Visit to BHP includes
physical health
screening
Has PCP?Wants BHP to
provide PC?
Linkage Model
Ensure PCP, health screening
and monitor health conditions,
co-management with PCP,
patient education
Partnership Model
Partner with PC Clinic to
embed medical services in the
BH Center
NOYES
Referrals to other needed services and supports (e.g. Social Services, Vocational Rehabilitation)
Full Integration
A single organization provides
all PC and BH services
Integration Door #2
YES NO
Workflow 2 for Person with BH Disorders
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Interrupt Health Problems/ Secondary Prevention Questions
• How far along is your organization in it’s strategy to embed behavioral health services in local primary care clinics to address the mental health and substance use needs of the practices’ patients?
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Interrupt Health Problems/ Secondary Prevention Questions
• Have you implemented a secondary prevention approach in your centers to identify and interrupt the progress of health problems for your clients before they become chronic health problems?
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The current ecosystem is not getting us what we need…
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The Third Layer of the Puzzle: The Creation of a Hospital/ER Prevention System
• An integrated system of care that contains new models of service delivery to identify those with complex health and behavioral health problems and wrap whole person care around them to help them move toward rehabilitation and recovery.
Hot Spotting
Identify and engage the 5%/
50% population
Community Health Teams
Connect patients to primary
care, get to appointments,
transition from hospital, stay in
their homes, etc.
Complex Care Management
Help patients with chronic
health conditions self-manage
their care and move toward
health
Specialty Providers that are
Health Neighbors to PCHHs
Providing high value services
that support health homes
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Stanford Social Innovation Review
• There are important lessons to learn from poor countries
• Expanding the definition of health care, including:
– The Product that is provided
– The People who provide care
– The Places where care is provide
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• Identifying the 1% of 100,000 people who use 30% of costs and wrapping care around them is an example of the expansion of product, people and place.
• Product: Helping with housing, food, other basic needs.
• People: Community health workers as part of the team.
• Place: Going to where people are including their homes.
• Question: Are you involved in hot spotting the most expensive and complex cases in your community?
Camden’s Hot Spotting
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Vermont’s Community Health Teams • Connect patients
to primary care
• Track patients overdue for appointments or tests
• Help patients being discharged from hospitals
• Health and nutrition coaching
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Question: Are staff in your organization part of interdisciplinary community health teams that fulfill the roles similar to Vermont?
Missouri’s Complex Care Management
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Question: Are you involved in providing complex care management for persons with BH disorders and complex health conditions?
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Person-Centered Medical Home Neighbor
• ACP’s PCMH-N Principles: To be recognized as a neighbor, specialists must demonstrate competency around: – Communication, coordination,
& integration
– Timely consultations & referrals
– Timely, effective exchange of clinical data
– Effective participation in co- management situations
– Patient-centered care, enhanced care access, and high levels of care quality and safety
– Supporting the health home practice’s work
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Health Neighbor National Council Healthcare Reform Readiness Assessment • We are well underway
developing the capabilities to be good neighbors to Person Centered Health Homes.
• Toward this end, we provide or have partnerships with other organizations to offer and seamlessly provide a full array of mental health and substance use services for persons with mild, moderate, serious and severe disorders.
Question: How would you score your organization: ready; almost there; working on it; contemplating it; haven’t thought about it?
Specialty Providers that are
Health Neighbors to PCHHs
Providing high value services
that support health homes
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Prevention/Early Intervention
Initiatives to prevent health
conditions before they begin
to develop
Wellness Programs
Programs that engage
individuals, helping them
move toward health
Housing, Social Supports
Efforts to Address the Social
Determinants of Health
Public Health
Monitor, investigate,
educate, mobilize, assure the
health of the public
Person-Centered
Healthcare Homes
Cradle to Grave Well Care
(Secondary Prevention) and
Sick Care
School-Based Clinics
Provide health, behavioral
health and a host of other
services to children at youth
onsite at schools
Employer Clinics
Healthcare Homes and
pharmacies embedded in the
workplace
Retail Clinics
NP/PA-run clinics in shopping
centers; no appointment; treat
40+ conditions; 98%
satisfaction rates
Hot Spotting
Identify and engage the 5%/
50% population
Community Health Teams
Connect patients to primary
care, get to appointments,
transition from hospital, stay in
their homes, etc.
Complex Care Management
Help patients with chronic
health conditions self-manage
their care and move toward
health
Specialty Providers that are
Health Neighbors to PCHHs
Providing high value services
that support health homes
Questions and Comments
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