Community Based Models of Integrated Primary Care and ...
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COMMUNITY BASED MODELS OF INTEGRATED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICE Clinton Kuntz, CEO MHC Healthcare
Transcript of Community Based Models of Integrated Primary Care and ...
COMMUNITY BASED MODELS OF INTEGRATED PRIMARY CARE AND BEHAVIORAL HEALTH SERVICE
Clinton Kuntz, CEO MHC Healthcare
DISCLOSURE
I have no actual or potential conflict of interest in relation to this program/presentation.
CLINTON KUNTZ
Clinton Kuntz has been CEO of MHC Healthcare since 2013. Before coming to MHC, Dr. Kuntz served as CEO and COO in community health centers in Ohio. Clinton has a Doctoral Degree in Behavioral Health from Arizona State University, a Master’s Degree in Management and Information Systems from Boston University and an undergraduate degree in Computer Science from Mount Vernon Nazarene University.
MHC HEALTHCAREMHC Healthcare currently operates a network of 17 community health centers throughout Pima County, AZ and the Tucson Metro area. MHC offers fully integrated primary care and behavioral health services. Our services include family practice, pediatrics, internal medicine, dental, laboratory, radiology, WIC, pharmacy, Urgent Care, and behavioral health, most often under one roof.
TRADITIONAL VIEWS OF PRIMARY CARE AND BEHAVIORAL HEALTH
INTEGRATED CARE TO WHOLE PERSON CARE
LEVELS OF INTEGRATED CARE
COORDINATED CO-LOCATED INTEGRATED
LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4 LEVEL 5 LEVEL 6
Minimal Collaboration
Basic Collaboration at a
Distance
Basic Collaboration
Onsite
Close Collaboration
Onsite with Some System
Integration
Close Collaboration
Approaching an Integrated Practice
Full Collaboration in a Transformed /
Merged Integrated Practice
MHC’S MODEL OF WHOLE PERSON CARE
TEAM BASED CARE
EXPANDING WHOLE PERSON CARE THOUGH TEACHING
START WITH WHY
At MHC our WHY is to provide compassionate, quality, and accessible whole person health care to our community.
RATIONALE FOR INTEGRATING MENTAL HEALTH INTO PRIMARY CARE
• Skyrocketing cost of healthcare
• Fragmented health systems and unmet healthcare needs
• Persons with mental health problems often don’t get care and those with SMI die, on average, 25 years earlier
• Many people with mental health problems have co-morbid medical problems.
• Primary care providers manage care for 80% of persons with psychiatric disorders and are the “de facto” mental health care system
• Currently 20% of persons in healthcare system use about 85% of resources
• Research reveals that cost-offset is greatest when behavioral and primary healthcare are integrated
BEHAVIORAL HEALTH-RELATED PRIMARY CARE OFFICE VISITS
0%
5%
10%
15%
20%
25%
30%
35%
Overall <12 12-17 18-24 25-44 45-59 60-74 >74
Age group (years)
CENTERS FOR DISEASE CONTROL AND PREVENTION. “QUICKSTATS: PERCENTAGE OF BEHAVIORAL HEALTH–RELATED PRIMARY CARE OFFICE VISITS, BY AGE GROUP — NATIONAL AMBULATORY MEDICAL CARE SURVEY, UNITED STATES, 2010.” NOV. 28, 2014. AVAILABLE FROM: BIT.LY/3F7CLET.
RESEARCH EVIDENCE ON INTEGRATED HEALTHCARE
• Studies have shown that integrating mental/behavioral health services into primary care clinics Improves patient satisfaction
Improves provider satisfaction
Increases adherence to medication
Decreases medical utilization among “high users”
Improves patient outcomes
Reduces healthcare costs
Improves patient quality of life
PATH TO INTEGRATION
Identify and Stratify BH &Co-Morbidity
General Education: PHQ & SBIRT
General Stratification
Additional BH ScreensSpecific Stratification
Increase BH Knowledge/Confidence
Medication Treatment for Depression
Dealing with Suicidal PatientsDealing with Difficult Patients
COPD and AnxietyChronic Pain
Education, Training, & Coaching around specific clinic pain
points
Increase Capacity to Manage within Primary
Care Team
Motivational InterviewingBest Practices for Integrated Care
CoordinationSelf Management Tools
Mobile AppsTrainings for members & families
Building on existing external BH partnerships
Psychiatric ConsultationBuilding on existing internal BH resources including planning for
sustainability, billing, etc.
Access Issues, Referral out to Specialty Care
Coordination with referralsClosing gaps in community
resources
TelepsychiatryTelebehavioral health
Explore options for adding or improving effectiveness of BH
resources within clinic
PATH TO INTEGRATION
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Establish the mission of integration
Both primary care and behavioral health leaders and stakeholders need to establish a shared vision of integration.
Collaborate to develop shared
solutions
All involved stakeholders should meet regularly during early implementation to discuss the needs and challenges of integration and celebrate successes and progress.
Measure outcomes
Identify meaningful metrics (e.g., number of warm handoffs per month, number of depression screenings, etc.).
Be deliberate in recruitment
Hiring the right clinicians is crucial. Not all healthcare and behavioral health providers are suited for the model.
Sufficient funding
It is vital to have complete buy-in from primary care leadership. Because the startup costs and ongoing maintenance cost of the model are not insignificant, leadership must have a clear understanding of the need for integration and fully support the model.
SUMMARYWhole person care is progressive in its integration of behavioral health services within primary care environments and promotion of preventive screenings, timely interventions and a team-based approach to care, especially for those patients who may not initially seek help on their own.
