Promises and Perils of Integrated Care
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Transcript of Promises and Perils of Integrated Care
Julia Beatty, MD, Assoc. Medical Director, The HealthCare ConnectionBrenda Coleman, MHPA, Principal, BJC HealthCare Consulting Tony Dattilo, MA, CEO, Greater Cincinnati Behavioral HealthJohn Francis, MSSW, Executive Director, Centerpoint HealthDolores Lindsay, MPA, CEO, The HealthCare Connection Edward Shelleby, PhD Psychology, Director of Special Projects and Quality Improvement, Central Community Mental Health Board
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Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Session # G2October 28, 20112:15 PM
Faculty Disclosure
I/We have not had any relevant financial relationships
during the past 12 months.
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Learning Assessment
A learning assessment is required for CE credit.
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Need/Practice Gap & Supporting ResourcesPeople in Ohio with Severe Mental Illness (SMI) die
32.2 years earlier than the rest of the population (Miller, Paschall, Svendsen, 2006)
Studies show that 60% of patients with SMI die of preventable health conditions
Access to primary care is limited/a problem for SMI clients
By report a large percentage of SMI clients have poorly controlled chronic health problems, e.g., Diabetes, Hypertension
Care for SMI clients is fragmented–not coordinated. 4
Objectives1. Identify the key contributing factors for
the successful integration of primary care and behavioral health services
2. Articulate the reasons for setting realistic performance objectives. It’s A Journey!
3. Identify the pros and cons of partnering with a Federally Qualified Health Center (FQHC)
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Expected OutcomeAt the end of this session, participants will:
Understand the benefits of integrating care using the co-location model
Identify barriers and success factorsArticulate pros/cons of partnering with a
FQHCUnderstand the importance of setting
realistic performance expectationsRecognize and know: “Rome was not built
in a day.”6
OUR PARTNERSHIP CO-LOCATION MODEL
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Supervising PC Physician
MD & APN
Psychiatrist
Partnership’s Client Flow
MH intake
PC intake
Referral
Client
Behavioral Health Clinic SiteIndependent, Parallel Clinical Processes
Case Manager
Support Staff: LPN & MA
The PartnersThe HealthCare ConnectionFederally Qualified Health Center (FQHC)National Committee for Quality Assurance ,
Patient Centered Medical Home recognitionSeven locations serving 18,000 patients annuallyMission: Provide quality, culturally sensitive
and accessible primary care focusing on the medically underserved, underinsured and uninsured in northern Hamilton County Ohio and surrounding areas
Oldest FQHC in Ohio. Founded in 1967 www.healthcare-connection.org
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The PartnersCenterpoint HealthComprehensive behavioral health provider formed in
2008 through merger of three local community behavioral health agencies
Five office locations + four treatment sites serving 7,000 clients annually in Hamilton County, Ohio
Mission: Strengthen communities served by providing the best quality mental health care to children, adults and families
Services: Adult Outpatient, Child Case Management, Adult Case Management, Adult Support, and Crisis & Prevention, including the 24/7 suicide hotline for Hamilton County
www.centerpointhealth.org9
The PartnersCentral Community Health Board of Hamilton
County A Private, non-profit corporation founded in 1970.Provides comprehensive mental health and drug treatment, alcoholism referral services and HIV prevention services to Hamilton County, Ohio residents.Mission: Provide the best possible mental illness, substance abuse and HIV prevention and treatment services Services: Case management, psychotherapy, partial intervention, emergency and long-term residential, psychiatric , addictions and methadone treatment.
www.cchbinc.com 10
The PartnersGreater Cincinnati Behavioral Health Services A comprehensive mental health agency serving
adults with severe mental illness in the Cincinnati area.
300 care professionals serve over 4,000 adults annually
Rehabilitation services at 10 locationsProvides psychiatric, nursing, counseling, care
management, residential, vocational, day programs and others
SMI clients include the homeless, incarcerated, and those with many dual disorders.
www.gcbhs.com11
Key Factors for Successful IntegrationShared mission, goals, and be
comfortable with risk. Roles and responsibilities clearly defined (MOU) Handout 1
Committed boards, executives, and senior leaders
Mutually understanding the need to work to determine the right payer mix and be realistic about what it will take to achieve objectives (financial and service)
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Key Factors for Successful IntegrationManagement level “champion” in each
organizationThe “right” providers and staff in the
“right seats on the bus”Strong inter/intra organizational
communication systemsPrimary care office location easily
accessible to clients and psychiatristsHandout 2
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Pros of Partnering with a FQHC
Have similar missionsExperience serving underserved at-
risk populationsPrimary care billing system in placeHave a system approach to health
careAre familiar with public health policyFederal level support (i.e. funding
and enhanced Medicaid rate)
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Pros of Partnering with a FQHC
Shared client populations. May already serve SMI individuals at other locations
Federal level support (i.e. funding and enhanced Medicaid rate)
PCMH expectation and requirements closely mirror behavioral health accreditations (i.e. CARF)
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Cons of Partnering with a FQHC Learning curve. Operates in a different
world (billing, reimbursement, funding, clinical language)
FQHC not in service area FQHC not widely known or respected
in the community. Is this the right partner?
FQHC and behavioral health agency uncertain or lukewarm about establishing a relationship
Set Realistic Performance Measures/Objectives
Determine the right number and types of objectives. Measure what really matters. This will help in: Making administrative decisions Course correcting as needed Building success Finding/applying for new money
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Set Realistic Performance Measures/Objectives
Maintaining funding Clinical decision making Replication Maintaining focus
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Our Primary Care Performance Measures# Visits% Insured Visits# Visits/Work Day% Appointments Kept# Unduplicated Patients
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Our Primary Care Performance Measures% Insured PatientsNet Gain/LossRevenue/Visit as % of Cost/VisitCost/Patient
Handout 3
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Our Primary Care Performance Measures% Diabetic Patients with most recent
HgA1c < 8 % Hypertensive Patients with most
recent BP under 140/90
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Session Evaluation
Please complete and return theevaluation form to the classroom monitor
before leaving this session.
Thank you!
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