Integrating Primary & Behavioral Health Across Wyoming Andrew Philip, PhD, LP Senior Director – Clinical & Population Health
About PCDC Primary Care Development Corporation (PCDC) is a national nonprofit organization and a community development financial institution catalyzing excellence in primary care through strategic community investment, capacity building, and policy initiatives to achieve health equity. 2
Catalyzing excellence in primary care to achieve health equity TRANSFORM INVEST ADVOCATE We provide capital to integrate We partner with health care We advance policy initiatives to services, modernize facilities, or providers to build capacity bring resources, attention, and expand operations and improve services and innovation to primary care outcomes 3
Our Impact 10,630 2,800 Organizations Jobs strengthened created or preserved 3.8M 1.1B Dollars leveraged Medical visits in low-income communities added through expansion 4
The Current Healthcare System: Dis-integrated Mental Health, substance use, and physical health care providers are typically: • Located in different facilities /spaces • Non-holistic in approach : focus only on a narrowly defined set of problems (assessment, treatment, and outcomes) • Lacking in communication/coordination of services for patients with multiple needs • Limited in interactions with other provider types Regulated, licensed, and credentialed by separate agencies • • Lacking in understanding of the interdependence of emotional functioning, physical health, and substance use • Unfamiliar with multi-disciplinary team work 5
Cost of Treating Comorbid Conditions is High Costs for treating patients with chronic medical and comorbid mental health/substance use disorders can be 2-3 times higher Additional costs incurred by people with behavioral comorbidities estimated to be $293 billion in 2012 Estimated $26 - $48 billion can be potentially saved annually through effective integration of medical and behavioral services Source: Melek, et al (2014). Economic Impact of Integrated Medical-Behavioral Healthcare Implications for Psychiatry. https://integrationacademy.ahrq.gov/resources/new-and-notables/economic-impact-integrated-medical-behavioral-healthcare-implications 6
Cost of Treating Co-Morbid Conditions is High >2x cost >2x cost Source: Melek, et al (2014). Economic Impact of Integrated Medical-Behavioral Healthcare Implications for Psychiatry. https://integrationacademy.ahrq.gov/resources/new-and-notables/economic-impact-integrated-medical-behavioral-healthcare-implications 7
What is Behavioral Health Integration? “The care a patient experiences as a result of a team of Primary Care & Behavioral Health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population.” Source: C. J. Peek & The National Integration Academy Council’s Lexicon for Behavioral Health and Primary Care Integration (2 013) 8
From Roots to Leaves (or leaves to roots?) 9
A S pectrum of Integration Coordinated care (off-site) Highly integrated care Level 1: Minimal collaboration Level 5: Close collaboration • Patients are referred to a provider at • Providers develop and implement another practice site, and providers have collaborative treatment planning for minimal communication shared patients but not for other patients Level 2: Basic collaboration Level 6: Full collaboration • Providers at separate sites periodically • Providers develop and implement communicate about shared patients collaborative treatment planning for all patients Co-located care (on-site) Level 3: Basic collaboration • Providers share the same facility but maintain separate cultures and develop separate treatment plans for patients Level 4: Close collaboration • Providers share records and some system integration Adapted from: Gerrity, M., Zoller, E., Pinson, N., Pettinari, C., & King, V. (2014). Integrating Primary Care into Behavioral Health Settings: What Works for Individuals with Source: Gerrity, M., Zoller, E., Pinson, N., Pettinari, C., & King, V. (2014). Integrating Primary Care into Behavioral Health Settings: What Works for Individuals with Serious Mental Illness. New Serious Mental Illness. New York, NY: Milbank Memorial York, NY: Milbank Memorial Fund. Fund 10
Bi-Directional Opportunities in an Integrated System of Care Behavioral health into physical Physical medicine medicine into behavioral health Does direction make a difference? CCBHC? FQHC? Small Practice? 11
Integrated Care in Practice Universal Providers screenings for accessible for both common needs Same day and curbside and in- (depression, anxiety, ‘warm hand - off’ exam room substance use) and availability to reduce consults , same-day use of a registry to visits (15 – 30 minute no-shows and ensure monitor population consultation), and connection to care needs prevention education/ guidance Shared health Behavioral health & records and care primary care plans : All providers providers working and members of the side-by-side, along care management with other team have access to disciplines (social and document the work, nutrition, patient’s care in a pharmacy, others) single medical record Partially adapted from: Robinson, P.J. and Reiter, J.T. (2007). Behavioral Consultation and Primary Care (pp 1-16). N.Y.: Springer Science + Business Media. 12
Meet our experts! 13
Andrew Philip, PhD, LP Senior Director – Clinical & Population Health Aphilip@pcdc.org @APhilipPsych (212) 437-3956 pcdc.org PrimaryCareDevelopmentCorp @PrimaryCareDev 14
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