Behavioral Health Hom e Plus and Optim al Health James Schuster, MD, MBA CMO, Medicaid, SNP, and Behavioral Services UPMC Insurance Division
What is a Behavioral Health Hom e? • A behavioral health home (BHH) is a service delivery model that provides a cost-effective, longitudinal “home base” – Facilitates and coordinates access to behavioral health care, medical care, and community-based social services and supports for people with complex medical, behavioral health, and substance use disorders.
What is a BHH? The BHH is anchored in wellness • – “Wellness is not the absence of disease, illness and stress, but the presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, presence of happiness” -- Peggy Swarbrick, PhD • Guided by the Triple Aim: Improving individual experience of care, Improving population health, and Reducing per capita health care costs.
Key BHH Com ponents Comprehensive care management • Care coordination and health promotion • Comprehensive transitional care • Enhanced engagement in primary care and other physical health • systems of care Individual and family support • Community and social support services • The use of health information technology to enhance population • management
Com m unity Care’s BHH Plus • Community Care is 501(c)3 MCO, part of UPMC, 1,000,000 members in PA • Successful early collaboration with Community Care & BH providers in North Central region of PA to address wellness through BHH model in 2010
Behavioral Health Hom e Plus • BHHP enhances the traditional BHH model by: – Adding a Wellness Nurse to the existing team – Using wellness coaching to address self- management of modifiable lifestyle factors – Developing a health registry to track health needs and improvements – Improving health literacy and health navigation
Wellness Nurse • Coordinates the BHHP team intervention including the “virtual team” of community-based medical and social service providers • Serves as a medical consultant to non-medical team members and wellness coaches • Guides the team in identifying and addressing gaps in clinical care and coordinating care • Develops a health resource library for the team
Wellness Nurse • “Manages” the monthly registry of population- focused data that identifies and stratifies individuals who have high-risk behavioral and medical indicators • Reaches out to the highest risk individuals on the registry to discuss doing a physical health assessment which helps to raise the individual's awareness of need
BHHP Outcom es: Optim al Health Optim izing Behavioral Main partners include: • • Health Hom es by Focusing – Community Care on Outcom es that Matter – University of Pittsburgh Most for Adults w ith – Stakeholder Advisory Board Serious Mental Illness – BHARP, NC and Chester Counties and Providers (Optimal Health) Study Principal investigators: • – James Schuster, MD, MBA, A multi-stakeholder • Community Care collaboration to study the – Charles (Chip) Reynolds III, key components of the MD, University of Pittsburgh BHHP model – Tracy Carney, CPRP, CSP, Community Care Supported by the Patient- • Contract awardee: • Centered Outcomes Research Institute (PCORI) – UPMC Center for High- Value Health Care
CER to Exam ine BHH Models’ Im pact • Patient Self Directed – Wellness Coaches – Member Registry – Self Management Toolkits • Provider Supported – Wellness Coaches – Member Registry – Nurse focused on Wellness and Health
Study Methods and Design Cluster-randomized design with mixed methods approach • Models implemented in 11 community mental health centers (CMHCs) over • 2 years starting in 2013 Research participant inclusion criteria: • – Medicaid-enrolled – 21+ years of age – Diagnosed with a serious mental illness – Receives services at community mental health center within Community Care’s network Institute for Healthcare Improvement’s Learning Collaborative Model used • to support implementation – Institute for Healthcare Improvement Breakthrough Series: http:/ / www.ihi.org
Learning Collaborative Process Cre ate I mple me nt Me asure Chang e Ac tio n Pro g re ss Pac kag e Pe rio ds Ho ld De ve lo p L e arning Charte r Se ssio ns Se le c t Be g in Pre - T e ams Wo rk
Patient-Centered Outcom es & Data Se c ondar y Data Sour c e s Pr imar y Data Sour c e s Se lf-R e por t Me asur e s He althChoic e s E ligibility Data (Patie nt ac tivatio n,** (Me dic aid e lig ibility) he alth status,** ho pe , quality o f life , func tio nal status, satisfac tio n with Administr ative Data PCOR I c are , so c ial suppo rt) (De mo g raphic info ) Optimal He alth Qualitative Data Be havior al He alth Claims Par tic ipants (Se rvic e use r & pro vide r (BH diag no sis, utilizatio n) inte rvie ws) Physic al He alth Claims L e ar ning Collabor ative (E ng ag e me nt in (L C) Data primary/ spe c ialty c are **) (I mple me ntatio n info rmatio n) Phar mac y Claims (Me dic atio n utilizatio n) **Primary o utc o me
Prim ary Outcom es Findings • Patient Activation: – More rapid increase in provider-supported sites (with wellness nurse) than self-directed sites – Greater increase in activation for women in provider- supported; greater increase for men in self-directed • Engagement in Primary/ Specialty Care: – 36% increase in frequency of visits in both study arms • Health Status: – Small improvement in perceived mental health status – Small decline in perceived physical health status
Qualitative Findings: Patient View Shift in definition of health and wellness, away from vague to • more personalized Increased awareness of interconnectedness of mental and • physical health Overall favorable intervention experiences • No major distinctions between arms – no evident differences • in engagement in or satisfaction with interventions Most important factor leading to intervention participation • was relationship with wellness coach
Qualitative Findings: Provider View High degree of agency support for wellness coaching • Culture of wellness that benefitted both service users and providers • Models integrated into routine practice • Providers simplified/ casualized wellness coaching to increase • service user engagement Nurses often mentioned as most beneficial component of the model • Robustly positive impact on service users’ health/ wellness • Acute needs sometimes trumped wellness coaching • Results published at • https:/ / www.healthaffairs.org/ doi/ 10.1377/ hlthaff.2017.1115
PCORI Award Contract Awardee : UPMC Center for High-Value Health Care in • collaboration with Community Care Purpose : Disseminate findings from our recently completed • PCORI-funded study to improve the overall health and wellness of other priority and high-risk populations – Residential Treatment Facilities (n=5) – Opioid Treatment Programs (n=7) Contract Duration : Two years (March 1, 2018 – February 2020) • Principal Investigator : James Schuster, MD, MBA • – Co-Investigators: Tracy Carney, CPRP, CSP; David Dan, MSW, LCSW; David Loveland, PhD, MA
JS7 Specific Aim s Aim 1 : Adapt BHHP for residential treatment for children • and methadone treatment program settings – Implement and assess the feasibility of using a Learning Collaborative approach to support RTF and OTP teams to deliver BHHP – Assess barriers and facilitators to Learning Collaborative participation and success Aim 2 : Increase service user involvement and confidence in • managing their physical health/ wellness Aim 3 : Examine change/ trends over time with BHHP • implementation on engagement in primary/ specialty care and unplanned health care utilization
Slide 18 JS7 We see an important aim of this project as being adapting BHHP for and implementing it in a new setting. If you agree, helpful to state explicitly. Joanna Siegel, 5/15/2018
BHHP in RTF and OTP • The project team has developed additional materials to create tailored BHHP implementation manuals for RTF (residential treatment) and OTP (methadone program) service providers – Family-centered wellness coaching – Group wellness coaching
Im plem entation Challenges • Physical health and wellness often seen as “foreign” by BH practitioners • BH practitioners did not know many PCPs and vice versa, services were “siloed” • Members often not engaged in routine, preventive care • The idea of “guideline based” care was novel to many case management providers
Supportive Interventions • Buy in by agency leadership • Structured learning collaborative process • Provider “share and steal” approach to work with each other • Learning community for wellness nurses • Extensive technical assistance from Community Care
Project Update • Received approval from the UPMC Quality Improvement Committee • Engaged Advisory Boards – Family of Child and Youth Members Board – State Recovery Member Board • Conducted Wellness Coaching Training with RTF and OPT staff • Completed RTF and OTP Learning Collaborative kick-off sessions and initial webinars
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