Integrated Health Care Initiative Collaborative Quarterly Meeting November 14th, 2018 www.mhahouston.org
Collaborative Introductions www.mhahouston.org
Today we… www.mhahouston.org
HOPE Clinic Demonstration Project Rodolfo Orna, M.A. LMFT, Behavioral Health Director & Shahrzad Afshin Yakta, Behavioral Health Consultant www.mhahouston.org
Mission To provide quality healthcare without any prejudice to all people of greater Houston in a culturally and linguistically competent manner Rodolfo Orna, LMFT Director of Behavioral Health
Main Clinic Alief Clinic West Clinic ADULT OB -GYN PEDIATRICS PSYCHIATRY BHS OPTICAL DENTAL Visits & Encounters 2017 104,000 Visits 17,898 Patients (BH 3,271 visits)
25% 29% Asian Hispanic 25% 20% African Caucasian American 1% Multiracial
OUR PATIENTS AGE DISTRIBUTION 65+ 0-4 45-64 5-12 20-44 13-19
BHC=Behavioral Health Consultant BHS= Behavioral Health Specialist Main Clinic Alief Primary Care Location Primary Care 2 BHC West BHC Location BHS Primary Care PCP Psych BHS PSYCHIATRY Child Adult BH Coordinator Child Child/A MA/Front Office Adult Adult
Main Clinic Primary Care Visits triggered by: BHC: Adult & OB-GYN BHC: Pediatrics Screening PHQ-9 Edinburgh PSC-17 CAGE PCP referrals PCP
Integrated Primary Behavioral Health Care Flow Chart MA Triage + PHQ-9 or Edinburgh Medical Provider Screening Consult • Health outcomes ation • Emotional Active Suicidal, disturbances Behavioral Health Homicidal or • Mental Health Consultant Psychosis Crisis Additional Screenings: PSC-17, CAGE,DAST, Follow TRAUMA, Crisis Protocol to determine Hospitalization MEDICAL Behavioral Health Visit Completed Specialty: Psycho- therapy(Counseling) and/or Psychiatry Coordinates discharge and referrals to BH Specialty
Main Clinic Primary Care PCP BHC: Adult & OB-GYN BHC: Pediatrics HOPE Alief Clinic HOPE West Clinic
PROGRESS : LEVELS OF COLLABORATION/INTEGRATION LEVEL 4: Close Collaboration Onsite with Some System Integration: Communications, Collaboration, Meeting, Roles LEVEL 5: Close Collaboration Approaching an Integrated Practice: Treatment Delivery, Patient Experience, LEVEL 6: Full Collaboration in a Transformed/Merged Integrated Practice: Facilities, Resources, EMR, Leadership Support,
2018 CFHA Conference Takeaways www.mhahouston.org
www.mhahouston.org
Practice Integration Profile • Organizational self-assessment survey www.practiceintegrationprofile.com • Dimensions: – Workflow – Clinical Services – Workspace – Shared Care & Integration – Patient Engagement www.mhahouston.org
Practice Integration Profile Dimension: Shared Care & Integration In our practice… 1.…BH and Medical Clinicians regularly and actively exchange information about patient care. 2.…there are regular educational activities including both BH and Medical Clinicians. 3.…BH and Medical Clinicians regularly spend time together collaborating on patient care. 4.…patients with BH needs have shared care plans developed jointly by the patient, BH and Medical Clinicians and updated over time. www.mhahouston.org
www.mhahouston.org
CFHA 20 th Annual Conference Session B1 Takeaways • “Dynamic Evolution of Integrated Behavioral Health: Developing Data Management Systems for continuous Quality Improvement.” • Presented by the University of California San Diego • Presentation takeaways: – National trends and needs – Program structure and background – Clinical & operational aspects – Measures of integration (tools) – Financing integration review www.mhahouston.org
Clinical Quality Report Sample www.mhahouston.org
Provider Productivity Report Sample www.mhahouston.org
Operational Report Sample www.mhahouston.org
Measures of Integration • Practice Integration Profile (PIP) • PCBH-based Provider Adherence Questionnaire (PPAQ) • TCARE (Targeted Collaborative Assessment and Response Empowerment) – UCSD’s real-time consultation EHR tool Recommendation : Define/identify your approach identify outcomes • identify measures. Also, identify resources within department to partner with, to develop systems to input and extract data www.mhahouston.org
Individual Profit & Loss Report Sample www.mhahouston.org
www.mhahouston.org
CFHA 20 th Annual Conference Session E6 Takeaways • “Integrated Behavioral Health at Mayo – Bringing Together Mental Health Disciplines in Primary Care to Better Address a Population.” • Presented by the Mayo Clinic • Presentation takeaways: – Program structure & team – Types of services provided – Challenges & recommendations – Tracking of outcomes www.mhahouston.org
The Multidisciplinary Team www.mhahouston.org
“You Are Not Alone!” https://www.ruralhealthinfo.org/toolkits/services-integration/2/primary-care-behavioral-health www.mhahouston.org
www.mhahouston.org
CFHA 20 th Annual Conference Session E7a Takeaways • “The Validation of Ultra-Brief, Patient Feedback Measures Intended to Improve the Care of Chronic Illnesses in Primary Care” • Presented by University of New England faculty and Peak Vista Community Health Centers staff • Presentation takeaways: – “Privileging the patient perspective” – Patient values & preferences as a key component of evidence-based practice – Partners for Change Outcome Management System (PCOMS) https://betteroutcomesnow.com/ www.mhahouston.org
PCOMS – BH (Behavioral Health) Outcome Rating Scale (ORS) Session Rating Scale (SRS) Individually: I did not feel heard, Relationships I felt heard, understood and understood and (Personal well-being) respected. respected. ____________________________________ We did not work on Goals and Topics We worked on and or talk about what I talked about what I Interpersonally: wanted to work on wanted to work on (Family, close relationship) and talk about. and talk about. ____________________________________ Approach or The therapist’s Methods The therapist’s approach is not a approach is a good Socially: good fit for me. fit for me. (Work, school, friendships) ____________________________________ There was Overall Overall, today’s something missing session was right in the session for me. today. Overall: (General sense of well-being) ____________________________________ www.mhahouston.org
PCOMS – WRS & PAS Chronic Illness Measures • PCOMS – WRS (Wellness Rating Scale) – Personal Health, Relationships, Activities, Quality of Life – Scale from to • PCOMS – PAS (Provider Alliance Scale) – Relationship, Communication, Partnership, Treatment – Example (Relationship) – I did not feel comfortable asking questions or raising concerns about my health and treatment. I felt comfortable asking questions and raising concerns about my health and treatment. • Peer-reviewed validation study: http://link-springer-com-443.webvpn.jxutcm.edu.cn/article/10.1007%2Fs11136-018-1967-4 www.mhahouston.org
Workgroups 2019 Projects Overview MHA Staff www.mhahouston.org
2019 Work Group Projects • Service Delivery Work Group • Institutions of Higher Education Work Group – Screening to Treatment Roadmap White Paper – Institution Presentations – Public Education on – TMC Policy Institute IHC Course Integrated Care – Professional & Accrediting – Educational Forums Association Presentations • Financing Work Group • Public Policy Work Group – 87 th Legislative Session Agenda – Sustainability Toolkit Planning – 86 th Legislative Session Advocacy Task Force www.mhahouston.org
Evaluation Pathway We are here! Q3 2018 Source: Collective Impact Forum. FSG. “A Framework for Performance Measurement and Evaluation of Collective Impact Efforts” www.mhahouston.org
Integrated Health Care Initiative Timeline IHCI Launched Action Plans Finalized Policy Project 18 Guiding Work Groups Q2 2015 Recommendations 5-Year Report Biennial Report Q4 2018 Developed Progress to date Progress to date Retreat Q4 2020 Q4 2022 Biennial Report Q2 2016 Progress to date Today Q4 2024 10-Year Report Stakeholder Collaborative Meeting Meetings Accomplishments Q4 2018 Q4 2025 Interviews IHCI Report Q3 2015 Published Recommendations Q4 2016 Collaborative & WG Demonstration Projects / Meetings / Action Collaborative & Learning Communities Plans Implementation Work Group Launched Exact Milestones TBA Meetings 2019 - 2025 Quarterly/Bimonthly Q1 2017 – Q3 2018 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Late Years (2) Early Years (3) Middle Years (5) www.mhahouston.org
Looking Ahead Into 2019! • Continuing: – Quarterly Collaborative Meetings – Quarterly Networking Events – Monthly Work Group Meeting – Biweekly Resource Bulletin – In-depth Educational Events • Potential Opportunities: – Learning Community Calls (Various Focus Areas) www.mhahouston.org
2018 CFHA Conference Takeaways MHA Staff www.mhahouston.org
Thank You! www.mhahouston.org
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