Learning Objectives MHA Village is a community based mental health - PDF document

APNA 29th Annual Conference Session 2012: October 29, 2015 Disclosure This speaker has no conflicts of interest, commercial support, or off ‐ label use to Promoting Health and Wellness Using Concepts of Integrated disclose. Healthcare and Psychosocial Recovery Principles Kathleen McDermott, DNP, RN, MSN, PMHNP BC Background Learning Objectives  MHA Village is a community based mental health center of Mental Health  Describe how an integrated system of care can impact America of Los Angeles (MHALA) the health of vulnerable populations, specifically those  Founded in 1990 as a pilot project with serious mental illness  Pioneer of the recovery movement  Identify logistical issues in planning, coordinating,  Provides support and assistance to its and implementing primary care in a community members in their recovery journey mental health setting and examine implementation  Mission – “To assist people with mental illnesses recognize their strengths and challenges power to recover and achieve full participation in community life. Also, to  Evaluate data supporting embedding primary care encourage system ‐ wide adoption of the services and care coordination within a community practice and promotion of recovery and mental health center well being” Guiding principle info Recovery ‐ focused Care  Hope  Client choice  Empowerment  Quality of life  Self ‐ Responsibility  Community focus  Meaningful Role in Life  Whatever it takes McDermott 1

APNA 29th Annual Conference Session 2012: October 29, 2015 Statistics System Issues  Mental Illness affects 59 million people annually in US  Mental health and addiction treatment historically separated (as cited in NIMH, n.d.) from the rest of medicine (Barry & Huskamp, 2011)  9.6 million of US have serious/severe mental illness (SMI) (as cited in NIMH, n.d.)  Schizophrenia  Gaps in care, inappropriate acre, disjointed care, redundant care  Bipolar Disorder and ↑ health costs (Kaiser Commission on Medicaid and the Uninsured, 2014)  Severe Depression  Mortality rates for persons with SMI are more than double that  Calls for integrated care have been noted for several decades of the general population (Zolnierek, 2009) however, segregated systems of care have persisted.  Deaths are largely from treatable conditions, associated with modifiable risk factors (smoking, obesity, substance abuse) &  Affordable Care Act (ACA), Mental Health Parity and Addictions inadequate medical care (Barry & Huskamp, 2011) Equity Act (MHPAEA) of 2008, SAMHSA and HRSA  models of integration being implemented & evaluated (Barry & Huskamp, 2011) Barriers to optimal health for people Barriers (continued) with mental illness (SMIs):  Existence of mental illness seems to affect the  Increased incidence of modifiable risk factors quality of medical care  smoking, alcohol/substance abuse, STDs  Lack of clarity of responsibility of physical health  Medical conditions go un ‐ identified / untreated of people with SMIs  Limited access for preventative and routine care  Lack of awareness of physical symptoms appointments  Insurance – ability to apply, maintain, navigate  Decreased access to quality care Timeline Even more barriers  Transportation issues  What was happening in CA and the Village during  Poor relationships with healthcare providers – lack this time of education, empathy, flexibility  Limited continuity of care  Convergence of grant and ACA,  MediCaid (MediCal in CA) expansion  Complexities of Health System McDermott 2

APNA 29th Annual Conference Session 2012: October 29, 2015 Four Quadrant Clinical Integration Model Low High Our Population Quadrant II Quadrant IV Behavioral Health Risk/Status ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ BH ↑ PH ↓ BH ↑ PH ↑  60% of members uninsured in 2009  High percentages of CAD, diabetes, HTN, obesity Quadrant I Quadrant III  Similar to info in literature ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ BH ↓ PH ↓ BH ↓ PH ↑ Physical Health Risk/Status Low High The Chronic Care Model Integrated Care Project California Community Foundation Grant ‐ Objectives • Physical assessments, short ‐ term primary care (average 2 ‐ 4 visits) and education to 125 individuals with mental illness • Connect/Reconnect 100 eligible individuals to public medical insurance and provider • Collaborate with physical healthcare provider for 125 individuals with multiple needs Concept of the Program… McDermott 3

APNA 29th Annual Conference Session 2012: October 29, 2015 Clinic operations  Staff  LVN  MD  Clinic hours  6 hours per week with LVN and MD  Funding “Graduating” from program… Medical clinic at The Village acting along the continuum to provide a bridge to care Goals of the program have been achieved. (catalyst, stop gap clinic) Well integrated into medical care Engaged with primary care provider Compliant with clinic visits and medications Insurance coverage is active uninsured or seen PCP once happy and ineffectively keeping utilizing appointments insurance with PCP, none We will see the member in ___ months to ensure stability of coverage, off to very few ER the streets, visits, active medical care. increased ER health utilization insurance coverage Member Perspective  Video So let’s talk results…. a.k.a. – here comes the data! McDermott 4

APNA 29th Annual Conference Session 2012: October 29, 2015 Results ‐ Insurance Insurance Results  159 members seen, Applied Applied Unaware No Inurance 1% 6% • 59 identified to have no insurance 0% 10% • 62 Insured ‐ aware of status / 36 Insured ‐ Unaware 23% unaware of status Insured 39%  By end of grant, 43/59 applied for insurance or became insured ( 77% ) No Inurance 37% • 16 members not connected with insurance or Insured 84% application process Ins. status at beginning of grant Ins. status at end of grant Results – Community PCP Community Primary Care Provider Status  159 members seen, Grant initiation Close of Grant • 98 had no community PCP • 15 connected to community PCP • 2 had 1 st appt. with community PCP Not connected 14% Not connected Connected • 43 have identified a community PCP 22% 30% Connected 45% Identtified 24%  In the end, 55 connected, 22 members not connected Identified 26% First visit • 122 members connected, 1 st appt, identified PCP 22% First visit 17% What worked? What didn’t? Program Approach  Systems issues  Community integration  Empowering members to make health decisions  Member issues  To advocate/understand their care  Switch doctors as desired  Strategies to promote success  Graduate from MH doesn’t mean losing your PCP  Partnerships with the community  Know / learn community resources McDermott 5