Joint Webinar National Council for Behavioral Health & The American Hospital Association February 6 at 3:30 p.m. ET Partnering to Address Behavioral Health: A Deep Dive into Hospital/Health System Partnerships with Community Behavioral Health
2 We are the national advocate for America’s hospitals and health systems. OUR MISSION OUR VISION To advance the health of all individuals A society of health and communities. The AHA leads, communities, where all represents and serves hospitals, individuals reach their health systems and other related highest potential for health. organizations that are accountable to the community and committed to health improvement.
3 Our History With roots dating back to 1898, the American Hospital Association now counts among its members… more than 5,000 hospitals, health care o systems and other health care organizations 33,000 individual members o We partner with state, regional and metropolitan hospital associations to advocate for mutual members. We operate out of offices in Washington, DC and Chicago
Our Strategic Imperative To lead the field in support of: Access | Health | Innovation Affordability | Individual as Partner 4
5 Our offerings We share vital information We are deliver insights, We deliver data data, advocacy, networking opportunities, and education We educate you won't find anywhere We help you tell the story else. We convene leaders We lead the field We advocate
The National Council for Behavioral Health • Over 3000 Members providing or supporting treatment for Mental Illnesses and Addiction • Member Types – Community Mental Health Centers – Addiction Treatment Centers – Child and Adolescent Behavioral Health Organizations – Federally Qualified Health Centers – Hospitals – Health Systems
Over 1 Million People trained in Mental Health First Aid
Consulting and Technical Assistance • Training and implementation support for best practices – Integrated Care – Screening, Brief Intervention and Referral to Treatment (SBIRT) – Motivational Interviewing – Whole Health Action Management (WHAM) – Case Management to Care Management • Management and leadership development – Middle Management Academy – Mastering Supervision – Leadership/management coaching and support – Executive Leadership Program • Individualized technical assistance to behavioral health and primary care settings • Webinars, online learning, national and regional gatherings
Partnering to Address Behavioral Health: A Deep Dive into Hospital/Health System Partnerships with Community Behavioral Health Victor Armstrong, VP, Behavioral Health-Charlotte Manuel Castro, MD, Medical Director Behavioral Health Integration Wayne Sparks, MD, Senior Medical Director, Behavioral Health Services
Objectives: • Explore the value of hospital/CBHO partnerships • Identify the essential steps and perceived barriers to integrating care in hospitals and health systems • Review outcomes and the future of Atrium’s vision
Atrium Health: Size and Scope 65,000+ teammates | 47 hospitals across 3 states 29 urgent care locations | 33 emergency departments 350+ primary care practices | 25+ cancer care locations 3,000+ physicians | 16,000 nurses 6.5% population growth in Charlotte region 8,700+ licensed beds Email questions to Quiana.Smith@carolinashealthcare.org
In ONE Day at Atrium Health: 31,750 patient encounters | 23,000 physician visits 600+ home health visits | 4200 ED visits 85+ new primary care patients | 88 babies delivered 13,975 virtual care encounters! Email questions to Quiana.Smith@carolinashealthcare.org
Vision for Behavioral Health: Atrium Health will develop a transformative , clinically integrated , and sustainable system of high-quality, patient- and family- centered care to serve the Behavioral Health needs of patients, their families and the community . Email questions to Quiana.Smith@carolinashealthcare.org
The Behavioral Health Continuum: Acuity/Resources 18. Inpatient Psychiatric Services Key 18 17. Psychiatric Physical Service Locations Observation Unit 17 Virtual Services Available 19. Partial Hospitalization 16. Psychiatric ED 16 Services (Adult & C/A) Rely on Community Services 19 15 14. Acute Care Hospital 15. Acute Care ED (C/L and Tele-C/L) 14 20. Substance Use (Telepsych and BHPP) Intensive Outpatient (Adult 13 & C/A) 12. Crisis Line Call 20 10. Brain Center 8. Outpatient Behavioral Stimulation 13. Medical Detox Health 12 Services (Therapy, Medication Mgmt., (ECT and TMS) 11 Injection Clinics) 10 11. Assertive 21 6. School-Based 9 Community Services 8 Treatment Teams 21. Residential 4. Care 9. Intellectual & 2. Employee 7 Management Developmental Assistance 6 Disabilities Clinic Programs 7. Medication 5 Assisted 4 3 Therapy 1 2 5. Nalaxone Project 3. Primary Care 1. Mental Integration Home Health First Aid
Virtual Health Defined: Telemedicine Teleconsultation Connecting Telecommunication patients to care. Telemonitoring Teleconferencing Greater than 5.1 million encounters annually
Virtual Care…Not just Technology. Care is Care Benefits Core Competencies Evidence Based Timely Access Scalability Industry Alignment Sustainability
Virtual Emergency Behavioral Health: Management and Placement
A Chaotic & Fragmented System: $ ? $ ? $ ? ? ? $ $ $ ? ? $
The BIG Idea: To establish a coordinated, efficient, and patient centered system of access to evaluation, management and treatment for patients in our system requiring inpatient behavioral health services. Centralized Behavioral Behavioral Telepsychiatry Health Patient Health Bed Transport Management
Process: The Model The Team Tele-psychiatry Clinician / Patient Navigator • LCSW/LPC Tele-psychiatry Provider • Adult Psychiatrist • Child and Adolescent Psychiatrist • Nurse Practitioner BH Patient . . Patient Placement Nurse • Registered Nurse Patient Placement Admission Transfer . Coordinator • Bachelor level with psychiatry related experience Virtual BH Support Team Email questions to Quiana.Smith@carolinashealthcare.org
Process: BH Provider completes consults and determines inpatient BH need Inpatient BH Treatment BH placement ED initiates Emergency searches for consult and BH Department (ED) inpatient bed and clinician collects arranges transport collateral Discharged to home, treatment Navigator Initiates facility, or community Patient Contact BH Patient Virtual BH Support Team Email questions to Quiana.Smith@carolinashealthcare.org
Streamlined Communication:
Patient Placement and Bed Management: Total Placements Bachelor Level Admission 10000 9207 9180 Transfer Coordinators/ RNs work 8944 24/7 9000 8227 8000 7000 Placements based on clinical and 6000 exclusionary criteria 5000 4355 4000 3000 Scope focused on locating and 2000 allocating appropriate Psych Beds 1000 0 2014 2015 2016 2017 2018
Email questions to Quiana.Smith@carolinashealthcare.org Current State and Outcomes: PATIENTS PER MONTH 1000 1200 200 400 600 800 0 Jan-15 Feb-15 Mar-15 2015-2018 System Wide ED Psych Volume vs. LOS Apr-15 May-15 Jun-15 baseline Jul-15 45 hrs 2014 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Volume Oct-16 DATE Nov-16 Dec-16 Jan-17 Feb-17 LOS Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 18-Jan 18-Feb 18-Mar 18-Apr 18-May 18-Jun 18-Jul 18-Aug 18-Sep 0.0 5.0 10.0 15.0 20.0 25.0 LOS IN HOURS
Current State and Outcomes: Clinical Outcomes Healthcare Utilization Cost of Care ▲ Patient Experience of Care ▲ Bed Occupancy ▼ Sitter Expense ▲ Timeliness to appropriate care ▼ ED & Psychiatry LOS ▲ ED Capacity ▲ Teammate/Provider Satisfaction ▲ ED/Psychiatry Discharge Rates ▼ LWBS ▲ Increased Contribution ▲ Maximizes BH resources ▲ Teammate/Provider Satisfaction Margin throughout the state ▲ Continuity of care through IT ▲ Access to Timely Treatment Email questions to Quiana.Smith@carolinashealthcare.org
Virtual Behavioral Health Integration
Upstream…..Primary Care: • Stigma • 70% of visits are Psycho- Socially related • Greater than 50% of all psychotropics prescribed by PCP’s • 45% of patients completing suicide saw their primary care provider within 30 days • 38% had a healthcare visit in previous week
Comorbid Behavioral Health and Chronic Medical Conditions:
vBHI Overview: The vBHI Care Model The Team Behavioral Health Professional • LCSW/LPC, Psych RN PCP Health Coach • Bachelor level with two years’ experience • Obtain Health Coach Certification within 1 year of Consulting BHP/Care Patient hire date Psychiatrist Manager Other Provider Additional Clinic Behavioral Health Resources • Adult Psychiatrist Clinicians • Child and Adolescent Psychiatrist • Nurse Practitioner Outside Substance Treatment, Vocational Resources Rehabilitation, CMHC, Pharmacy Other Community Resources • Board Certified Psychiatric Pharmacist (BCPP) Virtual BH Support Team
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