Primary Care/Behavioral Health Integration (3ai) Standards of Care - PowerPoint PPT Presentation

Primary Care/Behavioral Health Integration (3ai) Standards of Care Summary Opportunity for PIC Input DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care - Workgroup Workgroup Charge “It is expected that standards of care be developed around treatment planning, medication management, care engagement, communication of results, joint decision making, communication and collaboration, warm transfers, and referral to outside providers .” Workgroup Membership Organizations Represented: Counties Represented: Psychological Healthcare Lewis County General Hospital Lewis Oswego Hutchings Psychiatric Center NOCHSI Madison Upstate Oneida HealthCare Oneida St. Joes Crouse Onondaga Dates Met 8 meetings between 3/31/16 and 6/3/16 DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard I – Integrated Delivery System Workgroup Recommendations: • Creation of formal, two-way lines of communication to support care across the continuum, rapid engagement into integrated care, and coordination of services provided outside of an integrated site. • Two-way communication should include the frequent use of the Regional Health Information Organization (RHIO) (alerts, direct messaging, etc.) and CNYCC’s Population Health Management System (PHM). • Development of policies and procedures to support site use of information technologies in care delivery. Noted overlap with ED Care Triage (2biii) and Care Transitions (2biv) DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard II – Team Based Care Workgroup Recommendations: • Development of patient Care Teams • Regularly held Multidisciplinary Team Meetings that include Daily Huddles and larger Team Meetings • Use of Integrated Care Plans to coordinate care Resource: Cambridge Health Alliance Toolkit http://www.integration.samhsa.gov/workforce/team-members/Cambridge_health_alliance_team-based_care_toolkit.pdf Noted overlap with PCMH recognition, DSRIP Care Management (2aiii), Cardiovascular Disease Management (3bi), and Palliative Care Integration (3gi) DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard III – Screening (Model 1) Depression (DSRIP Project Requirement) • Universal, short-form screening. If short-form is positive, long-form screening required. Recommended Screens Ages: USPSTF recommends opportunistic • PHQ 2/9/A 12 -18 screenings • Edinburg Postpartum Depression Scale • 18 & up Workgroup recommends screening Geriatric Depression Scale patients annually at minimum, and more • Columbia Suicide Rating Scales when frequently based on patient life nececcary circumstances and clinical judgement. DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard III – Screening (Model 1) Alcohol and Drug (DSRIP Project Requirement) • Universal pre-screen at every encounter with 1 or 2 questions about use included in initial patient information gathering. • Positive responses to pre-screen trigger screening with evidence based tool. Tiered approach to screening: 11 & up Recommended Screen 1. Pre-screen questions asked at every encounter • CRAFFT (adolescents 11-21) 2. Short form screening when triggered by pre-screen • AUDIT & AUDIT C (adults) 3. Long form screening when triggered by short form • DAST-10 (adults) DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard III – Screening (Model 1) Anxiety (Workgroup Recommends) • Pediatric Population – Used if triggered by broader behavioral assessment. • Adult Population – Universal, short-form screening. If short-form is positive, long-form screening required. Workgroup recommends screening Recommended Screening All ages • SCARED (parent and youth) patients annually at minimum, and • GAD 2/7 more frequently based on patient life circumstances and clinical judgement. DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard III – Screening (Model 1) Eating Disorders (Workgroup Recommends) General patient population: Recommended Screening Ages: Annual health supervision 11-21 • ESP (short) examinations and pre-participation • EAT-26 (long) sports physical examination Patients w/ high risk factors: At routine office visits DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard III – Screening (Model 2) Workgroup Recommendations: • Cardiovascular Disease • Diabetes • Hypertension Noted overlap with Cardiovascular Disease Management (3bi) DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard III – Screening (Model 2) Screening Age Frequency Weight/Body Mass Index All ages Quarterly Blood Pressure All ages Quarterly Fasting Lipoprotein Profile All Ages Varied based on age and risk factors 5 – 17 Blood Glucose Quarterly 18 and up DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard IV – Comprehensive Assessment Workgroup Recommendations: • Screening positive for any of the conditions identified in Standard III (Model 1 or 2) results in the completion of an assessment to more fully understand patient needs. • The assessment should be inclusive of identification of patient’s eligibility or engagement in Health Homes or DSRIP Care Management services. Noted overlap with DSRIP Care Management (2aiii) DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard V – Treatment When needs can be met at the integrated site: • Model 1 (BH-> PC): The primary care provider will drive care and coordinate with onsite specialty services, including onsite behavioral health staff. • Model 2 (PC-> BH): At an integrated behavioral health site, care will be coordinated by the care team. When needs cannot be met onsite: • The integrated site will coordinate care to ensure communication with outside care and to support patient engagement in services. • Documentation of the outside care becomes part of the integrated patient record onsite. DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard VI – Warm Transfer • An ideal warm transfer is a same-day, person-to-person introduction (See National Coalition for Behavioral Health’s video.) • If the ideal is not available, the workgroup suggests a stratification and prioritization based on need and a patient’s likelihood to engage. DRAFT Standards of Care DRAFT 6.16.2016 KDL

Warm Transfer Diagram – Workgroup Suggested DRAFT Standards of Care DRAFT 6.16.2016 KDL

Warm Transfer Diagram – Workgroup Suggested DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard VII – Documentation & Information Sharing • Connection and regular use of the RHIO as an information source and as a mechanism of communication to/from other providers (Standard I) • Screening results documented in the EHR (Project Requirement). Workgroup Recommends: Initial screening results are available to the provider to address in the visit. • Warm Transfers documented in the EHR (Project Requirement). • Medical and behavioral healthcare are documented in an integrated EHR (Project Requirement). DRAFT Standards of Care DRAFT 6.16.2016 KDL

Primary Care Behavioral Health Integration (3ai) Standards of Care Standard VIII – Standards of Care Review • Reviewed at minimum, annually • More frequently as needed to maintain up-to-date standards DRAFT Standards of Care DRAFT 6.16.2016 KDL

Questions/Comments/Feedback DRAFT Standards of Care DRAFT 6.16.2016 KDL