SIM PTO TRAINING MAY 23, 2018 9:00 AM Call Instructions: Please - PowerPoint PPT Presentation

SIM PTO TRAINING MAY 23, 2018 9:00 AM Call Instructions: Please • Mute your phone, microphone, and speakers on your computer/device • Turn off the zoom video feature • Enter your name/organization in the chat box feature for attendance • Submit questions via the chat box feature • Questions will be answered following the presentation Time to ask questions via audio will be offered for those on the phone • 1

MAY 23, 2018 Presenters: COLORADO SIM PTO TRAINING: Stephanie Kirchner, MSPH, RD MAC REVIEW – 6 MONTHS Andrew Bienstock, MHA Marjie Harbrecht, MD

TRAINING OBJECTIVES ▪ Review COHORT 1 Preliminary Results ▪ Review COHORT 2 MAC Results @ 6-Months ▪ Next Steps 3

COHORT HORT 1 FI 1 FINAL NAL SU SURVEYS VEYS PR PREL ELIMIN MINARY ARY ANAL NALYSES YSES STEPHANIE KIRCHNER, MSPH, RD ANDREW BIENSTOCK, MHA

COHORT 1 - PRACTICE DEMOGRAPHICS ▪ 92 practices successfully completed SIM ▪ Private/solo or group practice – 42 ▪ FQHC or lookalike – 22 ▪ Hospital or health system owned – 24 ▪ School-based health center – 3 ▪ HMO – 1 __________________________ ▪ Family medicine - 38 ▪ Pediatrics - 19 ▪ Mixed primary care – 21 ▪ Internal medicine - 10 ▪ Nurse-led primary care - 3 ▪ Geriatrics - 1

ACCESS TO A BEHAVIORAL HEALTH PROVIDER ONSITE BEHAVIORAL HEALTH PERSONNEL (ONLY THE 79 WITH ONSITE) ▪ Full time onsite - 58 ▪ Part time onsite - 21 ▪ Full-time telehealth - 1 ▪ Consult only - 4 ▪ No answer - 8 ▪ A total of 8 mentioned telehealth

ONSITE BEHAVIORAL HEALTH PERSONNEL (ONLY THE 79 WITH ONSITE) ▪ Licensed Psychologist (LP): 13 in 12 practices ▪ Licensed clinical social workers: 65 in 51 practices ▪ Psychiatric nurse (RN or NP): 6 in 6 practices ▪ Licensed professional counselor: 34 in 28 practices ▪ Licensed marital and family therapist: 5 in 4 practices ▪ Licensed addiction counselor: 5 in 5 practices ▪ Licensed behavioral health provider, PhD: 14 in 9 practices ▪ Licensed behavioral health provider, PsyD: 13 in 8 practices ▪ Licensed behavioral health provider, MD/DO: 8 in 4 practices ▪ Other behavioral health provider: 19 in 12 practices

WHAT DID PRACTICE DO TO IMPROVE BEHAVIORAL HEALTH? ▪ 64 implemented more aggressive screening and follow-up for targeted conditions ▪ 37 hired an integrated behavioral health provider (BHP) ▪ 37 implemented a registry for targeted conditions ▪ 25 developed a collaborative agreement with a community mental health center ▪ 22 added a care manager at the practice site ▪ 12 contracted for integrated BHP with another organization

WHAT DID PRACTICE DO TO IMPROVE BEHAVIORAL WHAT PRACTICES DID HEALTH? ▪ 12 arranged for a co-located BHP for the practice site ▪ 12 arranged for telephone or online counseling services ▪ 11 developed a collaborative agreement with a psychiatrist ▪ 9 added telepsychiatry services at the practice site ▪ 6 added a health coach at the practice site ▪ 5 contracted for integrated BHP with a community mental health center ▪ 20 Other (wide variety, almost all tied to behavioral health)

COHORT 1 NUMBER OF PRACTICES ACROSS IPAT LEVELS OF INTEGRATION Baseline (n 5 4 11 6 25 28 13 = 92) Midpoint 2 2 9 2 26 33 18 (n = 92) Final (n = 1 4 3 2 14 31 36 91) Level 0 Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 10

COHORT 1 CLINICAL QUALITY MEASURES: QUARTER 4, 2016, VS QUARTER 4, 2017 Measure N for Q4 Mean (STD) Q8 Mean (STD) Average Comparison Difference (p- value) Asthma 35 71.9 (27.4) 78.2 (23.2) 6.3 (0.01) Depression 69 42.6 (28.7) 56.7 (30.0) 14.2 (<0.0001) Development 6 93.0 (5.9) 93.8 (6.0) 0.8 (0.92) HbA1c 61 31.6 (18.3) 25.7 (11.7) -6.0 (0.004) Hypertension 53 66.7 (10.3) 64.1 (11.2) -2.6 (0.18) Falls 23 52.5 (33.0) 72.3 (24.9) 19.9 (0.002) 12 59.6 (29.7) 77.0 (21.7) 17.4 (0.07) Maternal Depression

COHORT 1 CLINICAL QUALITY MEASURES: QUARTER 4, 2016, VS QUARTER 4, 2017 Measure N for Q4 Mean Q8 Mean Average Comparison (STD) (STD) Difference (p- value) Obesity 60 48.1 (18.0) 50.2 (20.3) 2.0 (0.41) 4 63.4 (43.7) 5.5 (10.6) -58.9 (0.12) Substance Abuse 21 89.8 (16.9) 85.6 (18.6) -4.2 (0.17) Adolescent Obesity 19 51.2 (31.5) 61.1 (32.1) 9.9 (0.01) Adolescent Diet Adolescent 18 51.9 (28.5) 58.0 (30.4) 6.0 (0.13) Exercise Tobacco NA NA 99.8 (1.2) NA 12

COHORT 1 MILESTONE INVENTORY N = 54 MILESTONES Cohort 1 Milestone Inventory Results 35 30 25 20 15 10 5 0 Baseline Midpoint Final Series 1 Series 2 Series 3 GREEN = Well established workflows, YELLOW = Some established work done & room for improvement, RED = No work being done & room for improvement 13

Practice Confidence in Behavioral Health Services RATE THE PRACTICE SITE CONFIDENCE LEVEL THAT CURRENT ARRANGEMENTS FOR PROVIDING BEHAVIORAL HEALTH SERVICES ARE MEETING THE NEEDS OF PRACTICE SITE PATIENTS (SCALE: 1 - NOT CONFIDENT AT ALL TO 10 - EXTREMELY CONFIDENT) ▪ Mean = 7.5 HUGE SUCCESS IN CULTURE CHANGE!!!

IS THE INTEGRATION OF AN ONSITE BHP AND THE PROVISION OF INTEGRATED CARE SERVICES FINANCIALLY SUSTAINABLE FOR THIS PRACTICE SITE? (ONLY THOSE WITH ONSITE BHP = 79) ▪ Yes - additional revenues available through current payment models cover the costs of providing integrated care – 23 ▪ Yes - although revenues from current payment models do not cover integrated care costs, the service can be sustained through other revenue – 22 ▪ No - additional revenue sources will be needed in order to continue providing integrated care – 25 ▪ Unknown - information related to costs and revenues is insufficient to answer this question – 9

WILL THIS PRACTICE SITE CONTINUE TO OFFER INTEGRATED CARE EVEN THOUGH THE REVENUES MAY NOT BE SUFFICIENT OR IS UNKNOWN? (ONLY THE 34 WHO ANSWERED THE PREVIOUS QUESTION NO OR UNKNOWN) ▪ Yes 24 ▪ Unknown 4 ▪ Undecided 5 ▪ No 1

MAC RESULTS BASELINE TO 6 MONTHS ACROSS COHORT 2 ANDREW BIENSTOCK, MHA 17

COHORT 2 – MAC RESULTS BASELINE VS 6 MONTHS 18

COHORT 2 – MAC RESULTS GOOD STANDING 19

MAC RESULTS BASELINE TO 6 MONTHS PTO INDIVIDUAL PRACTICE REPORTS STEPHANIE KIRCHNER, MSPH, RD 20

COHORT 2 - MAC 6 MONTH PTO REPORT SIM ONLY EXAMPLE 21

COHORT 2 - MAC 6 MONTH PTO REPORT SIM/CPC+ EXAMPLE 22

ACTION STEPS MARJIE HARBRECHT , MD 23

COHORT 2 – SIM ONLY - REQUIRED MILESTONES FOR YEAR 1 24

COHORT 2 – SIM/CPC + - ADDITIONAL REQUIRED MILESTONES FOR YEAR 1 25

TOUCH BASE CALLS TO REVIEW PROGRESS AND NEXT STEPS ▪ JUNE 4 TH & 5 TH from 1 – 4 pm ▪ Please look for sign up genius request sent on Saturday, 5/19/18 ▪ Reach out with questions ▪ Discuss at future PTO Trainings 26

PHASE 5 (JUNE 15 – SEPT 14, 2018) BB8 – PROMPT ACCESS TO CARE, INCLUDING BH BB9 – COMPREHENSIVE CARE COORDINATION FOR PRIMARY CARE / BEHAVIORAL HEALTH BB10 – FULLY INTEGRATED BEHAVIORAL HEALTHCARE TO PROVIDE WHOLE PERSON CARE 27

PHASED APPROACH TIMELINE

SIM COHORT 2 MILESTONE OPERATIONAL ALGORITHM (OVERVIEW) BUILD INFRASTRUCTURE BB1 - ENGAGED LEADERSHIP WHERE TO START? Year 1: Establish agreements with payers, set up budget, QI team, champion attends CLS, set vision for behavioral health (BH) integration and pathway PATIENT POPULATION BUILD INFRASTRUCTURE UNDERSTAND THE ("ACTIVE" PATIENT PANEL) BB2 - USE DATA TO DRIVE CHANGE MAKEUP OF YOUR Year 1: Data, care gaps, CQMs, cost drivers POPULATION ------------ BB4 - TEAM-BASED CARE IMPROVE CONTINUITY Year 2: Workflows for three CQMs (at least 1BH) THROUGH BB3 - EMPANEL AT LEAST 75% of EMPANELMENT BB5 - PARTNERSHIP WITH PATIENTS PATIENT POPULATION ------------ Year 1: Establish PFAC SCREEN FOR BH/SUD Year 2: Shared decision-making aids and self-management support ______________ ------------ tools USE DATA TO BB7 - SCREEN UP TO 90% FOR BH/SUD POSITIVE BH/SUD CLOSE GAPS & BB8, BB9 and BB10 - BEHAVIORAL HEALTH ISSUES Connect to BH/Community IMPROVE CARE Year 1: Start building infrastructure to address BH Year 2: Develop collaborative care agreements with BH providers BB6 - RISK STRATIFICATION Year 2: Risk stratify at least 75% of EXPAND and MAINTAIN EFFORTS population STRATEGICALLY MANAGE ALL PATIENTS YOUR POPULATION BY CONTINUE BB1, BB2, BB4, BB5 RISK STRATIFYING TO LOW RISK MEDIUM RISK HIGH RISK DETERMINE WHO NEEDS BB6 - HIGH RISK PATIENTS ADDITIONAL Year 2: Risk stratify, use data to manage ATTENTION/SERVICES care gaps/track outcomes, develop care Prevent Low and Medium Risk patients plans for 75% of high-risk patients from becoming High Risk COORDINATED -------------- PATIENTS WITH BH ISSUES and/or BB8 - ACCESS TO BH CARE BUILD COLLABORATIVE BB6 - CLOSELY MANAGE at INTEGRATED AGREEMENTS WITH Year 2: Bi-directional data sharing least 75% of HIGH RISK BEHAVIORAL HEALTH CARE PATIENTS (EITHER ONSITE OR BB9 - CARE COORDINATION TO REDUCE OFFSITE) COSTS AND IMPROVE CARE TO IMPROVE BB10 - BH REFERRAL PATHWAY WITH COORDINATION AND 24/7 EHR ACCESS; CARE PLANS, MANAGEMENT TRACK BH PATIENT OUTCOMES USE REGIONAL HEALTH CONNECTORS TO ASSIST YOU WHEN POSSIBLE Improve Quality of Care Reduce Costs Improve Experience for Patients & Healthcare Teams

COLLABORATIVE LEARNING SESSION PEARLS SELECT ONE “PEARL” THAT YOU LEARNED DURING THE CLS AND SEND IT TO: KELLYN.PEARSON@UCDENVER.EDU 30