THE ROAD To Better Outcomes What does Integrated Care Look Like? - PowerPoint PPT Presentation

THE ROAD To Better Outcomes What does Integrated Care Look Like?

INTEGRATED CARE IS A DISRUPTIVE INNOVATION IN HEALTHCARE DELIVERY 2

WHY WHY IS INT NTEGR GRATION ON A PRIOR ORITY? BEHAVIORAL HEALTH’S STAGE

CONVERGING FACTORS DRIVING INTEGRATED CARE Costs of Health Life Expectancy Care and BH with SMI/SUD Role P o p u l a t i o n H e a l t h Team Based Health Care Care Reform 4

ANNUAL COST OF CARE Total Population Common Chronic Medical Illnesses with Comorbid Mental Condition “Value Opportunities” Annual Cost Illness % with Comorbid Annual Cost with % Increase with Patient of Care Prevalence Mental Condition* Mental Condition Mental Condition Groups All Insured $2,920 10%-15% n Arthritis $5,220 6.6% 36% $10,710 94% n Asthma $3,730 5.9% 35% $10,030 169% n Cancer $11,650 4.3% 37% $18,870 62% n Diabetes $5,480 8.9% 30% $12,280 124% n CHF $9,770 1.3% 40% $17,200 76% n Migraine $4,340 8.2% 43% $10,810 149% n COPD $3,840 8.2% 38% $10,980 186% n *Approximately 10% receive evidence-based Cartesian Solutions, Inc.™--consolidated health plan mental condition treatment claims data

BEHAVIORAL HEALTH DRIVING TOTAL COST OF CARE Large claims data base Medicaid, Medicare, Commercial Insurers 2010 – no MH/SUD, non-SMI MH/SUD, SMI, SUD Patients with treated MH/SUD cost 2-3 times more ($400 PMPM compared to $1,000 PMPM) Most of the added cost is in facility-based Source: Milliman/APA Report Melek, S.P., Norris, D.T., & costs (ER and inpatient) for medical care Paulus, J. (2014) Economic impact of integrated medical- behavioral health care.: Implications for psychiatry. 6

MORE THAN TRADITIONAL BEHAVIORAL HEALTH EXPERTISE IN BEHAVIOR CHANGE 10% [CATEGORY NAME] 5% 40% Environmental [CATEGORY Exposure NAME] 30% Genetic Predisposition 15% Source: Schroeder, Steven A. Social We Can Do Better – Improving the Health of the American Circumstances People. N Engl J Med 2007;357:1221-8 7

IMPACT OF MENTAL HEALTH AND SUBSTANCE USE 8

THE “SWEET SPOT” OF CARE Primary Care Team Manages Mild to Moderate Mental Illness and Substance Use None Mild Moderate Severe Target Population • Issues with depression and substance abuse must be pre-empted, rather than treated once advanced • Goal is to detect early and apply early interventions to prevent from getting more severe 9

THE “SWEET SPOT” OF CARE McLellan, (2014). The affordable care act and treatment for “substance use disorders:” Implications of ending segregated behavioral healthcare. Journal of Substance Abuse Treatment, 46, 541-545. 10

BEHAVIORAL HEALTH IS NOT DIFFERENT Addiction Chronic Diabetes Specialty Specialty Care- Care-SUD Endocrinologist Treatment Moderate Controlled Diabetes Substance Use Primary Care Primary Care/ Provider/Integrated Integrated Care Care Team Team Risk Factors for Use Risk Factors for Diabetes Primary Care Staff/ Primary Care Staff/Provider Provider 11

CONT ONTINUUM NUUM OF OF INT NTEGR GRATION ON Evolving Models

CENTER FOR INTEGRATED HEALTH SOLUTIONS LEVELS OF INTEGRATED CARE 13

COMMON APPROACHES TO INTEGRATED CARE Traditional Behavioral Health Co-Location Consultation Consultant Solidly grounded in a Limited access Access and interaction clinical practice culture Limited feedback Better communication Generalist BHP Long waitlists and limited Rapid access to brief Expensive available providers behavioral interventions Limited ability for follow One Pass Limited evidence base through 14

EVIDENCE BASED FULL INTEGRATION TEAM PCP Core Program New Roles Consulting BHP/Care Psychiatric Patient Manager Provider Other Behavioral Additional Clinic Health Clinicians Resources Outside Substance Treatment, Vocational Rehabilitation, Resources CMHC, Other Community Resources http://aims.uw.edu 15

SECRET SAUCE Ingredients TEMP Team that consists at a minimum of a PCP, BHP and psychiatric consultant Evidence-based behavioral and pharmacologic interventions Measuring care continuously to reach defined targets Population is tracked in registry, reviewed, used for quality improvement Accountability for outcomes on individual and population level Recipe for Success Process of Care Tasks • 2 or more contacts per month by BHP • Track with registry • Measure response to treatment and adjust • Caseload review with psychiatric consultant Secret Sauce Whitebird Brand • Strong leadership support • A strong PCP champion and PCP buy-in • Well-defined and implemented BHP/Care manager role • An engaged psychiatric provider • Operating costs are not a barrier 16

INTEGRATED CARE IS DRIVING BEHAVIORAL HEALTH TO MEASUREMENT BASED CARE TREAT TO TARGET Remission Response • HAM-D 50% or <8 • Paroxetine and mirtazapine • Greater response • Shorter time to response • More treatment adjustments (44 vs 23) • Higher doses antidepressants • Similar drop out, side effects Quo T, Correll, et al. American Journal of Psychiatry, 172 (10), Oct, 2015 17

GROWING FOCUS ON MEASUREMENT BASED CARE https://www.thekennedyforum.org/ issuebriefs Psychiatric Services 2016; 00:1–10; doi: 10.1176/appi.ps.201500439 18

POPULATION WIDE INTEGRATED CARE Copy righted Lori Raney. Reprinted from Raney, Lasky, and Scott (2017). Integrated Care: A guide to effective implementation. 19

SCALI LING NG, , SUS USTAINABILI LITY , , AND ND IMPACT = LE LEADERSHI HIP

SCALABILITY ✚ Normalizing mental health and substance use for the whole population ✚ Increasing access to behavioral health care NOW IS THE TIME ✚ Address behavior change and FOR BEHAVIORAL make early intervention a reality HEALTH TO LEAD ✚ Shift the system from behavioral health to health 21

RISKS TO SUSTAINABILITY PAYOR BYPASS MODEL Integrated care is a provider/policy driven initiative and without robust outcomes, payors will move past it. We have to demonstrate the VALUE POLICY MAKERS Move away from integration as a “failed experiment” while not understanding the challenges or implementation POOR OUTCOMES Integration approaches that fail to LOSE MEDICAL meet expected BUY-IN clinical, operational, or Steep change for medical financial outcomes providers and we need their buy-in and support 22

PAY FOR PERFORMANCE IN INTEGRATED CARE 29 Reduced inpatient medical Mental Health Integration Decreased arrests Program (MHIP) Community Health Utilization of Centers • State of Washington Services 100 • Community Health Plan Initial Outcomes of Washington • University of P4P Community Health Washington AIMS Centers Process Measures Center 30 Reduction in Depression EB Integration Time required 64 to 25 weeks Community Mental 25% of Program Costs Health Centers Unützer, J., Chan, Y.F., Hafer, E. et al. (2012) American Journal of Public Health, 102(6). 23

RESEARCH ON THE ROLE OF LEADERSHIP Solidify Team Commitment to Set the Vision and Ensure LEADERSHIP IS Philosophy of for the Model Change in FOUNDATIONAL TO Care Practice EFFECTIVE Clarity of Articulate & IMPLEMENTATION Engage in Importance of Plan for Change Team Financial Leadership Development Sustainability and Set-up Leaders Create the Collective Value Base and Bring “Unity from Diversity” 24

8 COMMON ORGANIZATIONAL MYTHS IN IMPLEMENTATION Many organizations miss the breath and depth of the change shifting to effective integrated care and as a result fail in the set-up We Need a If we Hire Management Integrated Paradigm Shift Them, they is Sufficient Care is a but Don’t Will Team Mechanical Change Change Anything Rushing Through the Like Clinical The Jump to Kryptonite— Starting Gate Integration is False Negative Pulled to Silo to Miss the Enough Finish Line 25

IMPORTANCE OF LEADERSHIP SUPPORT OF EFFECTIVE INTEGRATION 70% of Integrated Care is ultimately about a organizational change in culture. change efforts fail to It is an innovation in health care that achieve desired Everyone requires both a philosophical shift as results. needs to be well as significant changes in behavior focused on Most change efforts this as a exert a heavy human CHANGE and economic toll. • Leader behaviors EFFORT • Organizational attitudes and behaviors Understanding change in terms of goals, • Provider staff behaviors leadership focus, • Operational staff behaviors process, and rewards can improve the odds • Patient behaviors of success. Beer & Nohria (2000). Cracking the Code of Change Harvard Business Review

LEADING INNOVATION Integrated Care Requires Visionary Leadership ✚ Desire to reduce silos in care ✚ Shifting to quality based care (effective models) and away from volume based care (ineffective models) ✚ Commitment to health and wellness beyond sick care ✚ Patient and community centered rather than health care system centered 27

CONTACT ME GINA LASKY Principal 720-638-6712 | glasky@healthmanagement.com www.healthmanagement.com