integrated behavioral health for complex patients roadmap, … · 2019-09-25 · shoulders by naomi...
TRANSCRIPT
National Center Conference: Putting Care at the CenterLos Angeles, California
Integrated Behavioral Health for Complex Patients: Roadmap, Tools and Technology
Jeffrey M. Ring, Ph.D.Elise Pomerance, M.D., M.P.H.
Kru Vyas, Ph.D., M.B.A.November, 2017
Faculty Disclosure
Dr. Ring is a Speaker for Merck Pharmaceuticals on doctor-patient communication and culturally responsive care.
Shoulders by Naomi Shihab Nye A man crosses the street in the rain,Stepping gently, looking two times north and south,Because his son is asleep on his shoulder.No car must splash him.No car drive too near to his shadow.This man carries the world’s most sensitive cargo but he’s not marked.Nowhere does his jacket say FRAGILE, HANDLE WITH CARE.His ear fills up with breathing. He hears the hum of a boy’s dream deep inside him.We’re not going to be able to live in this world if were not willing to do what he’s doing with one another.
The road will only be wide. The rain will never stop falling.
Objectives - Participants will:• Articulate core competencies for BH
integration for complex patients• Receive overview of initial project outcomes• Understand the successes and challenges of
the BHICCI
How does one build an integrated complex care initiative?• Who do you want on your team?• What skills do you want them to
possess?• How will you manage data to know if
patients are improving?
Bibliography / Reference
www.bhintegration.com
Inland Empire Challenges• 55% Minorities• Limited Education• Unemployment more than doubled
since 2007 > 14.7% (12% US, 10% CA)
• Poverty 12.7%
IE Health Inequities - Mortality1 Heart Disease2 Cancer3 Lung Disease4 Stroke5 Unintentional Injuries7 Diabetes (5x for Latinos/as)
Our Health Care System• Few providers• Isolated Partners• Disconnected BH• Fragmented Care• Poor Health Outcomes• Lack of IT Infrastructure• Very High Costs
Project Goals are consistent with National Goals: Address social factors in payment and performance through incentives and support for health equity efforts• Office of the Assistant Secretary for Planning
and Evaluation in DHHS• National Academy of Medicine• National Quality Forum
How many of these people with behavioral health concerns will see a mental health provider?
12
No Treatment Primary Care Provider
Wang P, et al., Twelve-Month Use of Mental Health Servicesin the United States, Arch Gen Psychiatry, 62, June 2005SlideCourtesyofAIMSCenter,UniversityofWashington
Mental Health Provider:psychiatric provider or therapist)
CourtesyofAIMSCenter,UniversityofWashington
A$30,000,000Investment
BHICCI Key Commitments• Improve patient and team experience• Improve care coordination and integration of
primary, specialty, addiction, and mental health care across and between healthcare/treatment settings
• Improve complex care management of individuals with chronic conditions
BHICCI Key Commitments• Improve population health
management by using data analytics• Improve access• Reduce overall health care costs in the
Inland Empire safety net
BHICCI Core Elements• 24 month pilot• 30 safety net sites: Primary
Care, BH, Hosp. Ambulatory Clinics
• Health Homes• Whole Person Care
Target Population• 2+ chronic conditions (PH/BH)• Benefit from care management• High cost• IEHP members
BHICCI Roadmap
Engage LeadersEngage TeamsPartner with PatientsData and MeasurementAdopt a QI MethodDefine/Identify PopulationBuild Multidisciplinary, Complex Care Teams/SCRIntegrate Behavioral Health Services with Complex CareSustain Change
TRIAD TEAMS and Coaches
Relationship-Centered Care
“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
-Maya Angelou
22
Registries to Track Progress
Courtesy of AIMS Center, University of Washingtonhttp://aims.uw.edu
Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months
BHICCIClinicSiteTypesBHICCIClinicSiteTypes #ofSites #ofMembersEnrolled(9/1/17)
MedicalClinics 19 2,859Behavioral HealthClinics 3 431Coordination-FocusedClinics 3 228PediatricClinics 2 234SpecialtyPainClinics 3 624BHIClinic(nocomplexcare) 1 148
Total 31 4,524
Workforce Education Sessions
Core Competencies• Outreach/engagement• Health Literacy• Medication Adherence• Supporting Self-Management• Shared Care Planning• Registry Management• Transitions of Care• Cross-System Leadership
Team and Patient Experience
PATIENT Participation & Sites Active
265
621
515
578
734
15
21
21
26
31
March
April
May
June
July
Completes SitesActive
Patient ExperienceMean & Net Promoter Score
29
Mean(avg ofthesequestions)– 5pts
1. Careteamlistenstomeandunderstand
2. Itrustmycareteam
3. Careteamalwaysinvolvesmeinthedecisions
4. Myoverallhealthisbetter
NetPromoterScore(NPS)– 10pts
1. Howlikelyisitthatyouwouldrecommendthiscarecenter
4.27 4.41 4.3 4.44 4.38
8.84 9.038.52 8.62 8.55
0
1
2
3
4
5
6
7
8
9
10
Marn=265 Apriln=621 Mayn=515 Junen=578 Julyn=734
Mean NPS
PatientExperience– Mean&NetPromoterScore
Team ExperienceMean & Net Promoter Score
30
3.87 3.9 3.94 3.85 3.78 3.89
0 0
8.01
0
7.81
00
1
2
3
4
5
6
7
8
9
Febn=79 Marn=123 Apriln=163 Mayn=167 Junen=179 Julyn=184
Mean NPS
Mean(avg ofthesequestions)– 5pts
1. Ifeelvaluedatwork2. IhaveeverythingIneedto providethebest
care3. Itrustmyteamtosupportme4. Mylifeisbetter5. Iplantobeherethreeyears(quarterly)
NetPromoterScore(NPS)– 10pts*
1. Howlikelyisitthatyouwouldrecommend
TeamExperience– Mean&NetPromoterScore
*NPSperformedquarterlyforTeamMembers
What are some early learnings from the data?
On average, patients with elevated Behavioral Health scores at Baseline had lower scores, on average, at their last follow-up assessment.
Patients with elevated HbA1c and blood pressure scores at Baseline experienced some improvements in scores, on average.
These results represent a small percentage of all BHICCI patients.
The majority of BHICCI patients are enrolled at Med HCOs and are fairly new to BHICCI (less than 6 months).
More recent data review: what can we say now?
Datathrough8-2-17
35Note:*indicatesstatisticalsignificance
nrepresentsBHICCIpatientsenrolledforaminimumof1month
ChangeinAveragePHQ-9Scores(BaselineScore>=10)
BehavioralHealthOutcomes– PHQ-9
Datathrough8-2-17
Datathrough8-2-17
MeMeBeBe
SpSpBHBH
moderatedepression10
5mild
15
milddepression
average scoresat first assessment
average scoresat last assessment
MedHCO (n=281) * 9.6 8.9CCHCO (n=9) 8.1 7.9SpecPainC (n=15) 10.1 9.6BHI (n=22) 9.2 9.6Overall (n=315) * 9.5 8.9
3
4
5
6
7
8
9
10
11
12
13Change in HbA1c Average Scores (Baseline Score >= 7.0%)
diabetes
normal
prediabetes 5.7%
6.4%
38Note:*indicatesstatisticalsignificance
nrepresentsBHICCIpatientsenrolledforaminimumof1month
ChangeinAverageSBPScores(BaselineScore>=140)
PhysicalHealthOutcomes– SystolicBloodPressure
39
PreliminaryCostData(UCSD)
Preliminary Cost Data are Trending in the Right Direction
40
PreliminaryCostData(UCSD)
Preliminary Cost Data are Trending in the Right Direction
BHICCICaseRates
• ProjectGoal– DevelopCaseRatesfortheBHICCITeamsthatwillkickinafterthepilotendsinJuly2018.
41
BHICCI RoadmapHealthHomesProgram(HHP)– BHICCIisfootprintforCalifornia1115waiverHHP--startsJanuary2019
BHICCIAwardedDepartmentofCaliforniaHealthCareServicesManagedCareQualityAward– October,2017
Questions | [email protected]
[email protected]@desertclinics.com
©2017.LEADthedifferenceLLCforJCC.Allrightsreserved.
PhysicalHealthOutcomesHbA1c
44*Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months
PhysicalHealthOutcomes– Diabetes
9.5 8.9
3456789
10111213
OverallAverageScoreatFirstAssessment OverallAverageScoreatLastAssessment
ChangeinAverageHbA1cScores(BaselineScore>=7.0%)(n=132)*
PhysicalHealthOutcomesSystolicBloodPressurePhysicalHealthOutcomes– Diabetes(HbA1c)
PoorlyControlledDiabetes
PhysicalHealthOutcomesSystolicBloodPressure
45*Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months
151.9
135.3
80
100
120
140
160
180
200
AverageScoreatFirstAssessment AverageScoreofLastAssessment
PhysicalHealthOutcomes– Hypertension(SBP)ChangeinAverageSystolicBloodPressure(SBP)Scores(BaselineScore>=140)
(n=364)*
Stage1Hypertension
BehavioralHealthOutcomesPHQ-9
46*PatientHealthQuestionnaire(PHQ-9)– DepressionScreening**Note:ThecurrentaveragelengthofenrollmentforMembersinBHICCIis3-4months
17.1
12.4
0
5
10
15
20
25
30
AverageScoreatFirstAssessment AverageScoreofLastAssessment
ChangeinAveragePHQ-9Scores(BaselineScore>=10)(n=828)**
BehavioralHealthOutcomes– Depression(PHQ-9*)
ModerateDepression
ModeratelySevereDepression