integrating data between primary care and behavioral health … · 2018-08-30 · clinical profile...
TRANSCRIPT
June 26, 2018
Integrating Data between Primary Care &
Behavioral Health Services
The HITEQ Center is a
HRSA-funded
Cooperative Agreement
that collaborates with
HRSA partners to support
health centers in full
optimization of their
EHR/Health IT systems
HITEQ Center
Web-based health IT knowledgebase Workshops and
webinars Targeted technical
assistance
HITEQ Services
HITEQ Focus Areas
Objectives Describe a framework of behavioral health
coordination, collaboration, and integration.
List the four categories of factors that influence behavioral health integration.
Explain the role of data integration within any model of behavioral health coordination, collaboration, or integration.
Evaluate future plans of developing collaborative services for patients with Serious Mental Illness.
Presenters
Rina Ramirez, MD, FACP Chief Medical Officer Zufall Health
Shane P. McBride, MBA Founder & CEO Chiron Strategy Group
BEHAVIORAL HEALTH INTEGRATION FRAMEWORK
AND CONSIDERATIONS
Shane P. McBride, MBA Founder & CEO Chiron Strategy Group
HITEQ Resource Focused on data
integration
Curated set of 11 pieces, including 2 deep reads
Each piece has a key Health Center Takeaway
https://hiteqcenter.org/Resources/HITEQ-Resources/behavioral-health-integration-compendium-2
Behavioral Health Integration Compendium
Polling Question: How many of you have seen a framework for behavioral health integration or used one to think about your service offering?
Polling Options (pick one): Used 1 or more BHI frameworks Seen a BHI framework before Maybe have seen BHI framework Never seen a BHI framework What’s a framework?
Models of Integration The Standard Framework for Levels of Integrated Healthcare was developed by The Center for Integrated Health Solutions (CIHS), a program funded jointly by HRSA and SAMHSA.
Models of Integration The Standard Framework for Levels of Integrated Healthcare was developed by The Center for Integrated Health Solutions (CIHS), a program funded jointly by HRSA and SAMHSA.
Key Elements
Communication
Physical Proximity
Practice Change
Framework Components
Location of Services Systems Communication Clinical Delivery Patient Experience Practice/Organization Business Model Advantages Weaknesses
Comparing Co-Located Levels 3 and 4
Polling Question: What level of integration are your current behavioral health services?
Possible Answers (pick one): Coordinated care w/ other org Co-located care Integrated care w/ BH & PC Not sure/Not applicable
Stigma with trad’l BH services Interest in add’l services New conditions (e.g. opioids)
Holistic approach to patients BH med mgmt in primary care Provider burnout
Factors Influencing Integration
Factors influencing integration can be grouped into 4 categories
Exploring the addition
or modification of model of
care
Patients
Internal
Regulatory/ Compliance
Revenue/ Reimbursement
A rrow icons made by Freepik from www.flaticon.com
Additional Billable Visits Quality Incentives Lower Total Cost of Care Medicare BHI visits
NCQA BHI Distinction Behavioral Health Homes Medicaid ACO Expectations
Integration Areas of Focus
The Center for Integrated Health Solutions (CIHS) has developed a comprehensive Quick Start Guide to Behavioral Health Integration for Safety-Net Primary Care Providers.
4 key areas of focus:
Administration Workforce Clinical practice Technology
Example from Quick Start Guide
Health System Experience
Intermountain Healthcare, a health system based in Salt Lake City, developed a model for Mental Health Integration within their primary care sites.
5 Key Mental Health Integration Components:
Leadership and culture Workflow integration Information systems integration Financing and operations integration Community resource integration
ER Visits
23% Hosp Admits
10.6%
Questions to Consider
Workflow integration - Who is involved and what
needs to be changed? - How can structured data
support the clinical practice? - How are roles changing?
Information systems integration
- Current EHR and reporting technology sufficient?
- Cost of modify or additional technology?
- IT staff training?
Financing & operations integration - How does billing and finance
need to change? - How do reports change to
management and the board? - What staff training is needed? -
Community resource integration
- Who are the critical resources staff need to know?
- How do you develop bidirec-tional data & communication? How to store data in the EHR?
ZUFALL HEALTH’S INTEGRATION EXPERIENCE
Rina Ramirez, MD, FACP Chief Medical Officer Zufall Health
Established as the Dover Free Clinic in 1990 Federally Qualified Health Center since 2004 Zufall operates Eight offices in six counties Medical van Dental van Wellness Center
NCQA Accredited Patient-Centered Medical Home HRSA Designated National Quality Leader CDC Recognized “Hypertension Champion” Target BP Gold Level
Introduction
Served 37,000 patients in 125,000 visits
88% at or below 200% of Federal Poverty Level
50% uninsured 65% Latino 56% best served in a
language other than English
Patients & Services Core Services – Pediatrics,
Adult Medicine, Women’s Health, Dental, Behavioral Health, HIV Services, Podiatry, Neurology
Supportive Programs – 340B Contract Pharmacy, Clinical Pharmacy, Presumptive Eligibility/Enrollment, Case Management & Patient Navigation, Patient Portal Access
Community Outreach
and Service Programs - Health Education/Screenings, Enrollment Assistance, HIV Testing, Outreach and Programs for Special Populations, School-based dental screening and prophylaxis
eClinicalWorks (eCW)
Implemented in 2009, used for primary care visits Adapted Subjective, Objective, Assessment, Plan note
(SOAP note) to fit the model of documentation needed for behavioral health and dental
Includes standardized behavioral health screening and assessment tools known as “smart forms”
Evaluating recently-released eCW behavioral health module
Electronic Health Record
Structured fields allow robust reporting eCW data is extracted via BridgeIT to Excel Excel files are imported into Tableau, a business
intelligence and data visualization tool, which then produces management standing and ad hoc reports
Reporting
A rrow icons made by Freepik from www.flaticon.com
1. Behavioral Health Department – At all sites that have medical care – Standard Framework Level 4 (Co-located)
2. Collaboration with Saint Clare’s Health for patients with Serious Mental Illness – Began in 2011 – Standard Framework Level 3 (Co-located)
3. Integrated Behavioral Health – Pilot began in 2018 – Standard Framework Level 5 (Integrated)
Behavioral Health Services
Need: Enhance access by
addressing barriers Manage chronic medical
conditions; increase follow-up visits
Provide comprehensive services
Improve communication and coordinate care
Improve clinical outcomes
Collaboration Model Philosophy: Patient-centered, team-
based, one-stop shop Familiar faces, places,
processes Patient Navigator as link Case by case navigation Expedited access to
clinician appointments Sharing of medical and
psychiatric information (with informed consent)
More communication among staff at both sites
Saint Clare’s Health is the largest provider of behavioral health services in the region
2009: Collaboration started (outside of BH)
2011: Full-time Patient Navigator (Zufall staff), located at St. Clare’s Behavioral Health offices Has been key to the success of the program
2017: Mobile Medical Van starts weekly visits to Saint Clare’s Behavioral Health offices – Consistent care team sensitive to patient’s needs – Full range of services, incl. lab and point of care testing
Development of Model
Prior to Mobile Van Visit, Patient Navigator: Identifies patients needing services and assesses
needs Communicates with BH care team and accesses
paper-based records Prepares BH patient summary for scanning into EHR Accesses Zufall Health’s EHR to set up
appointments
Operational Details
During Mobile Van Visit, Care Team, Patient Navigator: PN assists patients to get on the van, serves as advocate Care team uses EHR to document care Care team orders lab tests and referrals as needed PN Prints visit summary for patient and Saint Clare’s Following Mobile Van Visit, Patient Navigator: Gives summary to Saint Clare’s Medical Records to include in
chart Follows up with patient and care team regarding next steps
Operational Details
790 patients attending 3,600 visits – 4.5 visits/year, compared to 3.5 for all Zufall
16.6% no show rate (17.2% for all Zufall)
1,100 dental visits Findings:
Findings to Date
Increased access (no new travel for patients) Decreased demand for appointments Increased patient and organizational satisfaction High satisfaction with Patient Navigator personal
assistance Greater access to multidisciplinary, team-based
care
Clinical profile of patients: – 74% overweight/obese – 31% have hypertension – 17% have diabetes
Patients are identified in EHR to facilitate reporting In 2013 started tracking:
– Hypertension – Diabetes – Cervical Cancer Screening
In 2017 added Breast Cancer Screening and Colorectal Cancer Screening
Clinical Measurement
Improved Clinical Outcomes
100%80% 70%
60% 61% 61% 60% 52%
40%20%0%
2013 2014 2015 2016 2017
100% 80% 80% 69% 67% 61% 60% 48% 40%20%0%
2013 2014 2015 2016 2017
100%78% 74% 73% 77% 80% 66%
60%40%20%0%
2013 2014 2015 2016 2017
Patients with Blood Pressure in Control (<140/90) • 80% in 2017 (75% for all Zufall)
Patients with Diabetes in Control (A1c under 9) • 77% in 2017 (73% for all Zufall)
Patients with Cervical Cancer Screening • 70% in 2017 (83% for all Zufall)
General: – Personal attributes as important as processes – Leadership support with devoted resources
Financial: – Potential increase in revenue under Fee-For-Service and
Value-Based Care – Increased costs – Patient Navigator grant-funded; Decreased
productivity (scheduling inefficiencies); Infrastructure not funded
Challenges: – PCP knowledge of psychiatric conditions and medications – Sharing of records, data, and outcomes; state regulations – Different practice models and payment systems – Size of partner organizations matter
Lessons Learned
RESOURCES AND LINKS
Links to Resources HITEQ: Behavioral Health Integration Compendium https://hiteqcenter.org/Resources/HITEQ-Resources/behavioral-health-integration-compendium-2
CIHS’ Standard Framework for Levels of Integrated Healthcare https://www.integration.samhsa.gov/integrated-care-models/CIHS_Framework_Final_charts.pdf
HITEQ: Utilizing and Integrating Behavioral Health Data into a Health Center’s Primary Care Services http://hiteqcenter.org/Resources/Health-IT-Enabled-QI/Accessing-Data-for-QI/utilizing-and-integrating-behavioral-health-data-into-a-health-centers-primary-care-services
CIHS’ Quick Start Guide to Behavioral Health Integration for Safety-Net Primary Care Providers https://www.integration.samhsa.gov/integrated-care-models/CIHS_quickStart_decisiontree_with_links_as.pdf
Medicare Fact Sheet: BHI Reimbursement https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf
National Council Description of Zufall Health Integration Project https://www.thenationalcouncil.org/integration-primary-care-behavioral-health/integrated-care-zufall-health-center/
Comments, Questions, and Discussion
Please ask your questions
in the chat box.
HITEQ Webinar Series
• Access our archived and upcoming webinars at hiteqcenter.org
• Please join us for upcoming webinars: – Health Center Framework for Effective
Electronic Patient Engagement for Diabetes Management
• July 24, 3-4 ET • Registration coming soon!
Thank You!
Contact Us: http://hiteqcenter.org [email protected]
1-844-305-7440
Shane P. McBride, MBA, Founder & CEO Chiron Strategy Group
Rina Ramirez, MD, Chief Medical Officer Zufall Health
THIS PROJECT IS/WAS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
UNDER GRANT NUMBER U30CS29366 TITLED TRAINING AND TECHNICAL ASSISTANCE NATIONAL COOPERATIVE AGREEMENTS (NCAS) FOR GRANT AMOUNT $500,000. THIS
INFORMATION OR CONTENT AND CONCLUSIONS ARE THOSE OF THE AUTHOR AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS
BE INFERRED BY HRSA, HHS OR THE U.S. GOVERNMENT.