Integrating Primary and Behavioral Care:A Basic PrimerRick Hankey

LifeStream Behavioral Center

Leesburg, Florida

Objectives

Provide a basic overview of integrated primary and behavioral care

Describe efforts at the national level of health care integration

Demonstrate an example of integrated care

Why Integration?

People with serious mental illness (SMI) aredying 25 years earlier than the general population.

Average age of death for those with co-occurring MH/SU = 45 years (vs. 53 for those with SMI)

Two-thirds of premature deaths are due to preventable/treatable medical conditions such as cardiovascular, pulmonary, and infectious diseases.

44% of all cigarettes consumed nationallyare smoked by people with SMI.

(Morbidity And Mortality In People With Serious Mental Illness Report (2006))

SMI Health Risks

OF THE SIX MAJOR CAUSES OF DEATH IN THE UNITED STATES, THERE IS AN INCREASED RISK OF DEATH AMONG THE SERIOUSLY MENTALLY ILL

MAJOR CAUSE OF DEATH INCREASED RISK OF DEATH(Times)

CARDIOVASCULAR 3.4

LUNG CANCER 3

STROKE 2

RESPIRATORY 5

DIABETES 3.4

INFECTIOUS DISEASES 3.4

(Florida Council for Mental Health)

Factors Increasing Health Risks

Poverty Poor access to Primary Care

Disconnectedness of “Physical” & “Mental” health care systems

Weight Gain

Tobacco and Substance Abuse

Medication Usage

Less likely to be screened

Self-Care Capacity/Resource

Cognitive, Affective and Behavioral symptoms

System Navigation Barriers

Patient Centered Medical Home

Frequently recommended in healthcare reform, the Patient-Centered Medical Home is a team-based clinical approach that includes the consumer, his or her providers, and family members, when appropriate.

This approach centralizes care management and supports individuals as they work toward self-management goals.

Care management is central to the Medical Home’s recent shift away from focus on episodic acute care to focus on health management of defined populations, especially those living with chronic health conditions.

Many now propose renaming this clinical approach “Person-Centered Healthcare Home,” recognizing the importance of caring for the whole person. Such a shift would necessitate integrating primary and behavioral healthcare explicitly building care manager/behavioral health consultant and consulting psychiatrist functions into the Medical Home model.

(SAMHSA/HRSA Center for Integrated Health Solutions)

Integrated Health Care

“…in essence integrated health care is the systematic coordination of physical and behavioral health care. The idea is that physical and behavioral health problems often occur at the same time. Integrating services to treat both will yield the best results and be the most acceptable and effective approach for those being served.” (Hogg Foundation for Mental Health, Connecting Body & Mind: A Resource Guide to Integrated Health Care in Texas and the U.S., www.hogg.utexas.edu)

What is Meant by Integration?

Bi-directional IntegrationIntegrating Primary Care services into Mental Health/Substance Use settings

ANDIntegrating Mental Health/Substance Use services into Primary Care settings

Services are not just provided, but coordinated with other care delivered in that setting

Focus is on the integration of services. This may or may not involve the integration, or merging, of the organization

Integration Model Level of Integration Attributes

MINIMAL COLLABORATION ISEPARATE SITE & SYSTEMSMINIMAL COMMUNICATION

BASIC COLLABORATION FROM A DISTANCE

IIACTIVE REFERRAL LINKAGESSOME REGULAR COMMUNICATION

BASIC COLLABORATION ON SITE IIISHARED SITE; SEPARATE SYSTEMS REGULAR COMMUNICATION

COLLABORATIVE CARE PARTLY INTEGRATED

IVSHARED SITE; SOME SHARED SYSTEMSCOORDINATED TREATMENT PLANSREGULAR COMMUNICATION

FULLY INTEGRATED SYSTEM VSHARED SITE, VISION, SYSTEMSSHARED TREATMENT PLANSREGULAR TEAM MEETINGS

National Effort to Integrate

With the goal of improving the physical health status of people with mental illnesses and addictions, the Substance Abuse and Mental Health Services Administration developed the Primary and Behavioral Health Care Integration (PBHCI) Program.

Through this program, SAMHSA provides support to communities to coordinate and integrate primary care services into publicly funded, community-based behavioral health settings, resulting in:

Improved access to primary care services; Improved prevention, early identification, and intervention to reduce the incidence of serious physical

illnesses, including chronic disease; Increased availability of integrated, holistic care for physical and behavioral disorders; and Better overall health status of clients.

SAMHSA awarded 64 community behavioral health organizations more than $26.2 million collectively in Primary and Behavioral Health Care Integration.

National Integration of Services

The W.I.N. Clinic-An Example of Integration

The W.I.N. Clinic Exam Room

CONSUMER CENTEREDAPPROACH

HEALTH HOME

The W.I.N. Clinic Model

Components Integrated Services Screen/registry tracking

and outcomes Primary Care staff

located in behavioral health setting

Embedded Nurse Care Managers

Wellness/Prevention programming

Evidence Based Models SBIRT IMPACT (Improving

Mood-Promoting Access to Collaborative Treatment) Model

Motivational Enhancement Techniques (MET)

Eli Lilly Wellness Program

LPN Care Managers

Jack of all trades Case Management Home Visits Consumer Education, Care Coordinator Wellness Activities Glue that holds the treatment team

together

Health and Wellness Activities

Offer stress management programs to include yoga, acupuncture, breathing exercises, physical exercises, relaxation/meditation.

Nutrition counseling, weight management, and healthy eating seminars. Cooking demonstrations to include organized grocery store shopping trips.

Time Management workshops. Organized peer support groups. Smoking cessation. Wellness testing (fitness and medical tests), health

risk appraisals, hypertension screening & education. Disease management seminars. In home education sessions by LPN Care Managers.

Questions???

Thank you for your attention.

Contact Information:

Rick Hankey

rhankey@lsbc.net