tpa 2015 ce trans to health settings pp handout€¦ · health settings: competencies,...

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+

Helen L. Coons, PhD, ABPP Women’s Mental Health Associates Texas Psychological Association CE Workshop June 13, 2015

Transitioning Your Psychology Practice to

Primary Care and Specialty Health Settings:

Competencies, Collaborations and

Contracts

+Psychologists in Mental Health Settings

+Collaborative Strategies with Health Care Providers

Small Group Exercise

List collaborative strategies

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+ Psychologists in Primary Care

Pediatrics and

Adolescent Medicine

Family Medicine

Obstetrics and

Gynecology

Internal and Geriatric Medicine

+Psychologists in Specialty Health Settings

Neurology Rehab

Medicine Oncology Cardiology Surgery

+Psychologists in Specialty Health Settings

Reproductive Endocrinology

Sports Medicine

Gastroenterology and Bariatric

Surgery

Nursing Homes/Elder

Care

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+What is different in 2015?

Patient Protection and Affordable Care Act

Health Care

Mental Health and Substance Abuse Care

+ACA à Triple Aims

Increase Access to

Care

Improve Health

Outcomes

Reduce Costs

+ Implications of Health Care Reform for Psychology Independent Practice?

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+Affordable Care Act

n  Change in service delivery, financing, reimbursement & outcomes

n  PCMH: Patient Centered Medical Home

n  ACO: Accountable Care Organization

n  Improve quality and lower costs

n  Public and private sectors

Integrated Health Care Systems

+ Transitioning Your Psychology Practice to Primary Care and Specialty Health Settings: Competencies, Collaborations and Contracts

Texas Psychology Association June 13, 2015

Workshop learning objectives n  Describe models of co-located psychology practices in health settings.

n  List clinical and professional competencies for practice in adult and pediatric primary care and specialty medical settings.

n  Identify strategies to transition a psychology practice to medical offices in the private sector.

n  Understand regulatory, legal and contractual issues related to developing co-located and integrated practices with private health care providers.

n  Assess business plan and readiness to transition to primary care and specialty medical settings.

+Workshop Participants

n  Your professional settings now?

n  Professional goals and settings in the future?

n  Your learning objectives for today?

n  Workshop guidelines and requests.

n  Slides and handouts.

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+Interactive Workshop

n  Clarify your interest in transitioning to medical settings

n  Clarity about competencies for these settings

n  Strategies to collaborate with health care providers and transition your practice to medical settings

n  Business planning and challenges


n  Increased funding of CHIP

n  Expanded coverage for young adults (until turn 26)

n  Protection for pre-exiting conditions and gender

n  Coverage for early retirees

n  Changes in Medicaid n  Increase access: changes in

eligibility n  States to receive federal matching

funds to cover additional low-income individuals and families

Increasing Access to Affordable Care


n  Medical information on line

n  Insurance companies can’t rescind coverage and can appeal decisions

n  Eliminating life time limits on coverage

n  Regulating annual limits on coverage

n  Can’t denying coverage to children or adults with pre-existing coverage

n  Hold insurance companies accountable for unreasonable rate increases

n  Establish consumer assistance programs in States

Consumer Protections

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n  Prevention and public health fund

n  Focus on prevention of illness and chronic disease

n  Free preventive care for seniors

Free Preventive Care Prevent Costly Conditions


n  EMR

n  Improve provider communication-interoperability

n  Improve care coordination

n  Reduce costs

n  Reduce errors

n  Improve quality of care

Reduce Paper Work and Administrative Costs


n  Value based care vs volume

n  Bundled and global payments

n  Offer hospital financial incentives to improve quality of care

n  Hospital quality becomes public

n  Patient clinical outcomes

n  Patient perception of care

n  Satisfaction with care

Payment and Quality

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Health Care Reform

n  Paradigm shift

Ø  health care delivery

Ø  financing

Ø  reimbursement

n  Diverse models of service delivery


n  PCMH: Patient Centered Medical Home

n  ACO: Accountable Care Organization

Ø  Improve Quality and Lower Costs

Integrated Health Care Systems

+PCMH and ACO’s Financing Shift to Organization

u Patient Center Medical Home (PCMH) u Accountable Care Organization (ACO)

ü  Access ü  Comprehensive ü  Seamless - Coordination ü  Patient Centered ü  Continuum of care onsite or refer ü  Quality measurement – at least 33 benchmarks ü  Organizational payment - capitation and pay for performance Ø  Entirely different model of reimbursement for PC and MH providers Ø  No mandate for mental health providers

Ø  On site behavioral health & substance abuse tx Ø  Refer to community providers

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+ Benefits of Integrating Behavioral Health Services in Primary Care Settings (Coons, 2012)

ü  Convenience of “one stop” care

ü  Trusting relationships with providers/team

ü  Avoid stigma associated with psychiatric settings

ü  Lack of parity in insurance coverage for mental versus physical health services

ü  Fewer geographic, cultural and linguistic barriers

ü  Improved health and mental health outcomes

ü  Increased satisfaction among women

ü  Decrease unnecessary utilization and cost ü  Cost offset ü  Patient outcomes

Coons (2012, 2103)

+Behavioral Health in Primary Care Summary Stats

n  PCPCC: Patient Centered Primary Care Coalition

n  AHRQ: Agency for Health Research and Quality

n  SAMHSA: Center for Integrated Health Solutions

n  CFHA: Collaborative Family Healthcare Association

n  National Council for Behavioral Health

n  SBM: Society of Behavioral Medicine

n  APA Division of Pediatric Psychology

n  APA Center for Psychology and Health

n  Behavioral Health Integration Group, LinkedIn

+Health Care Reform and Psychology Practice

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+Health Care Reform – Implications for Mental Health Care

n Psychologists may or may not play role in PCMH/ACO n  Pubic sector vs private sector n  Increase in IPC positions

n Changes in behavioral health delivery model n  Integrated and interprofessional --- shared care model n  BSIRT – short term interventions or specialty referrals n  Referrals from PCMH, ACO, and medical practices to community BH

providers

n Focus on health promotion and prevention

n Consumer choice in mental health care n  Market for private, fee for service tx will continue

+Health Care Reform – Implications for Mental Health Care

n How to pay for psychologists in IPC settings n  New payment models with bundled and global payments

n Fee for service models n  Reduced reimbursements rates from Medicare and private

plans n  State and county models for MH care - Coons (2011)

n Mental health medical homes

+Opportunities in Private Medical Settings

Primary Care

Specialty Care

Other Health

Settings

Individual and Group Exercise

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+Opportunities for Psychologists in Primary Care

n  VA and DOD

n  FQHC

n  AHC and Community Family Practice

n  Private Medical Practices

n  School based health centers

n  Nursing homes

n  Wellness programs

n  Urgent PC sites at malls, Walgreens

Likely IPC Settings Area

+Integrated Care Perspective

Ø Integrated care is not …. o  Multidisciplinary, Multi-specialty, Interdisciplinary,

Transdisciplinary

Ø Integrated care is ….. Ø Paradigm shift Ø Change in care delivery model Ø  Interprofessional Ø Team based

Ø shared responsibility for patient care and outcomes Ø Anton (2013)

+ www.integration.samhsa.gov/integrated.pdf

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+

Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013

+Models of Successful Transitions to Private Health Settings

+ Primary Care, Multispecialty & Specialty Health Settings

Primary Care

Specialty

Multispecialty Inpatient/Outpatient

Patients, Families and Communities

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+ Psychologists in IPC in the Public Sector Coons (2011), BPA Retreat on Health Care Reform

n VA

n DOD

n IHS

n FQHC

n School based health centers

n Planned parenthood

n Prison health centers

Federal Community

+ Psychologists in Primary Care and Specialty Settings in the Private Sector Coons (2011), BPA Retreat on Health Care Reform; Coons (2012), CHOP (2012)

q  Academic Health Centers q  Family Medicine

q  Pediatrics

q  Ob/gyn

q  Community Health Centers

q  Community Hospitals

q  Community Family Practice and Family Practice Residencies

q  Community medical practices

q  Major insurance companies q  Kaiser Permanente

q  Aetna demonstration projects q  Coons (2012, 2013, 2014)

Locations

+Models of Successful Transitions to Private Health Settings

n  Levels of collaboration with medical practice

n  Type of medical practice n  Primary care, multispecialty and specialty

n  Out patient or in patient

n  Size of psychology and medical groups

n  Structures of practice

n  Employment and contractual agreements

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+Payment Models in Private Medical Settings

q Salaried positions as faculty members

q Salaried positions q Director of Behavioral

Sciences q  Staff providers

q Independent contractors q Independent practice q Grants: foundations q Insurance reimbursement

and initiatives q Self pay

Coons (2012, 2013, 2014)

+Psychologists in PC in the Private Sector

Academic Health Centers n  Salaried positions as faculty

members n  Susan McDaniel, Ph.D., Family Medicine, URMC

n  John Linton, Ph.D., UWV, Family Medicine

n  Catherine Shisslak, Ph.D., Family Medicine, UAZ

n  Barbara Cubic, Ph.D., EVMC

n  Alexander Blount, Ed.D., Family Medicine, UMass

Community Hospitals

n  Salaried, independent contractors, grants n  John Gerdes, Ph.D., Internal Medicine,

Geisinger Health System

n  Paul Kettlewell,Ph.D. Pediatrics, Geisinger Health System

n  Diane Prescott, Ph.D, , Ob/Gyn, Maine

Health Systems

Trudy Helge, Psy.D., Kaiser Permanente

Community Family Practice Residencies n  Salaried positions - Director of

Behavioral Sciences n  Bill Gunn, Ph.D., Capital Region Family Hlth Ctr

n  Barry Jacobs, PhD., Crozer Keystone Family Practice Residency

+ Psychologists in Private Primary Care and Specialty Medical Settings

n  Carol Ellstein, Ph.D. Family Practice

n  Gary L. Goldberg, Ph.D.

n  Diana L. Prescott, Ph.D. Pediatric Obesity

n  Helen L. Coons, Ph.D., ABPP Ob/Gyn

n  Kate Hays, Ph.D. Sports Medicine

n  Steven Walfish, Ph.D. Surgery – Bariatrics

n  Dawn Jewll, Psy.D. Occupational Medicine

n  Helen L. Coons, Ph.D., ABPP Oncology, women’s health

n  Carol Goodheart, Ed.D. Retirement communities

Independent contractors, self pay, insurance reimbursement, grants

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+Psychologists in Private PC Small practice

n  Brandywine Village Family Medicine, PA

n  Family practice with two physicians and a nurse practitioner

n  Dennis Given, Psy.D.

n  www.ChesterCountyPsychology.com

Family Practice

+Psychologists in Private Sector PC Settings

President and Clinical Director

Helen L. Coons, Ph.D., ABPP

Independent Consultants Trudy D. Helge, Psy.D.

Elizabeth D. Krause, Ph.D.

Eva D. Greenberg, Ph.D.

Expertise

Clinical Health Psychology

Women’s Health and Mental Health

Completed Post-Doctoral Fellowships

Collaborative and/or integrated care in health settings

ABPP in CHP

+ Women’s Mental Health Associates Practice since 2000

q  Current locations §  Bryn Mawr Women’s Health Associates – Ob/Gyn practice at two locations §  PA Oncology Hematology Associates, Penn Medicine at Radnor

q  Past Locations §  MCP Hahnemann Center for Women’s Health §  Women’s Multispecialty, University of Pennsylvania Health System, CCA §  Women First, University of Pennsylvania Health System, CCA §  Joan Karnell Cancer Center, Pennsylvania Hospital, POHA §  Penn Health for Women, Penn Medicine at Radnor, University of Pennsylvania Health

System, §  Reproductive Medicine Associates §  Dahlia M. Sataloff, M.D., Breast Surgeon and Chair, Pennsylvania Hospital

n  Recent discussions §  Two primary care offices §  Reproductive Endocrinology §  Urology/pelvic floor

n  Relocation and rebranding in CO and nationally

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+Psychologists in Private IPC Large Group Practice

Delaware County Professional Services Pennsylvania

n  Aetna Behavioral Health IPC Mental Health Project

n  Multiple internal medicine and family practice sites in Greater Philadelphia area

n  Practices owned by TJHU, UPHS, private

n  Sent providers to IPC program at U Mass

n  Contact is Lynne DiCaprio, MA

Family practice Internal Medicine

+ Center for Integrated Care 765 Allens Ave., Suite 102 Providence, RI 02905 (401) 490-8900 www.PsychologicalCenters.com

Staff:

•  7 doctoral psychologists with prior specialized training in behavioral medicine

•  3 psychologists who perform only supervisory and administrative functions within CIC

•  4 doctoral psychologists without behavioral medicine backgrounds

•  4 Masters level clinicians with prior specialized training in behavioral medicine

•  9 Masters level clinicians without behavioral medicine backgrounds

•  2 Advanced practice prescribing psychiatric nurses

Rental sites (Medical practices):

•  3 Pediatric practices, 4 sites

•  1 Ob-Gyn practice

•  5 Internal Medicine and 3 Family Medicine practices, 9 sites (one with pain specialization)

•  1 FQHC

•  1 Rehab practice

•  Paul Block, PhD, Director [email protected]

+

n  7 Licensed Psychologists

n  2 Licensed Professional Clinical Counselors

n  1 Psychology Resident

n  4-7 Psychology Practicum Students

n  Located within a Family Practice Residency n  3 psychologists are residency

faculty members n  Provide Behavioral Science

training to FP residents n  Frequent consultations with FP

physicians and Sports Medicine

n  Serve ages 2 to 90+

n  General Services n  Individual, couple’s, and

family therapy n  Diagnostic evaluations

n  Specialty Services n  Pediatric Neuropsychology n  Sport Psychology n  Pre-surgical psychological

evaluations n  Interpersonal process group

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+Psychological HealthCare, P.L.L.C.

n  www.phcny.com

+

Gary X. Lancelotta, Ph.D., ABPP Clinical Child and Adolescent Psychology Pediatric Psychologist, Baptist Children's Hospital Behavioral Medicine Program Coordinator West Kendall Baptist Hospital – Florida International University: Family Medicine Residency - Clinical Assistant Professor Department of Psychiatry, Florida International University Serving children and families in South Florida Large Group Practice

+Co-location in Specialty Settings Small practice

Reproductive Endocrinology

n  Prepare for procedures

n  Decision making

n  Needle phobias

n  Coping with infertility

n  Coping with pregnancy loss

n  Consult and psychoeducation re donor egg and sperm

n  Donor and GC evals

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n  Kate Hays, Ph.D.

n  Canada


Helen L. Coons, Ph.D., ABPP

Women’s Mental Health Associates

Oncology

Surgical

Medical


Surgery

Steve Walfish, Ph.D.

Atlanta

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+

Ψ Consultation-liaison psychology group practice in Austin, Texas

Ψ  Founded in 1998 by Clif Moore, PhD and Lloyd Berg, PhD, ABPP

Ψ Began seeing referrals for one consulting MD in a long-term acute care hospital

Ψ Now 10 psychologists in ›25 facilities Ψ  6 acute care, 5 acute rehab, 2 LTAC hospitals

+ Prerequisite Checklist For Hospital-Based Psychology Practice

q Behavioral health competence q  Must be fluent in speaking,

reading and writing “medical”

q Understand credentialing & privileging process

q Strong differential diagnosis skills

q Strong crisis intervention skills

q Competence in suicide risk and decisional capacity evaluations

q Competence in evidence-based, short-term psychotherapy

q  Interdisciplinary competence

q Willingness to see ALL referrals

q Proactive billing service

q Cross coverage

www.bhc-austin.com

+

Transitioning Your Practice To Primary Care and Specialty Medical Settings: Is It Right For You? Kelly and Coons

PPRP (2013)

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+ Transitioning Your Practice to PC and Specialty Medical Settings

Pairs/group exercise

Ø Which primary and/or specialty health setting? Ø Competencies in complex roles and skills? Ø Is the setting the right fit? Ø Practice transition strategies? Ø Contractual issues?

see Coons & Gabis (2010); Ruddy, Borresen and Gunn (2008);

Readiness Self Assessment

+Transitioning Your Practice to PC and Specialty Medical Settings

n Which setting is right for you?

n  Readiness Self Assessment

+ Primary Care, Multispecialty & Specialty Medical Settings

Primary Care

Family and Internal Medicine

Pediatrics and Adolescent Medicine

Obstetrics and Gynecology

Geriatric Medicine

Specialty

Multispecialty Inpatient/Outpatient

Patients, Families and Communities

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+Specialty Medical Settings Individual and Group Exercise

+Specialty Medical Settings

n  Surgery

n  General

n  Transplant

n  Bariatric

n  Plastics

n  Oncology n  Surgical n  Radiation n  Medical n  Survivorship n  Palliative care

n  Reproductive Endocrinology

n  Labor and Delivery

n  Maternal Fetal Medicine

n  NICU

n  Sports Medicine

n  Neurology

n  Rehab Medicine

n  Palliative care

+Specialty Medical Settings

n  Cardiology

n  Rheumatology

n  Pulmonary

n  Urology and Urogynecology

n  Sexual Medicine

n  Otolaryngology

n  Gastroenterology

n  Dermatology

n  Endocrinology

n  Psychiatry

n  Emergency department

n  Other

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+Other specialty medical settings

n  Dental offices

n  Physical therapy

n  Nutrition

n  Retirement communities

n  Assisted living and long term care facilities


n Competencies in complex roles and skills?


+Health Service Psychology Competencies n  Health Service Psychology: Preparing Competent Practitioners. Health

Service Psychology Education Collaborative (HSPEC)

Competencies

I.  Science

II.  Professionalism

III.  Relational: Interpersonal Skills & Communication

IV.  Applications

V.  Education

VI.  Systems American Psychologists (2013)

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+Competencies for Roles in Primary Care

n  Evaluation, Consultation and Treatment

n  Collaborative n  Evidence based n  Brief problem focused n  Individual, couples, family (defined by pt) n  With or without other health care provider

n  Workshops, groups, presentations

n  Curb side consult

n  Crisis management: community, system or practice

n  Home visits with or without other provider

n  Resident, medical, nursing, psychology student training and supervision

n  Program development

n  Staff training

n  Health systems outcomes research

n  Leadership roles for team, practice, education and training, health system

n  Grant writer n  clinical services, resources, health provider education, research

+APA Competencies for Psychological Practice in Primary Care n  The Inter-Organizational Work Group on

Competencies for PC Psychology Practice (2012) n  Initiative of APA President Dr. Suzanne Bennett Johnson

n  Chair: Dr. Susan McDaniel

n  Charge: Integrate extant material on competencies for psychological practice for primary care into a single document

n  Slides from Catherine Grus, Ph.D., APA

n  APA.org/ed/resources/competencies-practice.pdf

n  American Psychologist (May-June, 2014). McDaniel et al.

+The Inter-Organizational Work Group on ��Competencies for PC Psychology Practice (2013)

PC Competency Clusters:

1.  Science 2.  Systems 3.  Professionalism 4.  Relationships 5.  Application 6.  Education

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+Cluster 1: Science

n Competencies: 1A. Science Related to the Biopsychosocial Approach 1B. Research/Evaluation

Grus, 2013

+IPC Competencies: Science

n  Evidenced based n  Assessment strategies n  Treatment interventions n  Prevention approaches n  Team development n  Diversity and health outcomes

n  Health Systems Research n  Patient outcomes n  Provider outcomes n  Health system outcomes n  Community outcomes

Coons, 2013

+Cluster 2: Systems

n Competencies: 2A. Leadership/Administration 2B. Interdisciplinary Systems 2C. Advocacy

Grus, 2013

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+IPC Competencies: Systems

n Language shifts

n Team building

n Health systems finance structure

n Leadership skills

n Advocacy for care, programs, staff, field n Practice, hospital, health system n Local, State and Federal level

+Value based IPC practice

n Health financing and outcomes n Assess outcomes n Value added n Pay for performance

+Cluster 3: Professionalism

n Competencies: 3A. Professional Values and Attitudes 3B. Individual, Cultural, and Disciplinary Diversity 3C. Ethics in Primary Care Setting 3D. Reflective Practice/Self-Assessment/Self-Care

Grus, 2013

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+ Primary Care Interacting and Complex Factors Coons (2011, 2012, 2013, 2014)

+ Ethical Issues in Primary Care and Specialty Health Settings

o  Disclosure

o  Who is the patient? o  Child or parents

o  Individual or family

o  Donor or intended parent

o  Privileged communication

o  Reporting requirements

o  EMR

o  Technology

o  Different health professions with diverse ethical codes of conduct

Coons (2011)

+Cluster 4: Relationships

n Competencies: 4A. Interprofessionalism 4B. Building & Sustaining Relationships in Primary Care

Grus, 2013

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+Integrated Care Perspective

o Integrated care is not: o  Multidisciplinary, Multi-specialty, Interdisciplinary,

Transdisciplinary

ü  Integrated care is:

•  Paradigm shift •  Change in care

delivery model •  Interprofessional •  Team based

•  Anton 2013

+Interprofessional Communication and Teamwork

n Models for Interprofessional Skills and Communication

n Teambuilding

Interprofessional Education for Practice

Curriculum Reform and Training Innovation

+Interprofessional Competencies

n  Cultural/language of medicine n  Internal and family medicine

n  Obstetrics and Gynecology n  Pediatrics

n  Specialty settings n  Administrators

n  Mission of health care providers

n  Theoretical framework n  Clinical decision making/problem solving n  Concrete

n  Goals during clinical encounter n  Action-oriented n  Specific recommendations

n  Build a relationship

n  Practice expectations

n  Boundaries between and across providers

n  Flexibility in roles at any time

n  Consultation framework

n  Collaborative reports

n  Respect for other health professions and staff

McDaniel et al

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+Relationships with Providers and Staff

n  Physicians

n  Physician Assistants

n  Nurse Practitioners

n  Pharmacists

n  Nurses

n  Nutritionists and physical therapists

n  Social workers

n  Genetic counselor

n  Medical assistants

n  Secretaries, office staff and manager

Collaborators Penn Health for Women -- Nurses, MA’s, Receptionists

+ Pediatric and Adolescent Primary Care

n Providers n  Pediatricians

n  Family Practice Docs

n  Nurse Practitioners


n  Other health providers

n  School teachers, counselors and psychologists

n  Social services

+Cluster 5: Application

n Competencies: 5A. Practice Management 5B. Assessment

http://integrationacademy.AHRQ.Gov/evaluationtools

5C. Intervention 5D. Clinical Consultation Grus, 2013

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+Clinical Competencies

Examples

n  Clinical presentation of acute, chronic and life-threatening conditions in primary care

n  Biopsychosocial issues in primary care

n  Differential dx and preventing mis-diagnosis

n  SBIRT approach

n  Psychopharmacology skills

n  Working with interpretors

+Interventions in Primary Care

“IPC Interventions are not shorter traditional mental health care.”

n  Parida Khatri, Ph.D., Oct 2013

+ SBIRT-Insomnia

n Screening n  Sleep screening n  Assessment tool

n Brief intervention n  Sleep hygiene techniques

� Referral for sleep study

� CBT for insomnia

62 year old man with poor sleep

Screening and Brief Intervention

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+ Pediatric & Adolescent Psychology in Primary Care Knowledge, Roles & Clinical Competencies

Roles of pediatric primary care psychologists

n  Psychoeducation

n  Therapist

n  Evaluation

n  Consultant to clinic

+Pediatric Psychology and Primary Care

Knowledge & Clinical Competencies

n  Medical issues: n  Anatomy n  Diseases processes n  Preventive medicine

n  Psychosocial aspects of child and adolescent acute and chronic medical conditions

n  Pediatric psychopharmacology

n  Differential dx n  Symptoms of disease n  Iatrogenic effects of tx n  Coping reaction

n  Prevent Misdiagnosis

+Pediatric Psychology and Primary Care

n  Goals n  Child’s medical home

n  Prevention, promotion of health and cure

n  Chronic vs acute illness

n  Understanding normal development

n  Facility with:

n  behavioral screening

n  developmental screening

n  Cultural sensitivity

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+ Pediatric Psychology and Primary Care

•  Competence to deliver BRIEF!•  solution-focused

individual & family systems!

•  treatments!

•  Psycho-educational Assessment & Intervention:!•  Parenting & Discipline!

+Adolescent Psychology and Primary Care o  Medical issues

o  Stress o  academic challenges, peer

relationships, self esteem, move toward independence, physical changes, family issues,

o  Attention and concentration, organization

o  Body image

o  Sexual activity

o  STD

o  Drugs and ETOH

+Women’s Primary Care and Multi-specialty Settings

n  Internal and family medicine

n  Ob/Gyn

n  Multispecialty Women’s Health

n  Internal or family med n  Ob/Gyn n  Reproductive Endo n  Urogyn n  Breast surgeon n  Nutrition n  Psychology

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+Decisions about Medication

91

+Health Promotion and Prevention Competencies Across the Life Span

n  Smoking prevention/cessation

n  Nutrition for life

n  Weight and BMI

n  Dietary cholesterol

n  Sleep hygiene

n  Exercise

n  ETOH and drugs

n  High risk sex

n  Reproductive health

n  Interpersonal safety

n  Injury prevention

n  Car safety – n  seat belts n  cell phones

n  Wellness!!!!

+Technology Competencies in Health Settings n  EMR

n  Health Monitoring n  Blood sugar, nutrition, exercise,

cardiac status

n  Preparing for procedures n  Insulin pumps, surgery, chemo, L and

D, cholostomy n  Advances in radiology, surgery and

radiology

n  Genetic testing

n  Viral treatment advances

n  Social networking

n  Telepsychology

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+Cluster 6: Education

n Competencies: 6A. Teaching 6B. Supervision Across the health professionals!

+ Template for Self-Assessment of Readiness for Delivery of Services to Patients with Medical-Surgical Problems

13 Self-Assessment Questions

Case # 1. New dx DM in 10 y/o boy in Pediatrics

Case # 2. New dx Dementia in 57 y/o woman in Family Medicine

Belar et al (2011). Self-Assessment in Clinical Health Psychology: A Model for Ethical Expansion of Practice. PPRP. (2001). Vol 32, No.2., 135-141.

+ Template for Self-Assessment of Readiness for Delivery of Services to Patients with Medical-Surgical Problems

Pediatrics Family Medicine

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+ Transitioning Your Practice to PC and Specialty Medical Settings

Brief Intervention Competency Assessment Tool (BI-CAT)

ü  20 item rating form for behavioral anchors ü  Practice Context ü  Intervention Design ü  Intervention Delivery, ü  Outcomes-Based Practice

ü  Rate 0-10 0= not adequate 5= adequate 10=exemplary

Patricia Robinson, Ph.D., Mountainview Consulting Group, 2013

PC Competencies Self Assessment

+Assess Your Readiness

n  Assess Team Readiness n  Individual, Providers and Health Setting

n  Integrated Healthcare Readiness Assessment

n  National Council for Behavioral Health

n  Compass-PH/BH

n  Developing Integrated Physical Health/Behavioral Health Capacity in Treatment Settings

n  Self-Assessment Tool for Behavioral Health and Primary Health Clinics and Programs

n  Cline and Minkoff (2011-2012)

+

n  Internship

n  Fellowship

n  VA

n  Re-specialization

n  Formal self study n  Courses - CE workshops and Post-Doctoral Certificates n  Reading n  Shadow pc and specialty providers n  Formal supervision

n  Life long learning n  Belar (2011); Coons (2013, 2014); McDaniel et al (2014)

Strategies to Develop PC and Specialty Medical Competencies

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+

Formal Self Study

ü Formal program or course work

ü Formal clinical work

ü Shadow providers

ü Supervision

ü Life long learning

Belar (2011); Coons (2013, 2014); McDaniel et al (2014)

Strategies to Develop PC and Specialty Medical Competencies

+IPC and Specialty Setting CE Workshops

n  APA convention, Office of CE and Practice Directorate

n  SBM

n  CFHA

n  SPTA’s

n  Small, focused conferences or workshops n  Pain, Sleep, Smoking Cessation

+Strategies to Develop PC and Specialty Medical Competencies

Formal Programs

1.  Medical Family Therapy Program, University of Rochester SOM

2.  Center for Integrated Primary Care, Certificate Program in Primary Care Behavioral Health, Worcester, MA

3.  Certificate in Integrated Primary Care, Fairleigh Dickinson University

4.  Post Doctoral Certificate in Clinical Health Psychology, Philadelphia College of Osteopathic Medicine

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+

The Medical Family Therapy Intensive is one week of interdisciplinary training that

blends clinical presentations, small group learning, and skill development. The primary

goal is to provide training for professionals interested in health care and mental health

collaboration when working with patients and families dealing with illness.

21st Annual

MEDICAL FAMILY THERAPY INTENSIVE

June 9th — 13th, 2014

Institute for the Family University of Rochester medical Center

Rochester, NY

http://urmc.rochester.edu/psychiatry/institute-for-the-family/family-therapy/mfti/cfm

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Ø  Trains psychologists to fulfill clinical and academic roles in primary

care medical settings

Ø  Education in family psychology and systems theory, collaboration, and health psychology through didactic, individual/group supervision, seminar, and clinical experiences

Ø  Pediatric, Women’s Health, Family Medicine/Geriatric Internal Medicine tracks

PRIMARY CARE FAMILY PSYCHOLOGY FELLOWSHIPS

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The Center for Integrated Primary Care

•  Workforce Development •  Technical Assistance •  Evaluation Services

For practices, health systems, and states wishing to integrate behavioral health and primary care services.

http://UMassMed.edu/CIPC

Alexander Blount, EdD Director

Alexa Connell, PhD Assistant Director

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+Post-Doctoral Certificate in Clinical Health Psychology

n  Year long program

n  Courses

n  Clinical rotations in medical settings

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+Certificates vs Board Certification

n  CE courses

n  Planned curriculum in primary care

n  Useful training

n  Not recognized by any credentialing board or organization

n  Documents expertise in specific area

n  National standard for health service providers

n  Consumer protection

n  14 specialty areas

n  Benefits

n  See www.ABPP.org

Board Certification (ABPP) Certificates


n Are Health Settings Right for You?


+ Transitioning Your Practice to Health Setting Is the setting right for you?

Clinical Approach

ü Focus on evaluation, consultation and short term tx

n SBIRT n Health behavior change n Limited time contact (15-20 vs 50 min hour) n Referral following 1-6 sessions

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+ Transitioning Your Practice to Health Settings Is the setting right for you?

Sitting with uncertainty n Practice

n  Provider and staff support n  Rooms n  New ownership

n Health system n  Different priorities n  CMS MAPP designation

n Reimbursement challenges

n  Coons, 2013, 2014; Kelly & Coons, 2013

+Strategies to Transition Your Practice Into Health Care Settings

+Strategies to Transition Your Practice Into Health Care Settings Individual & Group Exercise

List collaborative strategies you currently use?

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Building Collaborative Relationships with Health Care Providers

Psychologists in Independent Practice

+Strategies to Transition Your Practice Into

Integrated Health Care Settings Coons (2012, 2013, 2014)

n  Send consult notes to current collaborators

n  Which practices generate the largest number of referrals now

n  What types of relationships do you have with provider(s)

n  Ask providers about their practice and interests and refer patients to them

n  Attend team meeting for complex patients and families

n  Inquire about their interest in having you on site n  To see individuals n  To offer groups n  Crisis management n  Patient outcomes assessment

+Collaborative Consultation Communication Guidelines

n  Communicate with provider prior to consult n  Ask patient for verbal consent to speak with provider when she

calls for appointment

n  Speak with the provider to clarify reason for referral

n  Communicate with provider following the consult n  Obtain written consent per HIPAA guidelines

n  Phone call, letter, consult note, follow-up

n  Recommendations for patient, family and/or provider

n  Ongoing communication with provider n  Prior to patient’s follow-up visits with the provider

n  Discuss concerns, response to meds, progress, what provider can support

n  Hospitalization, death, crisis, etc.

n  Be flexible n  provider schedule

n  Phone issues (e.g., introduction)

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+Opportunities for Provider Communication and Relationship Building

n New patient - physician referred

n New patient - non physician referral

n Ongoing patient - no physician contact

+Consultation Reports

n Reports need to be brief!

n  Include patient’s date of birth (and no SSN)

n Give concise treatment recommendations for the patient, couple, family

n Do not include interpretations!

n Give recommendations for the provider

n Provide referral information (name & number)

n  Include follow-up plans

n Other


“When seeking a consultation from a psychologist or other providers, “ physicians are likely to expect clear statements of observed facts and specific intervention recommendations.”

Pace et al. 1995

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n Be relatively prompt n 1-2 weeks or before visit or call

n Watch what you say! n Reports can be sent on to others or seen by

others (e.g., other providers, lawyers, disability review, etc.).

n Consider HIPAA related issues and forms

n Mail, email, EMR > security

+Example Consultation Report

Dear Dr. Martinez:

Thank you for referring Sarah J. Smith (DOB: 1/19/25) for a consultation. As you know, Mrs. Smith is an 88 year old, retired school teacher with a history of HTN, DM, and Breast Cancer who cares for her husband of 68 years with an advanced dementia. In addition, her 47 year old daughter has advanced colon cancer and is in hospice. Mrs. Smith’s two sons live several hours away and her siblings are deceased.

Mrs. Smith was seen for an initial evaluation on September 8, 2013 and will continue in individual CBT to: 1) treat her marked symptoms of anxiety and depression with out suicidal ideation; 2) discuss her practical and emotional support needs; 3) assess her own cognitive status; 5) address options for ongoing care of her husband in their home or on a dementia unit; and 6) discuss her anticipatory grief during this very difficult time.

Mrs. Smith is willing to consider a medication consult to stablize her mood and sleep, and agreed to make a follow-up appointment with you. She is also willing to speak her Parish nurse as well as xx county Office on Aging to learn about respite care options.

Thank you for the opportunity to participate in Mrs. Smith’s care. If you would like additional information about her history and the treatment recommendations, my cell is:

Cc: other health care providers

+Calling & Texting Health Care Providers

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+Collaborate!

n  Take care of health care provider’s patients! n  Offer effective, ongoing treatment!

n  Be available, visible and flexible

n  Provide mini or curb-side consults on patients/families

n  Offer to see a patient/family at the provider’s office

n  Offer to do a home visit

n  Discuss and provide referrals

n  Offer to do groups at the provider’s office

n  Do not do secondary referrals before talking with the provider

n  Consider joining their managed care panels

+Share or Provide Resources!

n  Assist with referrals – give names and cards of other providers

n  Patient education pamphlets

n  CD’s and links for relaxation with guided imagery

n  Videotapes

n  Recommend/design assessment or screening tools

n  Journal articles relevant to clinical practice

n  Handouts from CE conferences

n  Other resources (e.g., community services)

+Preparing for Cancer Treatments

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+ Strategies to Transition Your Practice Into Integrated Health Care Settings Coons (2012, 2013, 2014)

n  Staff training

n  Lunch and learn

n  Holiday lunches

n  Grand rounds

n  Invite providers to present with you

n  Invite providers to write with you

n  If rural, send letters with example consult note –

Steve Walfish, PhD.

+Strategies to Transition to Health Settings

Groups Medication Stress management Weight Chronic pain Fertility Pregnancy loss PPD/PPA

HIV/AIDS Smoking cessation Parenting skills Cancer survivors Caregivers Bereavement

+Interprofessional Approaches

n  Physicians


n  Nurse practitioners

n  Nurses

n  Social workers

n  Genetic counselors

n  Physical therapists

n  Nutritionists

n  Pharmacists

n  Medical assistants

n  Secretaries, office staff, office manager

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+Collaborative Settings

n  Internal medicine n  Family medicine

n  Obstetrics and Gynecology n  Pediatrics n  Adolescent medicine n  Geriatric medicine

Primary Care Specialty Settings

+ Contractual, Legal and Regulatory Issues Affecting Co-Location in Private Health Settings

ü Contracts

ü Legal challenges

ü Regulatory issues

+ Contractual Options in Integrated Private Health Settings

n  Employee

n  Independent consultant under contract

n  Independent contractor with rental agreement

n  Group contract

n  Grant funded

n  Insurance funded- special initiative

n  Fee for service Coons (2012, 2013)

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+ Contractual Issues in Health Settings Negotiating On-Site Collaborations (Coons and Gabis, 2010)

ü  Clarify expectations n  Time n  Space n  Staff needs n  Patient scheduling n  Computer access n  Patient records

n  Ownership n  Access to and use of EMR

n  Referrals n  Signage n  Patient billing n  Groups/workshops n  PR/advertising n  Proprietary issues

n  Coons & Gabis 2010

+Contractual Issues in Private Health Settings

Rental Agreement

n Time n Four hour blocks

n Space n Consult room n Exam room n Rotate n Groups Coons & Gabis, 2010

+Contractual Issues in Private Health Settings

n Patient Scheduling n Mechanisms n Warm hand off n Providers give patient your name n Provider gives you patient’s name to call

n Referrals n No fee splitting n Referrals to you and others

n  Coons & Gabis (2010)

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+Contractual Issues in Health Settings-Technology

q Computer access n Patient information n EMR n Other

n Patient records n Ownership n Access to and use

of EMR n Content

n  Coons & Gabis 2010

+Understand Contractual Relationships and Partnerships

n  Privately held medical practice

n  Group held medical practice

n  Health system owned

n  Public – FQHC

n  ACO

+Contractual Agreements

Contacts for Co-located Practices

n  Individual psychologist

n  Group practice at one or more medical offices

Contracts for Referral Agreements in Community Practice

n  Accept referrals from PCMH

Organizational Contracts

see Good Practice (October, 2014)

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+Contractual Issues in Health Settings

ü  Hospital Privileges

ü  CMS MAPP

ü  Secure a contract and lease n  Know Federal and State laws

n  Contracts n  HIPAA n  Referrals

n  Partnerships

ü  State Corporate Doctrine of Medicine Laws

ü  Stark Laws - referrals

Coons & Gabis (2010). Contractual Agreements for Independent Psychologists in Medical Settings. Independent Psychologist.

Legal and Regulatory Issues


ü Seek legal consultation from health law lawyer

ü Secure liability and property insurance ü “other” Coons & Gabis (2010). Contractual

Agreements for Independent Psychologists in Medical Settings. Independent Psychologist.

Legal and Regulatory Issues


n  Negotiation

n  Relationship building n  Key players not just physicians n  Who owns and runs practice?

n  Go slow! Go slow!

n  Understand expectations of practice and staff

n  Considering shadowing providers

n  Talk to key players

n  Focus on needs of health practice and patients

n  Coons & Gabis, 2010

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+Challenges with Practice Transition

n  Time of uncertainty in health care, national and global economy

n  Reimbursement challenges

n  Regulatory issues

n  Contractual options for individual and group practices

n  Need for effective advocacy by all of us

n  Coons (2012, 2013)

+Rewards of Co-Located and Integrated Care

n  PC is defacto MH system

n  Where the national focus and dollars are

n  Problem focused

n  We make a difference

n  Learn every day

n  P, I and P gratifying

n  Relationships

+Transitioning Your Practice To Medical Settings: Is It Right For You?

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+ Walk, Run or Avoiding the Train to PC and other Health Settings?

+Opportunities for Psychologists in Independent Practice

n  Independent practice is not going to vanish

n  Consumer choice n  Need more than limited

sessions n  Want to chose private

behavioral health provider n  Theoretical orientation n  Past experience with

therapy

n  Referrals from medical practices, PCHM, ACO’s, schools, employers

+Referrals from ACO’s and PCMH’s

n  Pediatric & Adult

n  Network

n  Build referral relationships

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+Collaborative Strategies with Health Care Providers

Individual & Group Exercise

List collaborative strategies you currently use?

Benefits of Collaborative Care for Patients and Families --- and our Practices

TEAM

n Together n Everyone n Accomplishes n More

+Feelings about practice? Excited? Overwhelmed? Stuck?

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+Health Care Reform and Psychology Practice

+Where will you practice in 2015-2020?

n  Same location or ?

+What are the consequences of not leading or changing your practice model now?

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+ Business of Practice 2014-2017

q  Maintain

q  Expand portfolio > pts and/or size

q  Merge or transition to medical or other settings

q  Close

+ Business of Practice 2014-2017

Practice innovations ?

Business innovations ?

ü  Proactive business planning

ü  Consultation needs

ü  Collaborations