Care Integration A Case Study at WVCH

1. Care IntegrationA Case Study at WVCH By Ruth Rogers BaumanChairperson, WVCHCEO, ATRIO Health Plans

2. Who is WVCH • ATRIO Health Plans • Capitol Dental Care • Mid Valley Behavoral Network • WVP Health Authority • Northwest Human Services, Inc • Polk County • Salem Clinic, PC • Salem Health/Salem Hospital • Santiam Memorial Hospital • Silverton Health • West Valley Hospital • Yakima Valley Farm Workers Clinic

3. What is Integration • Is it integration of contracts? • Is it integration of OHP contractors? Physical Dental Behavioral

4. What is Integration • Is it integration of care? Primary Care Specialists Hospital Ancillary Outpatient Non traditional

5. Conventional Wisdom • Conventional wisdom says: • Mental Health needs to be integrated into primary care because so many high utilizers and chronically ill also have mental health issues • You have to have patient centered homes • Non traditional workers can help patients navigate the health system at a lower cost and with a closer bond • Nurse Case Managers are essential to coordinating primary care, specialty care and transitions of care

6. The WVCH ExperienceConventional Wisdom • Mental Health needs to be integrated into primary care because so many high utilizers and chronically ill also have mental health issues • Long history of WVP and BCN working closely together X Some clinics are beginning to add mental health resources as part of their PCPCH but warm hand offs are not the norm most of the time • You have to have patient centered homes • Large clinics and hospital systems are moving toward level 3, almost all PCP’s are level 1, and WVP is moving toward level 3 for the balance of the network • Non traditional workers can help patients navigate the health system at a lower cost and with a closer bond • Hired navigators last summer who had a huge impact on high utilizers of ED • Nurse Case Managers are essential to coordinating primary care, specialty care and transitions of care • WVP had 12 nurse case managers X we just needed more

7. WVCH ExperienceSurvey Says! • All we had to do was get more nurse case managers and more mental health workers and we would have it made • Then we did a survey • Salem Hospital reported 22 nurse case managers with 4 support staff and 10 MSW’s • West Valley Hospital had 1 nurse case manager • NW Senior and Disabilty Services reported 40 case managers, 2 program specialists and 2 screeners • Salem Clinic reported 1 nurse case manager dedicated to transitions • Salud had 1 nurse case manager • Polk County Mental Health reported 6.5 case managers and 1 drug case manager • WVP had 12 nurse case managers

8. WVCH Experience • 110 FTE’s were involved in care coordination • WVCH took a giant step forward by simply identifying resources already deployed • We learned that even among case managers, we needed a way to coordinate the coordinators! • Members of the clinical advisory committee gained a deeper understanding of what each organization was doing and a greater realization of where overlaps, gaps and missed opportunities lie

9. Key barriers • Limited Communication • Limited exchange of medical information • Lack of secure systems to exchange information • Lack of alignment of goals • Lack of sharing of care plans • Lack of understanding of care plans • Limited physical contact between team members and with patients

10. Another Interesting Finding No one mentioned: • Lack of financial incentive • Lack of shared risk • Lack of time • More people needed

11. What’s Next • Clinical Advisory Committee has a number of small projects that are closing the communication gaps • Navigators are being deployed to specific populations at the front end of care • Common care plans are being deployed for special needs population