1 / 10

Integrated Care: Where’s this going? Why?

Integrated Care: Where’s this going? Why?. IBHP Grantee Convocation Sacramento, CA September 12, 2008 Frank deGruy. Definitions. Integrated Combining dissimilar things into a coherent whole that has meaning and value Behavioral Health Mental disorders Substance use problems

fleur
Download Presentation

Integrated Care: Where’s this going? Why?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Integrated Care:Where’s this going? Why? IBHP Grantee Convocation Sacramento, CA September 12, 2008 Frank deGruy

  2. Definitions • Integrated • Combining dissimilar things into a coherent whole that has meaning and value • Behavioral Health • Mental disorders • Substance use problems • Health behavior change

  3. Where Did This Come From? • Mental Health Services Research • NIMH • AHRQ • RWJ • MacArthur • Substance Use and Criminality • Quality Improvement • Clinical Decisionmaking and EBM • PBRNs

  4. Progress In Methods, 1 • Basic Design Issues • Efficacy to effectiveness • Heterogeneous study samples • Usual Care control groups • Multilevel interventions • Multilevel and mixed methods evaluations • Stepped Care • Multistep interventions • QI “Research” • PBRN methods

  5. Progress In Methods, 2 • Economic analyses • Direct and Indirect Costs • Cost Offset • Cost Effectiveness • Cost Benefit • Chronic Disease Management • Registry • Self management • Care manager • Care protocol • Objective outcome measurement

  6. What Have We Learned? 1 • Prevalence and nature of the problems • Depression & impairment, then the others • Comorbidity • Adequacy of treatment • Health behavior change • Nature of primary care practices • Patients are reluctant to fragment care • Practices are overwhelmed: competing demands • Systemic nature of practice • Easier to change than to sustain

  7. What Have We Learned? 2 • Nature of the partners • Strange environment, different assumptions • Different work styles • Not used well • Teamwork: new layer of overhead • Nature of supporting systems • Commodification of clinicians and practices • Carveouts • More difficult to change • Different priorities, incentives (incentives!)

  8. The Medical Home • What is it? • Probable defining context • Behavioral/mental health integration at risk for marginalization • Mandate for MH resources to serve multiple purposes • Learn DM, Asthma, CAD literature • Comorbidity

  9. Today’s Problems • System Issues • Carveouts • Reimbursement rules & productivity incentives • Benefits design • How to deal with carveouts • Who pays for care managers? Specialty consultants? • Who “owns” them? Where do they live?

  10. Design Issues • Pilot Mentality • Running assessment • Midcourse corrections • Emphasis on teamwork • Vertical Integration

More Related