SAMHSA PBHCI Program

1. Program Purpose: To establish projects for the provision of coordinated and integrated services through the co-location of primary and specialty care services in community-based mental and behavioral health settings. Goal: To improve the physical health status of adults with serious mental illnesses (SMI) who have or are at risk for co-occurring primary care conditions and chronic diseases. SAMHSA PBHCI Program

2. 93 PBHCI Grantees • Community Behavioral Health Organizations • 63% partnering with an FQHC • 37% hiring PC capacity (mostly rural grantees) or partnering with a hospital • Majority are CMHCs, ~10% are SA providers • Served over 32,000 adults with SMI and/or COD • Grantee Cohorts: • 13 awarded 2009 • 43 awarded 2010 • 8 awarded 2011 • 30 awarded 2012

3. AK (2) Region 5 17 Grantees 93 PBHCI Grantees by HHS Regions Region 8 5 Grantees Region 10 7 Grantees VT ME (2) WA (3) Region 1 12 Grantees MN NH (1) WI MT ND MI (1) OR (2) Region 2 11 Grantees MA (4) NY(8) ID RI (2) OH (7) SD IL (5) IN (4) WY CT (3) PA (2) NJ (3) VA (2) UT (1) NE (1) IA WV (2) CO (4) DE NV MD (1) DC KS MO Region 7 1 Grantee CA (11) KY (1) Region 3 7 Grantees NC (1) TN (1) SC (1) AZ (1) OK (3) AR NM GA (3) MS AL LA (1) Region 4 14 Grantees TX (3) HI FL (7) Region 6 7 Grantees Region 9 12 Grantees

4. Individual PBHCI Grantee Outcomes • 44% of adults participating in services showed an improvement in physical health (Central Oklahoma Community Mental Health Center) • Significant decrease in mental illness symptoms after being enrolled 6 months in the PBHCI program (Postgraduate Center for Mental Health) • Significant increase in physical health rating after being enrolled for six months (International Center for the Disabled) • More than 50 patients have lost an average of 12 pounds per person (Centerstone)

5. PBHCI Grantee: Southeast, Inc. 3Rubin & Panzano, Psychiatric Services, 2002; 4 Represent 85% of Q1, FFY_13 PBHCI enrollees

6. Are We Lowering Cost through Improved Access to Primary Care? Source: Heritage Behavioral Health Center

7. Case Client SITUATIONThis adult Asian woman with paranoid schizophrenia had been without health care for over five years. She presented with uncontrolled diabetes and hypertension. OBSTACLESClient had little English, although she understood more than she could speak. With limited resources, she would have sought routine care through emergency rooms or 24-hour clinics. ACTIONSThrough the collaborative effort of a psychiatrist, nurse, counselor, interpreter, and physician, client enrolled in HIP and had a full physical. She was subsequently diagnosed, treated, and educated for diabetes, hypertension, and high cholesterol. • RESULTS Client has attended diabetes education classes. She has better control her of diabetes, high blood pressure, and elevated cholesterol with diet, exercise, and oral medications.  

9. What We Are Learning

10. Lessons Learned • Leadership • Executive Buy-In and Engagement • Setting Staff Expectations and Training • Organizational history of successful planned change • Clinical • Clinical Registries / Population Management • Patient/Consumer Patient Flow • Operations • Nurturing the PC/BH relationships / Conflict Management • Continuous Quality Improvement • EHRs and Care Coordination

11. Lessons Learned • Wellness • Consumer Engagement • Embedding Wellness across the organization • Financing • Billing and Coding • Community Partnerships and Resources

12. Organizations Change • Leadership - Leaders who employ research informed approaches are more likely to activate the organization to support a change initiative: • Communicating for buy in (what is the message? Who delivers the message? How do we know if the workforce understands and values the message? • How does an organization insure that the workforce supports the aims of the integration initiative? • How does the organization insure that the integration partners understand, value and act in ways that are likely to engage consumers and patients.

13. Relationships Matter Our childhood success strategies continue to serve us well

14. Produce Measurable Outcomes… • The national shift to accountable healthcare means mental health providers must show measurable results from interventions. • Using hard data to examine progress or lack of progress • Partnershipsbetween practitioner and consumer • Monitor – benchmark - staff variance in standards of clinical practice If we don’t measure it… …we can’t manage it …we can’t improve it …we won’t be paid for it!

15. Health Indicators Must be Collected, Shared, and Used to Improve Care and Activate Consumers! Blood Pressure—quarterly Body Mass Index—quarterly Waist circumference—quarterly Breath CO—quarterly Plasma Glucose (fasting) and/or HgbA1c—annually Lipid Profile (HDL, LDL, triglycerides)—annually National Outcome Measures (NOMs)—every 6 months

16. Business Process Analysis • Supports Clear, Precise, Accessible Communication • Step-by-step financial, clinical and practice management activities • Promotes cross-discipline understanding of each step • Connects multiple dimensions –billing, data collection and reporting, clinical services, practice management, etc. • what you do and why you do it