Presented by: Diana Knaebe, Heritage Behavioral Health Center. Macon County Initiative Integrating Behavioral Health and Primary Care. Integration Partnership Background. Description/History of Partnerships Rationale for involvement Evolution of Partnerships and programs – services offered
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Diana Knaebe, Heritage Behavioral Health Center
Macon County Initiative Integrating BehavioralHealth and Primary Care
Heritage and CHIC Integrated Care Project
Community Health Improvement Center
Description/History of Partnership
Community Health Improvement Center and Heritage
Ultimately to Implement a patient centered medical home – true integration of care
How patients/clients are seen – length of time for visit and follow up
Funding Streams and Mechanisms often very different
Determination of “hand-offs” and/or referrals
Releases – Medical Records
The Four Quadrant Clinical Integration Model For the Adult Population/ Heritage & CHIC Adaptation
The Administrative and Clinical Collaborative Committees continue to meet on the existing collaboration as well as expanding to additional behavioral health services on site at CHIC and with an intention of continuing to work towards the provision of primary health care in a behavioral health care setting. This project is the logical extension of efforts currently underway between Heritage and CHIC. Heritage and CHIC meet regularly to plan, coordinate, and implement our existing collaboration of integrating behavioral and primary health care. This collaboration is progressive and moving forward.
The MCMHB joined the Administrative Committee in late 2009 when we began a “pilot project” to add expertise, additional funds with Medicaid billing through them plus the matching local dollars.
Macon County Health Department
MCHD entered into partnership with IDPA ABCD II (Assuring Better Child Health and Development Initiative) project in 2005. State level partners included:
Illinois Chapter, American Academy of Pediatrics ( ICAAP) and Illinois Academy of Family Physicians
Ounce of Prevention Fund (OPF)
Illinois Department of Human Services (IDHS) Office of Family Health (OFH)
IDHS Office of Mental Health (OMH)
Illinois Department of Children and Family Services
Illinois Primary Health Care Association (IPHCA
Local partners included:
INITIAL NUMBERS INDICATED HIGH RATE OF NEED !
MCMHB Board Director enlisted local mental health providers to provide counseling services for clients with positive screening scores
Referral rates outnumbered available resources
MCMHB providers had long waiting times for client entry
Some MCMHB providers were charging clients for services against project agreement
Some providers requested clients not be referred if in prenatal state
Some OB providers declined to accept screening results
MCHD staff expressed frustrations and concerns related to referral inconsistencies
Administrative Team established and meeting to work through challenges, barriers, referral processes, medical record – computer
Members from MCHD, MCMHB, Heritage
Clinical Teams also providing feedback through their supervisors – funnels up to Administrative Team and back to clinical teams/supervisors to smooth the processes
January 2011-Part time MCMHB funded Heritage Counselor begins accepting onsite referrals at MCHD and completing home visits.
40 referrals received in the first month! Whew!
Initially ,frustration expressed regarding delayed contact time vs referral numbers …However …
Counselor provides assistance with multiple scenarios
Clients and staff express 100% satisfaction with follow up services
Expansion into Seniors
Plan to use Geriatric Depression Screen
One full-time mental health staff beginning July 2011 might expand to another part-time assigned to the MCHD clients/patients
Lost the psychiatrist that worked so well for both organizations as a result have added Psychiatric Nurse Practitioner to FQHC
Added Mental Health Therapist to the FQHC site with MCMHC Board Funding
Screening to determine who can be better served at the FQHC as primary – Medical Home
Have received SAMHSA Integrated Primary Care Grant which will allow us to emphasize wellness with SPMI population added Physical PA on site at the Mental Health Center.
MCHD has become 2nd site funded by MCMHB for therapists to see identified by MCHD staff in need of services – primarily an outreach, in-home model though which is different than that at CHIC
Can take much more time to work through because our systems are often actually complicated
Are the right people at the table for discussions?
Licensure of Sites – Scope of Practice Changes
Joint Contracts for purchasing of staff or services
Who is billing for what?
Health and Illness Background Information
In 5 months, established a Health & Wellness Suite, including a Primary Care Office at Heritage
Contracted with CHIC Primary Care Clinic to place a Primary Care Physician/Assistant on site
Developed a Clinical Registry
Admitted 57 clients to Health and Wellness Program since Mid March 2011