Integrated Behavioral Health Planning Meeting

1. Integrated Behavioral Health Planning Meeting October 25, 2013 Debra Hurwitz, MBA, BSN, RN CSI Co-Director

2. Agenda • CSI Strategic Plan for Integrated Behavioral Health • Draft Integrated Behavioral Health Charter • Understanding the landscape • Who else should be at the meeting? • Who else do we want to hear from/know? • What might we want to pilot? • Next Steps

3. CSI-RI Strategic Plan Mission: To lead the transformation of primary care in RI in the context of an integrated health system Charge:To lead, partner or participate with appropriate stakeholders to develop additional capabilities for PCMH. To align with EOHHS and HEALTH to leverage state resources to improve population health Timeline:1/14-1/16 Draft Charter

4. Models of medical and BH services • Coordinated: BH services by referral at separate location with formalized information exchange (little evidence yet of cost and clinical improvement) • Co-located: BH services by referral in the primary care practice space (moderate cost and clinical evidence + staff and patient satisfaction) • Integrated: BH services part of the “medical” treatment in primary care practice (abundant clinical and growing evidence and great satisfaction) (Blout, 2003)

5. Importance of relationship with primary care • First contact: When you need to “go to the doctor,” come see us • Continuous: Know the patient/family over time and in context; can address issues over time • Comprehensive: “We have what you need” • Coordinated: “If we don’t have it, we will find it” • Care for “undifferentiated” patient: No matter what the problem, you are in right place • (Blout , 2013)

6. Need and Access to Care • Need: 1 in 5 people have a mental health or addiction program • Identification: 2/3 of patients with BH/addiction problems seen in medical sector receive no treatment • Patient Response: The vast majority of people will not accept a referral to specialty BH offered by a PCP. It is care with primary care or no treatment • Kathol, RG el al (2005). General Medicine and pharmacy claims expenditures in users of behavioral health services. Journal of Internal Medicine 220 (2) 160-167 • Regier, DA, et al. The de factor US mental and addictive disorder service system. Arch Gen Psychiatry . 1993 Feb; 50(2) 85-94

7. BH problems seen in primary care PHQ 3000 • Major Depression 10% • Panic Disorder 6% • Other Anxiety Disorders 7% • Substance Use Disorders 14% • Any Mental Health Dx 28% (BH = MH, SA, and Health Behavioral Change Needs) (Blout, 2013 )

8. Prevalence of unhealthy behaviors • Smoking 25% • Obesity 30% • Sedentary lifestyle 50% • Non-adherence 20-50% Blout, 2013)

9. Chronic conditions that with BH component in standards • Asthma • Diabetes • CVD • Irritable Bowel Syndrome • Obesity • Substance Abuse

10. 2014 Draft NCQA Standards • The practice is responsible for coordinating care across multiple settings which include the scope of services available within the practice and how behavioral health needs are addressed • Comprehensive assessment: depression screening using PHQ 2, PHQ 9 or other standardized tool; mental health/substance abuse history of patient and family; behaviors affecting health

11. 2014 Draft NCQA Standards (cont) The practice implements clinical decision support following evidence based guidelines for: • A mental health or substance use disorder • Conditions related to unhealthy behavior The practice has a written process for implementing and managing referrals with specialists including behavioral health providers

12. What is happening in RI? • 2006 Inventory of Behavioral Health and Primary Care-what needs to be added? • Providence Center • Kent Center • Other? • Who else do we want to hear from? • What are barriers that need to be considered?

13. Next Steps What might we want to pilot? • Compacts/referral system • Co-location • Integration • Community health team integration • Psychiatry telemedicine • Funding sources • Other?