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Integrated Care in Practice

Integrated Care in Practice. Laura Galbreath, MPP Director, Center for Integrated Health Solutions May 15, 2013. About the Center .

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Integrated Care in Practice

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  1. Integrated Care in Practice Laura Galbreath, MPP Director, Center for Integrated Health Solutions May 15, 2013

  2. About the Center In partnership with Health & Human Services (HHS)/Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA). Goal: To promote the planning, and development and of integration of primary and behavioral health care for those with serious mental illness and/or substance use disorders and physical health conditions, whether seen in specialty mental health or primary care safety net provider settings across the country. Purpose: To serve as a national training and technical assistance center on the bidirectional integration of primary and behavioral health care and related workforce development To provide technical assistance to SAMHSA PBHCI grantees and entities funded through HRSA to address the health care needs of individuals with mental illnesses, substance use and co-occurring disorders

  3. Represents 2,500 community organizations that provide safety-net mental health & substance abuse treatment services to 8M adults, children & families National voice for legislation, regulations, and practices that protect & expand access to adequately funded, effective mental health & addictions services National Council for Community Behavioral Healthcare

  4. Technical Assistance Available from CIHS • Individual Technical Assistance: • Phone and video consultations, e-mail, site visits • Medicaid Health Home Consultation to States • Group Learning Experiences: • Regional and State Based Learning Communities • Trainings and Presentations • National Webinars • Tools: • Web-based Resources (http://www.integration.samhsa.gov) • Training Curricula • White Papers and Factsheets • eSolutions Newsletter

  5. Primary and Behavioral Health Integration: The New Standard of Care

  6. Tipping Point • Behavioral health is essential to health • Prevention/early intervention is possible • Treatment is Effective and People Recover • Primary Care Level of Behavioral Health

  7. The Affordable Care Act: Four Key Strategies

  8. The Future is Focused on Value • Developing and implementing a suite of value-based incentive programs that reward care providers for improvements in quality and efficiency • Supporting delivery systems as they become more integrated and accountable for cost, quality and experience outcomes • Coordination of medical and behavioral health services increases the value for payors and consumers

  9. Relationship of PC-BH Integration to Leading Delivery System Changes PCMH

  10. Get to Know Your ACO • ACOs can fund community organizations to take the lead on conducting community health assessments. • ACOs can fund community stakeholder groups to develop and/or adapt health promotion and disease prevention programs for their communities; help get them up and running • ACOs can fund successful prevention programs, especially when bringing them to new populations and communities • ACOs can fund the testing of new or adapted programs to support community buy-in

  11. NCQA PCMH & Behavioral Health • PCMH 1:Enhance Access and Continuity • Comprehensive assessment includes depression screening, behaviors affecting health and patient and family mental health and substance abuse • PCMH 3: Plan and Manage Care • One of three clinically important conditions identified by the practice must be a condition related to unhealthy behaviors (e.g. obesity) or a mental health or substance abuse condition • Practice must plan and manage care for the selected condition • PCMH 4: Provide Self-Care and Community Resources • Self-care support includes educational and community resources and adopting healthy behaviors • PCMH 5: Track and Coordinate Care • Tracks referrals and coordinates care with mental health and substance abuse services • PCMH 6: Measure and Improve Performance • Preventive measures include depression screening

  12. Health Homes and the ACA • Medicaid “health home” option under the ACA for enrollees with chronic conditions, including MH SU conditions • Program provides financial incentives for states • 90% FMAP for health home-related services for 1st 8 quarters • Alternative payment models • Incentive grants

  13. Compare and Contrast: Medicaid Health Homes & Patient Centered Medical Homes Source: National Council for Community Behavioral Healthcare [i] As defined in Section 2703 of the Affordable Care Act, P.L. 111-148. [ii] As defined by the National Committee on Quality Assurance, www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx. [iii] “Chronic conditions” includes, but is not limited to, (1) mental health condition, (2) substance use disorder, (3) asthma, (4) diabetes, (5) heart disease, or (6) being overweight, as evidenced by having a body mass index (BMI) over 25. (Section 2703 of the Affordable Care Act, P.L. 111-148).

  14. Missouri Community Mental Health Centers… 15

  15. Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013 www.integration.SAMHSA.gov

  16. SAMHSA Primary and Behavioral Health Care Integration (PBHCI)Grant Program

  17. PBHCI offers an important opportunity to reduce health disparities for Individuals with SMI • Eliminate the early mortality gap • Reach people who will not access primary care • Intervene early before medical co-morbidities develop or worsen • Reduce expensive emergency department use • Improve recovery outcomes

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