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Behavioral Health Integration; Experiences of RIPCPC and RIBHN 2010 - 2013. A bit on history and background Development of current model Demonstration of point-of-care database referral system Prospects for the future Questions. History of RIPCPC.

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Behavioral health integration experiences of ripcpc and ribhn 2010 2013
Behavioral Health Integration;Experiences of RIPCPC and RIBHN2010 - 2013

  • A bit on history and background

  • Development of current model

  • Demonstration of point-of-care database referral system

  • Prospects for the future

  • Questions

History of ripcpc
History of RIPCPC

  • RIPCPC formed in 1994 as an Independent Practice Association (IPA) with a focus on quality improvement

    • Originally formed to:

      • Challenge insurers that were lowering reimbursement

      • Combat the trend of hospitals buying up community based practices

  • RIPCPC is the largest IPA in Rhode Island

    • 140 Primary Care Physicians (began with 40)

    • Cover over 300,000 Rhode Island Lives

    • 25% of Rhode Island’s Pediatricians are Members

Ripcpc s focus on the patient centered medical home
RIPCPC’s Focus on the Patient Centered Medical Home

  • Principals of the PCMH

    • Personal physician provides care

    • Physician directed medical practice

    • Whole person orientation

    • Care is coordinated and/or integrated

    • Enhanced access for patients

    • Focus on safety & quality improvement

    • Payment appropriately recognizes the added value provided to patients

  • Behavior Health’s Integration is Essential to Improving Outcomes!

Patient centered medical home model
Patient Centered Medical Home Model

  • PCMH effect:

    • Care delivered by primary care physicians in a Patient-Centered Medical Home is consistently associated with better outcomes:

      • Reduced mortality

      • Fewer hospital admissions

      • Lower utilization

      • Improved patient compliance

      • Lower healthcare spending

Collaboration with specialists providers
Collaboration with Specialists/Providers

  • True patient care coordination can only happen with meaningful & efficient provider collaboration

  • We can improve outcomes and the effectiveness and efficiency of our care delivery systems by embracing this concept

  • Our effectiveness and efficiency as clinicians will soon be directly tied to our reimbursement

Behavioral health committee focus
Behavioral Health Committee Focus

  • Mission Statement:

    • To improve the health of our patients by facilitating communication and coordination of care between Rhode Island Primary Care doctors and Behavioral Health Professionals in Rhode Island

  • We have assembled a team of primary care doctors along with our IT professionals and behavioral health professionals and we have created a forum with regular monthly meetings focused on:

    • Improving access to Behavioral Health Providers

    • Improving communication between Behavioral Health Providers and PCP’s

  • Support the IPA by addressing behavioral health’s role in the PCMH, helping satisfy

    our behavioral health contract components

Behavioral health committee initiatives
Behavioral Health Committee Initiatives

  • Evaluate/Revise/Approve BCBSRI policies and procedures stated within the three-way contract between BCBSRI, RIPCPC & Behavioral Health Provider

    • Both the Co-located & Collaborative Model Agreements

  • Creation of a comprehensive list of Behavioral Health Providers and facilities for our physicians membership

    • Listing will be compiled and posted on our website

  • Refine pilot between the Behavioral Health Providers and PCP’s focused on securely exchanging standardized clinical


    • Patient Clinical Summaries / Referrals (from PCP)

    • Behavioral Health Evaluations (from BHP)

Behavioral health committee initiatives1
Behavioral Health Committee Initiatives

  • Things to Come (in 2012):

    • Database to access at point of care to allow for smooth referral of patients to appropriate providers

    • Collaborative agreements to allow for the majority of our physicians to enter into arrangements that enhance access and improve communication

    • Network wide ability to use the secure, HIPPA-compliant communication system piloted in 2011.

Goals of behavioral health integration
Goals of Behavioral Health Integration

  • Improve 2-way communication between clinician and the referring PCP

  • Better access to BH for our patients

  • Formation of quality metrics that can prove better outcomes with BH

  • Delivery quality comprehensive coordinated care to our Patients!

Behavioral health integration
Behavioral Health Integration

  • Through collaborative agreements spelling out expectations on both sides, a behavioral health pod within RIPCPC was formed:

    • Timely response to referral (same day for urgent referrals, 72 hours for routine) with willingness to accept patients

    • Thorough 2-way communication with detailed referral from PCP, and with regular progress notes for ongoing therapy

    • Emphasis on electronic communication

Point of care referral database
Point-of-Care Referral Database

  • A web portal, accessible at the point of care

  • Allows PCP to appropriately tailor referral to the needs of the individual patient with respect to geography, age, insurance, behavioral or mental health goals and need for comprehensive care.

  • Can refer to individuals, group practices or facilities

  • Preferred communication is electronic, but can be via web, fax or phone depending on providers preferences

What we accomplished
What we accomplished..

  • Formalized an affiliate membership between the RIPCPC physicians and behavioral health providers

  • Established a RIPCPC Behavioral Health Pod

  • Created a RIPCPC Behavioral Health provider and facility portal

    • This is a searchable database of BH providers that RIPCPC member physicians can filter by:

      • Specialty, insurance, city, hours of availability,

        insurances accepted & population treated

    • Utilize ‘Direct’ messaging to communicate

      with BH providers

Things to come
Things to Come

  • A focus on the collaborative model approach

  • Strengthen network and build lasting relationships

  • Assist patients in making better choices and measure those patient outcomes (healthier lifestyle = lowered health care costs)

  • Improve our communication and access with BH specialists for the benefit of our patients, this will help us better manage our patient population in an ACO/AQC/RISK environment

    • Successful behavioral health integration is

      vital to containing costs!