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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

correspondence

    • 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!

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