Where & How Behavioral Health can be Integrated into the Patient-Centered Medical Home (PCMH)

1. Where & How Behavioral Health can be Integrated into the Patient-Centered Medical Home (PCMH) *Originally adapted from PCPCC’s Behavioral Health Task Force Slide Deck. Last updated September 2014.

2. To allow users to adapt these slides for your own presentations. Please see the notes sections for more detailed information. This slide deck is focused on the “where” and “how” behavioral health is being integrated into the patient-centered medical home (PCMH). You may also pull slides from Deck 1 to learn about the “why” behavioral health should be integrated into the PCMH. Purpose of Slide Deck

3. Where Integrated Behavioral Health Models are Happening Models for Integrating Behavioral Health in the PCMH Coordinated Care Models Col-Located Models Integrated Models Resources & Acknowledgements Slide Deck Outline

4. Where Integration is Happening Source: AHRQ, The Academy Integration Map. Accessed September 2014. http://integrationacademy.ahrq.gov/ahrq_map

5. Models for Integrating Behavioral Health in the PCMH 5

6. Integration: An Evolving Relationship Source: http://uwaims.org

7. Based on Population Needs & Required Systems Source: Mauer BJ (2004). Behavioral Health / Primary Care Integration: The Four Quadrant Model and Evidence-Based Practices. National Council for Community Behavioral Health. www.mcpphealthcare.com

8. Collaborative Care Collaborative care optimizesall behavioral health resources Source: http://uwaims.org

9. Coordinated (shared costs) = Behavioral services by referral at separate location via synchronous (real-time) or asynchronous (later) information exchange Co-Located (separate funding sources)= By referral processes at primary care location (behavioral health visit in referral office) Integrated (same funding resource) = At primary care location (face to face with behavioral health team or by virtual synchronized telemetry) Relationship Between Medical & Behavioral Health Services (Collaboration for Same-Day Access) Source: Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems & Health: 21, 121-134.

10. Coordinated care elements: Appointment arrival notification Clinical information exchange protocols Coordinated treatment planning and/or problem solving for complex patients or as needed Expect communication to go both ways. Mental health clinicians are healthcare professionals who should be knowledgeable about the patient’s health issues. Ask about the person’s health behavior goals and consider them in treatment planning. Coordinated Care

11. Massachusetts Child Psychiatry Access Program For adults in NC, Medicaid pays for time of primary care physician and psychiatrist as patient visit rates (for consultation about a patient) whether the psychiatrist has met the patient or not. When behavioral health clinicians are working in primary care, referrals to specialty care for patients in need of longer-term work is more likely to be successful. Source: Center for Integrated Primary Care, UMass Medical School Coordination Plus – Specialty Mental Health as a Consultant to Primary Care

12. Co-Located Behavioral Health (Helps Reduce Stigma!) • Behavioral health in the same space with primary care • Involvement by referral • Separate behavioral health and medical treatment plans Advantages Challenges Referrals don’t show Case-loads fill up Slow primary care physician learning curve Communication still difficult • Access greatly improved • Improved patient & provider satisfaction • Cost effective • Improved clinical outcomes

13. Source: Center for Integrated Primary Care, UMass Medical School Management of psychosocial aspects of chronic and acute diseases Application of behavioral principles to address lifestyle and health risk issues Consultation and co-management in the treatment of mental disorders and psychosocial issues Integrated Primary Care: Behavioral Health Consultant

14. IMPACT/Diamond (Expanded Care Management):Disease based Research heritagePatient outcome evidence Care manager (SW or Psychologist) Behavioral Health Consultant: Program basedClinical heritage Cost & satisfaction evidence Behavioral health consultant Models of Integrated Behavioral Health The models are beginning to converge: Care manager does other behavioral health care and chronic illness added. Array of services beyond disease programs. Behavioral health care management and case managers added. Beginning disease programs. Source: Center for Integrated Primary Care, UMass Medical School

15. Stepped protocol in primary care using antidepressant medications and/or 6-8 sessions of psychotherapy (PST-PC) Treat to target Collaborative care model includes: Care manager: Depression Clinical Specialist Patient education Symptom and side effect tracking Brief, structured psychotherapy: PST-PC Consultation / weekly supervision meetings with Primary care physician Team psychiatrist Integrated Primary Care: The IMPACT Treatment Model Source: Center for Integrated Primary Care, UMass Medical School

16. Fully Integrated Primary Care The System Source: Center for Integrated Primary Care, UMass Medical School

17. Source: Center for Integrated Primary Care, UMass Medical School Substantial Improvement in Depression (≥50% Drop on SCL-20 Depression Score from Baseline)

18. Resources & Acknowledgements 18

19. Selected Resources • AHRQ Academy for Integrating Behavioral Health and Primary Care: http://integrationacademy.ahrq.gov/ • AIMS CENTER: http://aims.uw.edu/ • Center for Integrated Primary Care: http://www.umassmed.edu/cipc/ • Collaborative Family Healthcare Association: www.cfha.net • Evolving Models of Behavioral Health Integration in primary Care. Milbank Memorial Fund 2010. http://www.milbank.org • Lexicon for Behavioral Health and Primary Care Integration. AHRQ 2013: http://integrationacademy.ahrq.gov/sites/ default/files/Lexicon.pdf • National Alliance on Mental Illness. Integrating Mental Health & Pediatric Primary Care Resource Center: http://www.nami.org • SAMHSA/HRSA Center for Integrated Health Solutions: http://www.integration.samhsa.gov 19

20. Case Studies & Videos • Case Study: Colorado’s Advancing Care Together. http://www.advancingcaretogether.org/ • Video: AIMS Center. Daniel’s Story: An Introduction to Collaborative Care. http://aims.uw.edu/daniels-story-introduction-collaborative-care • Webinars: University of Colorado’s Department of Family Medicine Policy Channel. http://www.youtube.com/CUDFMPolicyChannel • PCPCC Online Resource: Successful Examples of Integrated Models. http://www.pcpcc.org/content/successful-examples-integrated-models 20

21. Special thanks to: PCPCC’s Behavioral Health Group PCPCC’s Behavioral Health Advisory Team Alexander Blount, EdD, University of Massachusetts Parinda Khatri, PhD, Cherokee Health Systems Benjamin Miller, PsyD, University of Colorado George Patrin, MD, Serendipty Alliance CJ Peek, PhD, University of Minnesota David Pollack, MD, University of Oregon Erik Vanderlip, MD, University of Oklahoma Acknowledgements *Originally adapted from PCPCC’s Behavioral Health Task Force Slide Deck. Last updated September 2014. 21