IBH Pilot Lessons Learned Year 1 Care Transformation Collaborative of R.I.

1. IBH Pilot Lessons Learned Year 1Care Transformation Collaborative of R.I. Date: March 10, 2017 Nelly burdette, psyD IBH Practice facilitator

2. Funding Partners

3. Overview • IBH in Primary Care Overview • PDSA: High ED Utilizers with Behavioral Health • Challenges • Lessons Learned

4. IBH in Primary Care Overview • 12 PCMHs to implement depression, anxiety and substance use screening for all patients over the age of eighteen in primary care across 2 years • Rescreened within 6 months if positive screening • Onsite IBH providers offer evidence-based treatment • Three PDSAs • Increase screening/rescreening rate • High ED utilization with behavioral health • Population health focus within behavioral health

5. 12 Practicing Sites Cohort 1 (blue) February 2016 Cohort 2 (yellow)November 2016

6. Practice Facilitation Deliverables • Monthly one hour practice facilitation meetings with each practice implementation team and Dr. Burdette • Deliverables: • Hire and train Licensed IBH Provider (0.5-1.0 FTE) to bill for and/or provide sustainable IBH services • Compact with Community Mental Health Center • Baseline assessment of IBH at beginning and end of pilot • Quarterly reporting of universal screening targets and patient-specific data, warm hand-offs, referrals to community partners • 3 PDSAs cycles

7. PDSA 1: Increase Screening/Rescreening Rates

8. PDSA 1: Increase Screening/Rescreening Rates

9. PDSA 1: Increase Screening/Rescreening Rates

10. PDSA 1: Increase Screening/Rescreening Rates

11. PDSA 1: Increase Screening/Rescreening Rates

12. PDSA 1: Increase Screening/Rescreening Rates

13. Why focus on high ED utilizers with behavioral health overlap? • Treating people with multiple conditions can cost as much as 7 times more than treating those with only one illness 1 • 15% of total health care spending for people diagnosed with a behavioral disorder was attributable to behavioral health-specific care 1 • 85% of spending represents costs related to medical care for physical comorbidities 1 • BOTTOM LINE: Depression + up to 4 chronic conditions, more = 82.4% of all costs 1

14. Medicaid Claims Data Community Care of North Carolina 2

15. CASE STUDY: PDSA (Plan) Tri-Town Community Action

16. Tri-Town Community Action PDSA: DO

17. PDSA (Do): Shared Decision Making Tool

18. Challenges • Financial and Billing • Data and Reporting • IBH Provider Culture and Training • Community BH Referrals

19. Lessons Learned • Difficult to impact high ED utilizers with BH • Timing • 6 months to get all systems in place to begin • Add another 6 months to begin to see 50% of sites accomplishing year 1 thresholds • Sustainability • Huddles/Interdisciplinary Care Conferences • Productivity = encompassing Primary Care pace

20. References Boyd, C., Leff, B., Weiss, C., Wolff, J., Hamblin, A. and Martin, L. (2010). Faces of medicaid: clarifying multimorbidity patterns to improve targeting and delivery of clinical services for medicaid populations. Center for Health Stratagies. Obtained online on 2/22/17 from http://www.chcs.org/media/FINAL_Super-Utilizer_Report.pdf Thorpe, K., Jain, S. and Joski, P. (2017). Prevalence and spending associated with patients who have a behavioral health disorder and other conditions. Health Affairs, 36 (1), 124-132.