Transcript Slide 1

Improving the Quality of Health Care for
Mental and Substance-Use Conditions
“America will not have a high-quality health system if equal attention is not
given to mental health issues and substance use problems…”
Mary Jane England
Frances M. Murphy, M.D., M.P.H.
Office of the Deputy Under Secretary for Health
For Health Policy Coordination
November 3, 2005
1
Health Care Provider
Organizations should:
•
•
•
•
Have policies to enable and support all
actions required of clinicians
Involve patients/families in design,
administration, and delivery of services
If serving a high risk population, screen
all entrants for M/SU problems
Involve leadership and staff in developing
the NHII
2
VA’S Mental Health System
Prior to Transformation ?
•
•
Strengths:
• U.S. leader in mental health care and research
• Integrated national healthcare system
• Full Continuum of Care: screening, health promotion and
disease prevention, outpatient care, acute hospital care, and
long-term care
• Comprehensive electronic health records
• VA system supports parity
Challenges:
• Variability in access and quality of services across the
country
• Lack of integration of mental health and primary care
• Increased projected workload and demand for mental health
services
3
What Can We Expect in the Future?
16,000
14,000
In Thousands
12,000
Mental Health Outpatient Stops
10,000
8,000
6,000
Overall Veteran Enrollment
4,000
2,000
Mental Health Bed Days of Care
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Fiscal Year
Mental Health Utilization Projections
4
Overarching Recommendation
•
The aims, rules, and strategies for
redesign set forth in Crossing the Quality
Chasm should be applied on a day-to-day
operational basis but tailored to reflect
the characteristics that distinguish care
for M/SU problems and illnesses from
general health care.
5
Events Leading to VA Health
System Transformation
•
Transformation of VA Healthcare
“Vision for Change” and “Journey for Change”
• Motivational force and culture change
• Organization-wide reorganization
• Full continuum of care including prevention
• Emphasis on evidence-based care
• Healthcare quality, safety and performance
measurement
Crossing the Quality Chasm: A New Health System for the
21st Century
President’s New Freedom Commission Report
•
•
•
6
Recommendation 3.1
•
To promote patient-centered care, organizations
providing M/SU treatment services should support the
decision making abilities and preferences for treatment
and recovery of persons with M/SU problems and
illnesses
•
•
•
Policies that implement informed, patient-centered
participation and decision-making in treatment, illness self
management, and recovery plans.
Involving patients and families
Incorporating informed, patient centered decision-making
active participation in treatment and recovery plans, advance
directives and informed decision making.
7
Recommendation 3-1
•
VA is embracing new approaches to care:
• Recovery Model
•
•
•
Peer Support programs
Veteran and Family Centered
•
•
Development of National VA Recovery Plan
Encourage establishment of Medical Center
Consumer Councils
Advance Directives
8
Personal Health Records
•
Patient centered tool supports informed decision-making, selfmanagement and expression of treatment preferences in achieving
optimal health
•
My HealtheVet Mental Health Portal (www.myhealth.va.gov)
•
•
•
•
Health Information and Veteran Education
Mental Health Screening
Disease Management dialogues and Self-Tracking tools
Enhancing the Internet-based, secure Personal Health Record to
include mental health.
•
•
•
Provides veterans with copies of key parts of their VA health
information
E-Prescribing
Messaging
9
10
Recommendation 4-2
•
Organizations should:
•
•
Increase use of valid reliable patient
questionnaires or other patient assessment
instruments to assess the progress and outcomes
systematically and reliably
Use measures of process and outcomes of care to
continuously improve the quality of care they
provide
11
Recommendation 5-1
•
Organizations should:
•
•
•
Make collaboration and coordination of patients’
M/SU care the norm by providing effective
linkages within their own organizations and
between providers of mental health and S/U
treatment.
Routine sharing of information on patients’
problems and pharmacologic and nonpharmacologic treatments
Valid, age appropriate screening of co-morbid
mental health, substance-use, and general health
12
VA’s Electronic Health Record
13
Clinical Reminders
Contemporary
Expression of
Practice Guidelines
• Time &
Context
Sensitive
• Reduce
Negative
Variation
• Create
Standard Data
• Acquire
health data
beyond care
delivered in VA
14
VA Sets the U.S. Benchmark for 18
Comparable Indicators
Clinical Indicator
VA 2003
Medicare 03
Best Not VA or Medicare
Advised Tobacco Cessation (VA x3, others x1)
75
62
68 (NCQA 2002)
Beta Blocker after MI
98
93
94 (NCQA 2002)
Breast Cancer Screening
84
75
75 (NCQA 2002)
Cervical Cancer Screening
90
62
81 (NCQA 2002)
Cholesterol Screening (all pts)
91
NA
73 (BRFSS 2001)
Cholesterol Screening (post MI)
94
78
79 (NCQA 2002)
LDL Cholesterol <130 post MI
78
62
61 (NCQA 2002)
Colorectal Cancer Screening
67
NA
49 (BRFSS 2002)
Diabetes Hgb A1c checked past year
94
85
83 (NCQA 2002)
Diabetes Hgb A1c > 9.5 (lower is better)
15
NA
34 (NCQA 2002)
Diabetes LDL Measured
95
88
85 (NCQA 2002)
Diabetes LDL < 130
77
63
55 (NCQA 2002)
Diabetes Eye Exam
75
68
52 (NCQA 2002)
Diabetes Kidney Function
70
57
52 (NCQA 2002)
Hypertension: BP < 140/90
68
57
58 (NCQA 2002)
Influenza Immunization
76
P
68 (BRFSS 2002)
Pneumocooccal Immunization
90
P
63 (BRFSS 2002)
Mental Health F/U 30 D post D/C
77
61
74 (NCQA 2002)
15
“VA’s integrated health care
information system, including its
framework for using performance
measures, is considered one of the
best in the nation”
Institute of Medicine
“Leadership by Example”
October 2002
16
Recommendation 5-2
•
To facilitate the delivery of coordinated care by
primary care, mental health and substance-use
treatment providers
•
Enhancing M/SU staff at Community-Based
Outpatient Clinics
•
•
•
Collocation of mental health, S/U, primary care
services (Level 3)
Performance Measure established
Collaborative Care Pilots
•
Delivery of MH, SU, and primary healthcare
through clinically integrated practices
17
Recommendation 5-3
•
To ensure the health of persons for whom they are
responsible, organization should: 1)coordinate their
services with those of other human-services agencies; 2)
establish referral arrangements for needed services.
• Large provider of Homeless Veterans services
•
•
•
•
•
•
Performance Measures established
VA-HUD collaborations
Grant and Per Diem program with non-profit providers
Supported Employment and CWT
State collaborations
Transition services for incarcerated veterans
18
Workforce Development
Academic Affiliations and Training

83,115 Total Trainees (Academic Year 2003)

29,179 Medical Residents

16,740 Medical Students

37,196 Associated Health Trainees
19
Summary
•
•
•
•
Mental Health transformation is a journey
The IOM report gives us an excellent roadmap
for improving the quality of healthcare in MH
and SUD
Health Care Organizational transformation
requires a systems approach and a strategic
plan
Transformation requires culture change
20