Transcript Document

8:30-8:40
Welcome and Introductions
8:40-8:50
Learning Session Overview
8:50-9:00
The Case for Integrating Behavioral
Health and Primary Care in Region 10
9:00-9:10
Intersection Between the Learning
Collaborative and DSRIP
9:10-9:20
Introduce Story Board Gallery Walk
9:20-9:30
Break
9:30-10:15
Storyboard Gallery Walk: Meet the
Other Provider Teams
10:15-10:40
Model for Improvement, Part 1 Aim
Statements, Monthly Measures, Run Charts
10:40-11:10
Team Meeting#1: Revise Aim Statement,
Data Collecting, Planning
11:10-noon
The Model for Improvement, Part 2: The
Plan-Do-Study-Act Testing Cycle
Noon-1:00 pm
Lunch
1:00-1:20
Overview of Change Package for Behavioral
Health: What do we know that works?
1:20-2:00
Panel Discussion: The Integrated Care
Imperative-Why We Must Succeed
2:00-3:15
Introduction to Motivational Interviewing to
Behavior Change
3:15-3:25
Break
3:25-3:55
Team Meeting #2: Planning for High Impact
Change, Drafting a PDSA Test
3:55-4:10
Teams Share Their Plans for Action Period 1
4:10
Evaluation
4:15
Adjourn
Learning Session
Welcome and Introductions
Aubrie Augustus, RN, BSN, MHA;
Senior VP Network Quality, JPS Health Network and
Administrative Director, Learning Collaborative
Learning Session
Overview
Gillian Franklin, M.D., MPH
Clinical Effectiveness & Integration Specialist
Project Manager & Performance Improvement Specialist,
Learning Collaborative
The Learning Session
Goal: Participants will learn about the Model
for Improvement .
Objective: Participants will understand the
various aspects of the Model for Improvement
and their functions.
Instructional Objective: Participants will work
on parts of the Model for Improvement (PlanDo-Study-Act Testing Cycle) to test change.
Model for Improvement
 Full engagement as early adopters
Strategies
 Process Improvement NOT Research
Elements
 “Best Practice” Changes
 Learning Collaborative Change Methodology
 Aim Statements; PDSA Testing Cycle; Monthly Measures; Run
Charts etc.
Action Period 1
Inquiry-driven
The Take Away
» Knowledge
» New Skills
» Immediate Changes
» Steal Shamelessly
» Share Relentlessly
What is a proven way to
test potential changes
without disrupting your
organization’s day-to-day
operations?
Model for Improvement
&
Plan-Do-Study-Act Cycle
Wayne Young, LPC, FACHE
Vice-President Operations and Administrator – Trinity
Springs
John Peter Smith Health Network
Director, Behavioral Health Learning Collaborative
US Adults Meeting Behavioral Health Diagnostic Criteria
Adults with Mental
Health Conditions, 25%
68% of Adults with
Mental Health Conditions
Also Have Medical
Conditions
Adults with
Medical
Conditions, 58%
29% of Adults with Medical
Conditions Also Have
Mental Health Conditions
Source: Druss, B.G., and Walker, E.R. (February 2011). Mental Disorders and Medical Comorbidity. Research Synthesis Report No. 21. Princeton, NJ: The
Robert Wood Johnson Foundation.
Total Healthcare Costs of Patients With and Without Depression
Melek, S. P. (2012). Bending the Medicaid healthcare cost curve through financially sustainable medical-behavioral integration. Milliman Research Report.
Mean Age at Time of Death
Year
All Clients Who
Died During Year
1997
1998
1999
55.0
55.0
54.0
Male Clients Who Female Clients Who
Died During Year
Died During Year
52.4
53.3
50.8
58.1
56.6
57.3
Mean Years of Life
Lost Per Client
28.5
28.8
29.3
This and next slide reference: Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and
causes of death among public mental health clients in eight states. Prev Chronic Dis [serial online] 2006 Apr [date cited]. Available from:
URL: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm.
Percentage of Deaths
Questions?
Regional plans should recognize the importance of learning
collaboratives in supporting continuous quality improvement, RHPs
will provide opportunities and requirements for shared learning
among the approved DSRIP projects in the region.
Learning collaboratives should strongly be associated with
Performing Provider’s projects and demonstrate a commitment to
collaborative learning that is designed to accelerate progress and
mid-course correction to achieve the goals of the projects and to
make significant improvement in the Category 3 outcome measures
and the Category 4 population health reporting measures.
The continuation of
the journey we
have all been on
together!
Over the last two
years we have all
experienced
together…
Shared Learning
& New
Experiences
Regional
commitment
to improve
care across
the
continuum
Newly
fostered
relationships
and
collaboration
• A networking opportunity to learn how other similar projects are
doing and best practices occurring in our community
• Focus on specific issues where multiple providers will collaborate
to see improvement for all
• An opportunity to bring performance improvement practices (CQI)
to your projects
• Recognition that it’s not just about the milestones, but the
broader impact of participation in the Waiver, willingness to
collaborate with peers, and show improvement at the individual,
regional, and state levels
Best practices
Collaboration
Performance
Improvement
Practices
Regional
Impact
Wayne Young, LPC, FACHE
Vice-President Operations and Administrator – Trinity
Springs
John Peter Smith Health Network
A standard framework for levels of integrated healthcare
Source: SAMHSA
MINIMAL
COLLABORATION




Separate systems
Separate facilities
Communication is
rare
Little appreciation of
each other's culture
BASIC COLLABORATION
FROM A DISTANCE





Separate systems
Separate facilities
Periodic focused
communication;
most written
View each other as
outside resources
Little understanding
of each other's
culture of sharing of
influence
BASIC COLLABORATION
ONSITE





Separate systems
Same facilities
Regular
communication,
occasionally face-toface
Some appreciation
of each other's role
and general sense
of large picture
Mental health
usually has more
influence
CLOSE COLLABORATION/
PARTLY COLLABORATED






"Nobody knows my
name. Who are you?"
"I help your consumers."
Some shared
systems
Same facilities
Face-to-face
consultation;
coordinated
treatment plans
Basic appreciation
of each other's role
and cultures
Collaborative
routines difficult;
time and operation
barriers
Influence sharing
FULLY INTEGRATED





Shared systems and
facilities in seamless
bio-psychosocial
web
Consumers and
providers have same
expectations of
system
In-depth
appreciation of
roles and culture
Collaborative
routines are regular
and smooth
Conscious influence
sharing based on
situation and
expertise
"I am your consultant."
"We are a team in the
care of consumers."
"Together, we teach
others how to be a team
in care of consumers and
design a care system."
Integrated Medical Care for Patients with Serious Psychiatric Illness. A
Source: Druss, B., et al. (2001). Archives of
Randomized Trial
General Psychiatry, 58, 861-868
32%
Flu Vaccination
12%
71%
Diabetes Screening
46%
80%
Cholesterol Screening
57%
81%
Exercise Education
53%
83%
Nutrition Education
62%
85%
Blood Pressure Tested
66%
85%
Smoking Education
64%
86%
Med Listed in Chart
64%
0%
10%
20%
30%
40%
50%
Integrated Care
60%
Usual Care
70%
80%
90%
100%
Percentage of
patients screened
with team’s selected
cross-specialty
screening
Numerator: Total number of patients in the population of focus who
have received screening with the selected screening tool within the
past 12 months
Denominator: Total patient population of focus for improved care
integration at you site.
Behavioral health screenings for primary care Physical health screenings commonly done in
settings
behavioral health settings
• PHQ2/PHQ9
• SBIRT (Screening, Brief Intervention and
Referral to Treatment)
• Tobacco use screening
• Alcohol abuse screening (audit), MAST
• Drug abuse screening (DAST)
• Screening for risk of harm to self or others
•
•
•
•
•
•
Diabetes screening
Hypertension Screening
BMI Calculation
COPD Screening
Cardiovascular disease screening
HIV, STD, hepatitis
Percentage of patients who
received the teams’ selected
integrated care intervention
in past 12 months.
Numerator: Number of patients in the population of focus who
have received the selected integrated care intervention in the
past 12 months
Denominator: Total patient population of focus for improved
care integration at your site.
• Patients with a shared care plan documented at both the PC Provider site and the BH
Provider site.
• Patients whose treatment plans include goals for both PC and BH.
• Patients whose care was covered in Care Coordination Conferences with PC and BH
Providers in the past 12 months (Note: Teams focusing on more complex patients may
want to track patients covered in coordination conferences at more frequent interval.
They could to use the different interval in addition to or instead of the 12-month interval) .
• Patients receive a visit with both their PC Provider and BH Provider within a set time
period (e.g. past 60 days for more complex patients).
Percentage of patients
receiving integrated care
whose condition
improved.
Numerator: Number of patients in the population of focus
whose care has been documented as improved in past 12
months, as measured by the selected indicator.
Denominator: Total patient population of focus for improved
care integration at your site.
Examples of improvement in behavioral
health conditions in primary care settings
• Screening results no longer positive
• Adherence to medication for behavioral
health condition (in DSRIP category 3)
• Completion of counseling for behavioral
health condition, based on documented
achievement of 1+treatment plan goals
• Reduced PHQ-9 score for all patients with
initial scores over 10, to less than 10
• Reduced PHQ-9 score for all patients with
initial scores over 10, to less than 5
• Behavioral health condition in remission
• Abstinence from alcohol or other drug use
• Reduced alcohol or other drug use
Examples of improvement in primary care
conditions in behavioral health settings
• Screening results no longer positive
• Reduced tobacco use
• Discontinued tobacco use
• HbA1c less than 9%
• BP to <140/90
• LDL-C control
• Patients engaged in or received treatment
for STD, HIV, hepatitis
Questions?
Melanie Cooper
Peer Support Specialist, JPS Health Network
Karen Dunn
Peer Support Specialist, MHMR of Tarrant County
Joan Barcellona
Family Member, Community Advocate
Patsy Thomas
President, Mental Health Connection