Transcript AMHC Integrated Service Approach February 9, 2010 AMHC Locations February 9, 2010 AMHC & Integration: 36 Year History        Strategic priority for AMHC Vision aligned with.

AMHC Integrated Service
Approach
February 9, 2010
AMHC Locations
February 9, 2010
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AMHC & Integration: 36 Year History
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Strategic priority for AMHC
Vision aligned with Four Quadrant, Strosahl and Care Model
Dedicated to improving health and wellness through a biopsychosocial
approach
Implementing brief treatment and Stanford chronic disease lifestyle
management model developed by
Guided by written, customized integration protocols for defined diseases
and supported by expert training resources
Grounded in principles of providing immediate access to most
appropriate, highest quality, affordable service
Informed by decades of experience working in Aroostook County, in
Maine, nationally through MHCA, and internationally through IIMHL
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IOM Influence
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Grounded in the Institute of Medicine’s
(IOM) Crossing the Quality Chasm aims:
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patient-centered
safe
timely
efficient
effective
equitable
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Service Models
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Four Quadrant Clinical Integration Model
Chronic Care Model
Strosahl Primary Behavioral Health Care
Model
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Four Quadrant Clinical Integration Model
Presentation by Service Population and Setting
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Care Model
Health System
Community
Resources and Policies
Health Care Organization
PHQ-9
Self-Mgmt
Tools
SelfManagement
Support
Delivery
System
Design
Care Mgmt
Informed,
Activated
Patient
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Productive
Interactions
Decision
Support
Registry
Clinical
Information
Systems
Psych
consult
Prepared,
Proactive
Practice Team
Improved Outcomes
/ ICIC
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Strosahl Primary Behavioral Health
Model
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Goal is to increase effectiveness of primary
care providers in addressing behavioral health
needs of patients.
Focus on managing psychosocial aspects of
disease by addressing lifestyle and health-risk
issues through brief consultative interventions
and temporary co-management of behavioral
health conditions.
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Self-Care
Self-Care
Psychosocial
and alternative
therapeutic
interventions
Medical &
drug
interventions
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Self-care Objectives
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Patient at the center and in control of his
health.
Uses a broad variety of techniques to attain
and achieve optimal health.
This is a fundamental shift in the paradigm of
health services currently focused on treating
disease and expects practitioners to work with
a patient to inform and support his ability to
guide his own self-care.
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Advantages
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Improve access to behavioral and physical health
services
Apply evidence based practices to improve client
outcomes
Improve provider communication and coordination
of care
Foster a multi-disciplinary team approach to treating
substance abuse with a co-occurring chronic health
issues (cancer, cardiovascular, COPD, depression,
diabetes)
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Advancing Approach to Practice
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Embedding primary care family practice physician
into AMHC’s service site to provide outpatient and
medication management services
Primary goals:
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Encourage self-care
Improve type and quality of services
Meet unmet needs
Increase cost efficiency
Address workforce issues and offer professional
advancement
Improve primary care physician ability to treat patients
with chronic mental illness
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Key Activity Milestones
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Administrators and clinical staff were oriented to the principles of the Four Quadrant Model
and how it interfaces and complements the Planned (Chronic) Care Model.
Written, customized integration protocols for depression, anxiety, substance abuse, sexual
assault, were developed
Assessment tools for depression, PQ-9, and substance abuse, the CAGE, were implemented
and are used at the sites.
One blended record at the primary care site.
Periodic provider team meetings held to address care coordination and collaboration issues
Scheduling, staff credentialing and billing issues were improved Successfully secured
DHHS reconsideration and approval for FQHC’s to bill MaineCare and be reimbursed for
services provided by LMSW-cc credentialed clinicians.
Clinician assignments to support the integration efforts were maintained, with 90% of initial
placements sustained throughout the life of the project.
Six Pines physicians have staffed AMHC’s opioid replacement therapy clinic since July
2006.
AMHC implemented an account management approach to working with the primary care
practices to ensure immediate responsiveness to addressing clinical approach, staff
availability, credentialing, scheduling, and billing issues.
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Why integrate services?
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International, national and state level movement to integration of services
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Federal Level Public Support
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Private National Organizations
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HRSA and SAMHSA and their counterparts in other countries through the
International Initiative for Mental Health Leadership (IIMHL)
Institute of Medicine (IOM)
National Council for Community Behavioral Healthcare (NCCBH)
Mental Health Corporations of America (MHCA) and its counterpart State Level
Public support
Department of Health and Human Services (DHHS)
Private Maine State Organizations
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Maine Health Access Foundation (MeHAF)
Quality Counts (QC)
Primary Care Association (MePAC)
Association of Mental Health Services (MAMHS)
Association of Substance of Abuse Programs (MASAP)
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Potential and Sought After Rewards
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Improved Health Outcomes
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Healthier Patients
Increased Patient Satisfaction
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MeHAF focus groups found
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MH & SA patients reported having a higher degree of integrated
care
PH patients express a sense of loss when case management services
offered by specialty providers were stopped and they returned to
“regular care”
Improved staff satisfaction
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Working Conditions
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Perceived effectiveness in delivering quality services
Coordination of services across multi-disciplinary professional
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Potential and Sought After Rewards
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Improved Organizational Performance
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Achieving Service Mission and Business Objectives
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Service Effectiveness
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Service Efficiency
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Increased capacity and productivity achieved through appropriate
utilization of multi-disciplinary staff resources
Improved Financial Performance
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More comprehensive array of service responses aligned with true
service needs
Reduced cost of providing services when responses are aligned
with true service needs
Improved revenues generation resulting from increased
productivity across multi-disciplinary staff.
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How integrated are we?
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5 Levels of Integration
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I. Minimal collaboration
II. Basic collaboration from a distance
III. Basic on site collaboration
IV. Close collaboration that is partly integrated
V. Fully integrated System
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Project Mission
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“To provide comprehensive, patient centered
care that offers concurrent prevention and
management of multiple physical and
behavioral healthcare service needs of a
patient in relationship to his or her family, life
events, and environment.”
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Project Activities
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1. Confirm:
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Medical Director’s commitment to participate in and help guide the
process.
Behavioral and Physical Healthcare Provider willingness to
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2. Provide Refresher and Ongoing Education
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Improve integrated services
Participate in regularly scheduled multi-disciplinary staff meetings
Integration Models and/or Evidence Based Practices
Strategies to reduce barriers and advance integrated service practice
3.Commit to Including Patients in the Project to Help:
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Increase awareness, encourage participation, and reduce stigma.
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Project Activities
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4. Improve Delivery of Substance abuse and
Co-occurring Disorder Services
5. Implement Care Coordination and Patient
Self-management Services
6. Identify, Implement and Monitor
Measurable Indicators to Support the
Reporting of Achieved Outcomes.
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Integration Barriers in Maine
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Culture and Practice Patterns
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Selecting integration model(s) based on practice
context
15 minute visit vs. 50 minute therapy session
Education of providers is silo’d and there is no or
limited understanding across disciplines.
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Integration Barriers in Maine
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Stigma and lack of awareness
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Stigma associated with some behavioral and
physical health service needs is a barrier to
seeking and providing service.
Patient and provider lack awareness about
integrated care and the advantages.
Patients generally lack an understanding about
how they may be able to self-manage care and
advocate for integrated services.
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Integration Barriers in Maine
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Reimbursement: No reimbursement for
integrative (e.g., collaborative care and team
approaches), care coordination, and
preventative services.
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Next Steps
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