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Paul Kettlewell, Ph.D. Tawnya J. Meadows , Ph.D. Shelley J. Hosterman , Ph.D.

Session F 1 c Friday October 17, 2014. A penny saved is a penny earned : Pharmacy and behavioral health cost savings in pediatric IPC clinics. Paul Kettlewell, Ph.D. Tawnya J. Meadows , Ph.D. Shelley J. Hosterman , Ph.D. Vanessa Pressimone, Ph.D.

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Paul Kettlewell, Ph.D. Tawnya J. Meadows , Ph.D. Shelley J. Hosterman , Ph.D.

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  1. Session F 1 c Friday October 17, 2014 A penny saved is a penny earned: Pharmacy and behavioral health cost savings in pediatric IPC clinics Paul Kettlewell, Ph.D. Tawnya J. Meadows, Ph.D. Shelley J. Hosterman, Ph.D. Vanessa Pressimone, Ph.D. Collaborative Family Healthcare Association 16th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

  2. Faculty Disclosure • We have not had any relevant financial relationships during the past 12 months.

  3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Identify data collection procedures to measure outcomes on cost offset. • Describe pharmacy savings found. • List two plausible reasons why behavioral health costs were found to be relatively cheaper per member per month in integrated primary care clinics versus standard primary care clinics.

  4. Bibliography / Reference Cummings, N.A., O'Donohue, W.T., & Cummings, J.L. (2009). The financial dimension of integrated behavioral/primary care. Journal of Clinical Psychology in Medical Settings, 16, 31-39. doi:10.1007/s10880-008-9139-2 Felleman, B.I., Athenour, D.R., Ta, M.T., & Stewart, D.G. (2013). Behavioral health services influence medical treatment utilization among primary care patients with comorbid sustance use and depression. Journal of Clinical Psychology in Medical Settings, 20, 415-426. doi:10.1007/s10880-013-9367-y Monson, S.P., Sheldon, J.C., Ivey, L.C., Kinman, C.R., & Beacham, A.O. (2012). Working toward financial sustainability of integrated behavioral health services in a public health care system. Families, Systems, & Health, 30, 181-186. doi:10.1037/a0028177 Wiley-Exley, E., Domino, M.E., Maxwell, J., & Levkoff, S.E. (2009).  Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study. Journal of Mental Health Policy & Economics, 12, 205-213. • Thielke, S. (2011). Health psychology in primary care: recent research and future directions. Psychology Research and Behavior Management, 4, 59-68. doi:10.2147/PRBM.S12996

  5. Learning Assessment • A learning assessment is required for CE credit. • A question and answer period will be conducted at the end of this presentation.

  6. Pediatric IPCModel & Outcomes

  7. Clinical Model & Services • Three pilot sites • Psychologist (4 days/week) • Postdoc fellows (2-3 days/week) • Behavioral health schedules • 6-7 billable units a day • Family, individual, group • Gaps in schedule for integrated activities • Always available

  8. Clinical Model & Services • Sites & staff • Problem focused eval/treatment • Family, individual, & group therapy • Consults & hand-offs • Crisis appointments • Same day evaluations • Screening tools • Handouts • Communication • Psychiatry telemedicine • PCP education • Liaison to MH/school • Clinic wide interventions |

  9. Collaborative Care: Consults & Handoffs Add Value |

  10. Reducing Hospitalization & Costs (ED Saves) n = 2 (2.1%) |

  11. GHP Data: Bending the Cost Curve • Average length of treatment in IPC (3.7 sessions) as compared to usual care (18.9 sessions). Able to serve more patients |

  12. Reduction in PMPM for Medications Allowed PMPM | Time of IPC Implementation

  13. GHP Data: Bending the Cost Curve |

  14. Reduced Costs: Treatment Costs DBD Anxiety Depression ■ Control ■ IPC • Total revenue generated per session resulted in significant gains for IPC clinic vs. control clinic (*p< .01) • Possible factors: Less staffing, higher show rates, lower drop out rates, shorter courses of treatment

  15. Reduced Costs: Medication Utilization • Prescription medications/month decreased by 3.25% after integration. Stimulant prescriptions decreased marginally. Levels & trends did not change among the control sites. |

  16. Implications • Value-based payment • Or • Share in cost savings • Or • Payment based upon members • Or • Flat percentage more of payment due to value added |

  17. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!

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