Connecting the Faces and Places of Integration: A Central Structure Working Regionally

1. Session# - C5 Track 3 – Population & Public Health Connecting the Faces and Places of Integration: A Central Structure Working Regionally CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A. Mary Jean Mork, LCSW, Vice President for Integration MaineHealth/Maine Behavioral Healthcare Cynthia Cartwright, MT RN MSEd, Program Manager Behavioral Health Integration, MaineHealth Neil Korsen, MD, Medical Director Behavioral Health Integration, MaineHealth Stacey Ouellette, LCSW, Director Behavioral Health Integration, MaineHealth/Maine Behavioral Healthcare

2. Or: How to build a beautiful kinetic sculpture for your system

3. Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months.

4. Learning Objectives At the conclusion of this session, you will be able to: • List centralized structural elements that support a system-approach to integration • Identify successful intervention strategies for spreading integration • Incorporate new strategies into your ongoing work to develop integration

5. References • Raney LE (Ed). Integrated Care: Working at the Interface of Primary Care and Behavioral Health. American Psychological Association, Washington, DC. 2015. • Robinson PJ, Reiter JT. Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer, NY, NY. 2015. • Kathol RG, Patel K, Sacks L, Sargent S, Melek SP. The Role of Behavioral health Services in Accountable Care Organizations. Am J Manage Care. 2015; 21(2):e95-e98. • Tear down this wall: Rocky Mountain Health Plans embarks on a mission to bring together behavioral health and primary care. www.coloradobeaconconsortium.org. 2012. • Enhancing Patient Outcomes and Health System Value through Integration of Behavioral Health into Primary Care. Institute for Clinical and Economic Review, Policy Brief, 2015.

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

7. BHI in Maine

8. BHC Model • Behavioral health clinician (BHC), most often LCSW, works side-by-side with PCPs • Brief, problem-focused treatment approach • Mental Health Problems • Behavioral and Psychosocial Aspects of Physical Health Problems • Warm handoffs

9. Progress to date • 7 Hospital Systems • About 40 FTE’s working in about 60 practices • Most LCSW; some LCPC or psychologist • Most 0.5 FTE - 1.0 FTE • Practice types • 25 FM, 15 IM, 10 Peds • 5 Ob/Gyn, 2 pain clinics, diabetes center, pediatric multi-specialty practice • Neurology, cardiology, oncology, bariatric center

10. Framework for this session: Toussaint, John, MD. Management on the Mend. TedaCare Center for Healthcare Value. Appleton, WI. 2015 • Standardization • Customization • Fingerprinting • Innovation

11. MaineHealth Dr. Van, Psychiatrist Kyle, Practice Manager Carol, Practice Manager Monique, BHC Mary, Practice Administrator

12. Standardization – creating the frame

13. Standardization • Contracts • Processes - operational, financial and clinical. documentation, billing, crisis management, policies • People – recruitment, hiring, orientation, training, supervision = FIT • Resources – supervision, training, policies, marketing • Central leadership connections among programs

14. Elements that support Standardization • Strong systemleadership that supports standardization • Standard contracts • Set orientation for staff and practices • History and reputation of the program • Regional presence with national ties • “Adequate” clinical and administrative resources • Placement of the program within the continuum of behavioral and medical care

15. Customization – working with the parts

16. Customization • Regional approach – diverse geography, rural & urban, poverty & age • Hospital system identification • Separate leadership within each hospital system • Relationships – all work starts with relationships at all levels • Face-to-face connections – site visits • Responsiveness • Connections – seeking connections with key staff and leaders. Active outreach. Care coordination focus. • Framework that allows for variation • Spread to specialty medical practices including Ob/Gyn, and others identified by hospital region

17. Elements that support customization • Administrative team meetings focused on care coordination, data and clinical • Point person for practices, regional leadership and BHI clinicians • Flexibility of expectations based on regional resources, culture and need • In-person presence of program staff • Responsiveness (high expectations) • Site visits to identify opportunities and regional needs

18. Fingerprinting – supporting uniqueness

19. Fingerprinting “The (staff) of every….unit that adopts the new work of the model… must feel that their fingerprints are all over the work.” (Toussaint) • Relationships – how best to approach • Team building within practices • Recognition and support for uniqueness • Acknowledgement of culture • Support for staff and practice attributes

20. Elements that support Fingerprinting • Strong physician leadership • Fit between practice and the BHC • Strong, supportive Practice Manager/management • Participation in regional meetings • Supportive clinical leadership • Number of competing practice initiatives

21. Innovation – where do you want to go next?

22. Types of Innovation • Psychiatry Consultation to primary care • Patient Centered Medical Home • Behavioral Health Homes & Health Homes • Specialized medical initiatives: Childhood obesity, Trauma screening, suboxone treatment models, Suicide prevention, • Link between pediatric and ob/gyn practices • Extending the program into specialty medical practices: oncology, neurology, bariatrics, palliative care, pain clinics, endocrinology…

23. How are you working centrally to support a regional structure?

24. Start where you are Use what you have Do what you can Arthur Ashe

25. Contact us: • Mary Jean Mork, LCSW • morkm@mmc.org • Cynthia Cartwright, MT RN MSEd • cartwc@mainehealth.org • Neil Korsen, MD • korsen@mmc.org • Stacey Ouellette, LCSW • souellette@MaineBehavioralHealthcare.org