Integrating Primary Care in Behavioral Health Settings for Improved Population Health

1. New and Emerging Services and Primary Care, Behavioral (MH/SA) Health Initiative Presented by: Kathleen Reynolds, Director of CIHS

2. PBHCI – SAMHSA/HRSA Center for Integrated Health Solutions Grant • Awarded to the National Council for Community Behavioral HealthCare • Four years; $5.3 Million/year • Target Audience • SAMHSA Grantees • HRSA Grantees • General Public • Services • Training and Technical Assistance • Knowledge Development • Prevention and Wellness • Workforce Development • Health Reform Monitoring and Updates

3. National Steering Committee

4. Primary Behavioral Health Care Integration (PBHCI) Program - Grantees • Program purpose • To improve the physical health status of people with SMI by supporting communities to coordinate and integrate primary care services into publicly funded community-based behavioral health settings, including substance abuse service organizations • Expected outcome • Grantees will enter into partnerships to develop or expand their offering of primary healthcare services for people with SMI, resulting in improved health status • Population of focus • Those with SMI served in the public behavioral (MH/SA) health system

5. Top Ten Areas for Consideration in Developing and Supporting Patient Centered Health Care Homes • State Level Leadership • State Level Management • Models/Strategies • Culture • Workforce • Collaboration • Confidentiality • Finance • Data • Training

6. State Level Leadership • Identify overarching vision and language for discussions • Language (coming soon) • Wagner Chronic Care Model • Four Quadrant Model • Doherty/Baird/Reynolds Continuum

7. Language Document – In Press – Available within 30 days

8. The Consumer and Staff Perspective/Experience

9. Wagner Chronic Care Model

10. Four Quadrant Clinical Integration Model

11. State Level Management • Using overarching structure – What do you expect? • This time we need “disruptive innovation” not paying for what we already do. What will be different and how will you know that changes are good change? • How do you envision substance abuse services to be involved in the Health Home?

12. Models/Strategies – Bi-Directional Integration Behavioral Health –Disease Specific • IMPACT • RWJ • MacArthur Foundation • Diamond Project • Hogg Foundation for Mental Health • Primary Behavioral Healthcare Integration Grantees Behavioral Health - Systemic Approaches • Cherokee Health System • Washtenaw Community Health Organization • American Association of Pediatrics - Toolkit • Collaborative Health Care Association • Health Navigator Training • Physical Health • TEAMcare • Diabetes (American Diabetes Assoc) • Heart Disease • Integrated Behavioral Health Project – California – FQHCs Integration • Maine Health Access Foundation – FQHC/CMHC Partnerships • Virginia Healthcare Foundation – Pharmacy Management • PCARE – Care Management • Consumer Involvement • HARP – Stanford • Health and Wellness Screening – New Jersey (Peggy Swarbrick) • Peer Support (Larry Fricks)

13. Models/Strategies for Involving/Integrating Substance Abuse Services • Wisconsin and UCLA – SBIRT Program • Baltimore – Two FQHC’s integrating co-occurring services into primary care • Connecticut – Methadone Program became primary care site • Philadelphia – Horizon House • Medication Assisted Treatment Options

14. Projects by State • Pennsylvania: • Milestone Centers • Horizon House • Rhode Island: • Kent Center for Human/Org Development • The Providence Center • Texas: • Austin-Travis CO MH/MR Center • Lubbock Regional MH & MR Center • Montrose Counseling Center • Utah: • Weber Human Services • South Carolina: State Dept of MH • Washington: • Asian Counseling and Referral Services • Downtown Emergency Service Center • West Virginia: Prestera Center for MH Services • Alaska: Wrangell Community Services • Arizona: CODAC Behavioral Health Services • California: • Mental Health Systems • Alameda Co Behavioral Health Care • Services • Asian Community MH Services • San Mateo County Health Services • Agency • Tarzana Treatment Centers, Inc. • Colorado: • Mental Health Center of Denver • Connecticut: • Bridges – A Community Support System • Community MH Affiliates • Florida: • Coastal Behavioral Healthcare • Lifestream Behavioral Center • Miami Behavioral Health Center • Community Rehabilitation Center • Apalachee Center, Inc. • Lakeside Behavioral Healthcare • Georgia: Cobb/Douglas Community Service Board • Illinois: • Human Services Center • Trilogy, Inc. • Heritage Behavioral Health Center • Indiana: • Adult and Child Mental Health Center • Southlake Community Mental Health Center • Centerstone of IN • Kentucky: Pennyroyal Regional MH/MR Board • Maine: Community Health and Counseling Services • Maryland: Family Services, Inc. • Massachusetts: Community Healthlink, Inc. • Michigan:Washetenaw Community Health Organization • New Hampshire: Community Council of Nashua • New Jersey: • CarePlus NJ • Catholic Charities Diocese of Trenton • New York: • VIP Community Services • Postgraduate Center for Mental Health • Bronx-Lebanon Hospital Center • International Ctr for the Disabled • Fordham Tremont CMHC • Ohio: • Center for Families & Children • Shawnee MH Center • Southeast Inc • Greater Cincy BH Services • Oklahoma: • North Care Center • Oklahoma Dept of MH/SA • Oregon: Native American Rehab Assoc of the NW

15. Culture • Acknowledge the differences between MH/SA/PC cultures • Do not allow it to deter or delay implementation • Address it through training • On the job training • Existing resources • Joint grand rounds • Webinars • Train together and separately • Provide support for moving forward

16. Workforce • Existing Workforce Needs • Reviewing and Credentialing standards • Substance Abuse Professionals – Treatment and Prevention • Mental Health Staff • Who? Can do What? Where? • Licensing Standards - Space • Scope of Practice Standards • Advanced Nurse Practitioners • Future Work Force • Linkages with training programs

17. Collaboration • Does this come naturally in your state? • Does your strategy support creating or breaking down silos? • Does your strategy make use of the solid investments in existing systems and take advantage of their strengths? • Will you system pay for or support collaboration for systems and for services now and in the future? • How has MH/SA collaboration/integration gone in your state?

18. Confidentiality • HIPAA allows for sharing information for Health Care Coordination • 42CFR Part II Issues may impeded information sharing • Does your state mental health code need revising?

19. Products at levels one, two, three, and four

20. Finance • Existing Options • 96100 series • SBIRT codes • Case Management Reimbursement • Dear Medicaid Director 2005 • Future Options • Healthcare Home – expanded reimbursement options • Include what we know works!

21. Data • What existing data can you develop/share with pilots sites? • Medicaid Data Based Integrated for MH, SA and PC? • What are the costs per consumer? • Is it available electronically? • What will you want in the future? • How will you know if you are successful? • Do you have registry option for providers?

22. Training • Keys to success • Change management training • Collaborative service provision – like professionals train like professionals • Health Navigator Training • BH staff (MH and SA) in primary care • PC staff in mental health and substance abuse agencies

23. CIHS Services to Assist You • Web-based Resource Center (http://www.centerforintegratedhealthsolutions.org) • eSolutions Newsletter • National Webinars • Regional and State Based Learning Communities