UW Health Primary Care / Behavioral Health Integration

1. UW Health Primary Care / Behavioral Health Integration United Way Forum September 22, 2014

2. UW Health Overview

3. UW Health Enterprise Facts and Figures • UW Health Healthcare Entities • UW Hospital and Clinics (566 beds) • American Family Children’s Hospital (61 beds) • UW Medical Foundation (1 of 10 largest medical groups in nation) • Facts and Figures • 26,797 Inpatient Admissions • 2,317,332 Outpatient Visits • 43,806 Emergency Visits • 1,200+ Physicians; 10,000+ Employees • Level 1 Adult and Pediatric Trauma Center • Comprehensive Cancer Center • 48 Primary Care & Specialty Clinics • Outreach sites in 50+ communities

4. UW Health Primary Care • 38 Primary Care Clinics* • Family Medicine = 21 • General Internal Medicine = 9 • Pediatrics = 8 • 194 Primary Care Physicians • 266,000 medically homed patients • 35,600 with behavioral health diagnoses • Top diagnoses: depression, anxiety, alcohol • *8 clinics with on-site Behavioral Health provider

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6. Impetus for Primary Care / Behavioral Health Integration • In pursuit of the Triple AIM • Improve health of populations • Improve experience of care • Reduce per capita cost • Primary Care Redesign launched 2008 • Patient Centered Medical Home Recognition • Behavioral Health Analysis 2013 • Demand exceeds capacity • 46% of behavioral health care is managed by UW Health PCPs • 85% of PCPs not satisfied with access to behavioral health services • Depression is #1 outpatient and inpatient diagnosis • Poor access and follow-up for behavioral health services • Poor continuity of care and communication between providers • Insurance barriers • Led to system-wide initiative to improve behavioral health services Institute for Healthcare Improvement

7. Primary Care / Behavioral Health Integration Model Development • Depression Screening launched for age 65+ (July 2014) • Interventions for patients who screen positive: • RN educational intervention • PCP prescribes medication • Psychiatry advice to PCP • Psychiatry consult • Foundation for new PC / BH integration model Total Depression Screening Rates for all Primary Care Clinics by Week

8. Primary Care / Behavioral Health Integration Model Development: Collaborative Care

9. DRAFT UW Health Collaborative Care Model Specialty BH Care BH Complex Case Management Specialty/Org Resources Psychiatrist Psychologist MS Therapist PCP PC Clinic Resources Care Manager (RN Care Coordinator Dep, DM, HTN) Consulting Psychiatrist Patient Adapted from University of Washington, 2013

10. Primary Care / Behavioral Health Integration Model Development • September 2014 • Endorsed by Primary Care and Behavioral Health leadership • October 2014 – January 2015 • Model design and build • February – March 2015 • Test model in five Primary Care Clinic locations

11. Primary Care / Behavioral Health Integration Model Strengths and Challenges • Strengths • Patient-centered • Evidence-based model • Proven cost-savings • Aligned with UW Health Primary Care Redesign and other organizational imperatives • Challenges • Paradigm shift for key roles • Investment in time and resources • Adapting model to variation in UW Health Primary Care clinics

12. Thank You • Contact Information: • Sue Ertl, RN, MSN • Vice President, Clinical Joint Ventures • 608.821.4806 • Sue.Ertl@uwmf.wisc.edu