Primary & Behavioral Health Care Integration Project

1. Primary & Behavioral Health Care Integration Project Community Support Services Cohort IV Northwest Region Akron, Ohio Frank Sepetauc sepetfra@cssbh.org Jon Garey gareyjon@cssbh.org Twanette Pinkerton pinketwa@cssbh.org

2. Community Support Services Primary & Behavioral Health Care Integration Project • Unified Primary Care and Behavioral Health Model • Primary Care Services delivered within Behavioral Health Care Agency. • Combined administration and financing. • Shared electronic record. • Co-located with a specialty pharmacy provider. • Contract with private lab company for on-site services . • Enrollment target • 300 clients first year. • Population Served • Consumers diagnosed with severe and persistent mental illnesses served. • Clinic is set within an Urban setting. • EHR vendor • “CREDIBLE” is the electronic health record vendor. • CREDIBLE has needed flexibility for integration of record and services.

3. Wellness services offered • YMCA fitness activities • Walk with a Doc ™ • Yoga • “Get- Connected” Health and Wellness Class • Four Peer Support Specialists • Complete NOMS. • Work with consumers on Fitness and Wellness Activities. • Escorts consumers from lobby to medical assistant to have vitals taken.

4. Implementation Team Terrence Dalton, M.Ed, LSW CEO Frank Sepetauc, PCC, C.R.C Vice President of Rehabilitation/ Project Director Jon Garey, MSCIS Director of Information Technology Agnes Andrasak Controller Kimberly Meals, PCC Director of Quality Improvement, Education, and Marketing Cindy Johnson, RN Supervisor of Med Som Services Twanette Pinkerton, MBA Healthcare Integration Project Coordinator Mary Phillips Consumer

5. HIT Successes EHR conversion Currently in process of converting remaining paper file into EHR HIT grant received from ODMH Positioning for Health Homes Meaningful Use Stage one completed

6. Wellness Success • Walk with a Doc ™ • Medical information from physicians • Physicians walking with consumers • Health and Wellness “Get Connected” course • Varied health related topics • “I enjoyed the program overall. I absolutely love the exercise group and learned a lot doing so.” • “If it wasn’t for ‘Get Connected’ I would not be drinking water.” • “It is a great program!” • “I love the health and wellness program. It teaches you good nutrition and the importance of staying active.” • “I would recommended this program to others to help with getting healthy and active.”

7. Wellness cont. • Overall Success • Participants lost a total of 35 lbs. in 10 weeks • Increased fitness interest and stamina • Consumers reported eating healthier • Undetected hypertension discovered and referred back to Primary Care Clinic for treatment • Monitored BP showed a decrease after exercise

8. The Future • Sustainability • Clinical: • Nurses became Nurse Care Managers. • Dietitian will be available for Medicare/Medicaid billing. • Case managers to start completing the NOMS for all consumers in agency. • Administrative: • In process of partnering with a local hospital that will provide reduced cost to contract with providers. • In process of contracting with a local hospital to analyze processes for maximum efficiency. • In process of contracting with a local hospital for services of a certified billing coder. • Will be contracting with the State of Ohio to become a Health Home by the end of 2012. • Financial: • New billing system to be started.

9. The Future cont. • Sustainability • Health Home • Awarded HIT grant. • Significant restructuring of treatment teams to allow each to become a Health Home. • Accountable Care Organization • Agency staff met with Ohio Department of Mental Health (ODMH) Director for assistance with hospital coordination.