Health Homes for the Homeless: Integrated Team Based Care

1. Health Homes for the Homeless: Integrated Team Based Care Health Care for the Homeless TrainingHawaii Primary Care Association June 27, 2013 Brenda Goldstein, MPH bgoldstein@lifelongmedical.org

2. IntegratedCollaborativeCare Behavioral Health Primary Care • A coordinated system combining medical and behavioral services • Coordinated detection, treatment, and follow-up of both mental and physical conditions. • Whole person care • Consumer experience is that, for almost any problem, they’ve come to the right place • Bidirectional

3. Access • Many people will not go to a specialty mental health provider – but they will go to see their primary care provider • Those receiving services in the specialty mental health system do not go for regular primary care • With ACA there will be a huge increase in insured adults with mental health needs – integrated care increases access

4. Health Benefits • People with serious mental illness are: • dying on average 25 yrs. earlier than the general population • 3.4 times more likely to die of heart disease • 6.6 times more likely to die of pneumonia and influenza • 5 times more likely to die of other respiratory ailments • 60% of premature deaths in persons with schizophrenia are due to medical conditions • 7 of 10 leading causes of death ( e.g. heart disease, stroke, respiratory disease, accidents, diabetes, suicide) have a psychological and/or behavioral component.

5. Cost Benefits • Patients who receive care for depression in integrated primary care were 54% less likely to use emergency departments • Adding integrated services in one study added $250 per patient to costs, but saved $500 in additional medical costs • A review of 57 studies found an average of 27% cost savings with integrated care • 21% decline in costs at 18 months for Medicaid high utilizers who received intensive psychosocial services compared to a 22% rise for those not receiving notreatment

6. Integration or Parallel Play?

7. Hallmarks of Integrated Care • Multidisciplinary staffing • Patient/Client driven goals • Shared space • Shared records • Informal and formal communication • Warm handoffs • Hallway consults • Case conference • E-mails Integrated care directly addresses the triple aim and patient centered health “homeness”

8. Staffing Considerations • Who is on the team? Licensed? Non-licensed? • Primary Care Providers • Behavioral Health • What is their training? • Productivity expectations? • Traditional mental health treatment vs. shorter term/behavioral change focused care? • Interruptions?

9. Using Data and IT • Can EHRs support collaborative care? • HIPAA – is it really a barrier? • Outcome driven care relies on collecting and using data from assessment tools • Can existing data systems be tweaked to support team based care? • Individual patient vs. population based management

10. Costs of Collaborative Care • Productivity issues • Same day visits? • Group visits? • Substance use services • FQHC vs. Specialty Mental Health billing – can this be combined? • Mental health diagnoses only or are behavioral interventions for chronic disease billable?

11. Integrated Behavioral Health Project • One of the best resources in the whole world for information on integrated primary care and behavioral health www.ibhp.org