Integration: Behavioral and Primary Physical Health Care

1. Integration: Behavioral and Primary Physical Health Care FAADA/FCMHC August, 2013 Diana Murray, RN, MSN Regional Account Manager The Joint Commission

2. Objectives • Discuss the changing environment in which today's behavioral health organizations operate • Discuss the Joint Commission model for providing integrated behavioral health and primary physical health. • Discuss Joint Commission standards related to integrated behavioral and primary physical care 2

3. The Joint Commission Mission • To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

4. Joint Commission Behavioral Health Care Accreditation • Accrediting Behavioral Health organizations since 1969 • Accredited over 2,000 Behavioral Health organizations • Range of settings/services • Our focus: helping behavioral health organizations help the people they serve.

6. Mental Health, Addiction Treatment and Primary Physical Care Traditions Separate delivery silos Sequential care, treatment and services Distinct professional training Minimal communication and collaboration

7. Various provisions of the ACA • Expanded access to rehabilitative, prevention and wellness services. • Incentives to coordinate primary physical care, mental health, and addiction services. • Enhances community-based service options for individuals with a serious mental illness. • Develop capacity to provide services in an effective and modern mental health system through various workforce initiatives, including education and training grants, loan repayment programs, and primary physical care residency training.

8. ACA: Defines health homes as “comprehensive and timely high quality services” Services provided must include: • Comprehensive care management • Care coordination and health promotion • Comprehensive transitions of care from inpatient to other settings, including appropriate follow-up • Individual and family support, which includes authorized representatives • Referral to community and social support services, if relevant • The use of health information technology to link services, as feasible and appropriate

9. Health Homes Section 2703 of the Affordable Care Act • States establish health homes through Medicaid State Plan Amendment • Primary physical and behavioral health integration grants • SAMHSA – HRSA Center for Integrated Health Solutions

10. Primary Physical Health Care • Basic level of physical health care • Promotion of physical health and disease prevention • Early diagnosis of disease or disability • Treatment of acute and chronic illnesses • Health maintenance and education

11. State Medicaid Plans • Building on the Patient Centered Medical Home experience to create health homes for Medicaid eligible recipients with people with serious mental illness and/or substance abuse condition

12. The Joint Commission Behavioral Health Home Certification

13. Joint Commission Accreditation and Certification for Integrated Behavioral and Primary Physical Care • Ambulatory Primary Care Medical Home Certification • Federally Qualified Health Centers tailored with Behavioral Health when provided • Ambulatory Care Clinics • Medical Groups • Behavioral Health Home Certification • 16 Settings and services • Primary Health care when provided

14. Concepts Integrated into the Ambulatory Accreditation Program Primary Care Medical Home Certification Standards* • Patient Centered Care • Comprehensive Care • Coordinated Care Superb Access to Care • A Systems-Based Approach to Quality and Safety *Agency for Healthcare research and Quality Medical Home Model

15. Behavioral Health Home Certification • Accreditation Requirements • Core Standards • Additional BHH Certification Standards

16. Care, Treatment and Services • For organizations that elect The Joint Commission Behavioral Health Home option • Define Population in BHH • Data collection • Arranges for the history and physical to occur, if necessary

17. Additions to Core StandardsCare, Treatment and Services • Individual’s short- and long-term physical health care goals • Screening and/or assessment for chronic physical health conditions • Individual’s ability to self-manage chronic behavioral and physical needs • Identification of physical health goals • Disciplines are collaborative and integrated

18. Care, Treatment and Services • The physical health care needs of the individual, - The physical health care goals of the individual, - How the organization will meet those needs,- How the organization will help the individual to work toward achieving his or her goals • verbal and written communication needs of the individual served including his or her preferred language for discussing health care. • Integration of both physical and behavioral health needs and goals.

19. Care, Treatment and Services • Coordination of External Referrals • Literacy Needs • Self Management • Education • Provides excellent access to integrated care, treatment, or services • Provides or facilitates the provision of prevention, screening, and primary physical health care, treatment, or services as part of integrated care

20. Care, Treatment and Services • Accountable for Integrated care • Integrated Team • Case Management • Training and Support

21. Environment of Care • Inspects, tests and maintains medical equipment

22. Human Resources • Orientation • Education and Training

23. Information Management • Health Information Technology

24. Leadership • Performance Improvement • Clinical Practice Guidelines

25. Performance Improvement • Data Collection • Data Analysis • Improves Performance

26. Record of Care • Contains the following behavioral and physical health information: • All behavioral and physical health diagnoses and conditions that have required care, treatment,or services • All hospital admissions • All hospital re-admissions • All urgent care and emergency department visits • Individual’s race and ethnicity • Self Management goals related to integrated care

27. Rights and Ethics • Receive information in a manner he or she understands • Collaborate in decisions about his or her care, treatment, or services • Receive information about the staff responsible for his or her care, treatment, or services • Functions and services of the behavioral health home • End of Life Care

28. Summary • BHH is not for every Behavioral Health Care Company • BHH is integration of Behavioral and Physical Care • Majority of standards found in Care Treatment and Services • Pre-publication Standards http://www.jointcommission.org/standards_information/prepublication_standards.aspx

29. Contacts • Peggy Lavin, Senior Associate Director • plavin@jointcommission.org • 630-792-5411 • Evelyn Choi, Senior Business Development Specialist • echoi@jointcommission.org • 630-792-5866 • Diana Murray, RN, MSN, Regional Account Manager • dmurray@jointcommission.org • 630-792-5295