assessing the integrated care capacity and technical ......jul 21, 2016 · trever to discuss: what...
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Assessing the integrated care capacity and technical assistance needs of the Health Choice Integrated Care Network
july 21, 2016
Michael S. Shafer, PhDNicole Janich, MSWTrever Davis, DBH, LAC
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coming up
background
methodology
findings
next steps
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part I: background
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PPACA, 2010 Integration
Parity
Carving In
Federally Qualified Health Centers
Electronic Health Records
Health Information Networks
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On the Arizona Front…
Medicaid Expansion
Pay for Performance
Dual Eligibles
Redesign of the Regional Behavioral Health Authority Contracts
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HCIC needs assessment project -how we ended up here (Mike)
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1. Baseline Assessment of Health Care Integration
2. Degree and Quality of Interagency Collaboration
3. Agency Readiness to Change
4. Training & Technical Assistance Needs
Four Critical Informational Needs
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HCIC Model
• Integrated Care Managers – Co-Occurring Acute Conditions and Serious Mental Illness (SMI)
• Health Home Case/ Care Managers
• Acute Providers• Specialty Providers
© 2015 Image is proprietary. Please contact HCIC Communications (928) 774-7128 regarding usage.
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Systemic Changes 2015 & Forward
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part II: methodology
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collect agency level information: agency overview and history relationships with other agencies information technology integration statusworkforce regulatory environment financials technical assistance needs
identify challenges experienced in providing integrated care
site visits: purpose
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site visits: logistics11 agencies in 2 months
Over 3,000 road miles
2 person site visit team
2 – 7 agency representatives from each agency
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assess practitioners’ readiness to integrate BH and primary care
identify self-described proficiency and training needs
assess agency capacity and need for technical assistance
staff survey: purpose
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• Screening & Assessment• Client Engagement & Early Intervention • Integrated Health Information/Technology • Interdisciplinary Service Delivery• Treatment & Care Planning• Care Managers• Care Coordination• Patient Access to Care• Pharmacological Approaches/Medication Management• Continuity of Care • Agency Culture
staff survey: domains
102 items totalsection 1: demographic and employment information section 2: 11 domains about integrated care
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Four emails sent to agency CEO:1) Pre-survey email – 1 week prior to survey being
sent out2) Survey email – contained link to survey3) 1st Reminder email – 1 week later, to remind staff
to participate4) 2nd reminder email – 2 weeks after survey was sent
out
survey launched Nov. 2015, closed Jan. 2016 11 agencies participated (567 respondents)
staff survey: protocol
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staff survey: respondentsEmployment Role
Behavioral Health
MedicalSupport Services
Administrative Total
Psychiatry 13 0 0 0 13Pharmacy 0 2 0 0 2
Care Coordination/Management 20 0 0 0 20
Case Management (non-clinical) 49 0 0 0 49
Counselors/Therapists (clinical) 70 0 0 0 70
Behavioral Health Technician 78 0 0 0 78Peer Support/Peer Recovery
Specialist28 0 0 0 28
General Medical Practitioner 0 40 0 0 40
Specialty Physician 0 6 0 0 6
Allied Health Professional 0 25 0 0 25Nursing 0 8 0 0 8
Administrative or Support Services
0 0 165 0 165
Other 0 0 0 28 28
Total 258 81 165 28 532
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part III: findings
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Conflicting & Duplicative Reporting Requirements
Guidance from RBHA
Reimbursement disparities Informality of
Interagency Processes
top provider challenges
EHR capacity
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findings: personal capacity
Integrated Care Readiness
Early Intervention Proficiency
Behavioral Health
Screening Proficiency
Inter-Agency Comm.
Pharmaco. Knowledge
Treatment Planning
Proficiency
Chronic Health
Screening Proficiency
Agency Agency Mean Score by Domain
A 4.31 4.30 3.85 3.75 3.59 3.76 3.01
B 4.21 3.93 3.45 3.46 3.42 3.27 3.79
C 4.12 4.06 3.44 3.67 3.46 3.44 2.88
D 4.33 4.16 4.01 4.04 3.67 3.78 2.93
E 4.28 4.27 3.97 3.67 3.53 3.17 2.91
F 3.96 4.14 3.59 3.68 3.73 3.33 2.51
G 4.38 4.10 3.07 3.86 3.18 3.28 2.31
H 4.16 4.00 3.92 2.89 3.21 3.56 2.58
I 4.47 4.73 3.90 4.10 3.59 4.33 3.20
J 4.36 4.38 4.38 4.00 4.19 3.17 3.72
K 4.25 3.67 3.08 4.00 3.42 3.42 2.83
High Need 1.00-2.50Moderate Need 2.51-3.75
Low Need 3.76-5.00
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findings: organizational capacity
Patient Access to
Care
Early Intervention Proficiency
Treatment Planning
Proficiency
EHR “Real Time”
EHR Documentation
Utility
EHR Integration
UtilityAgency Agency Mean Score by Domain
A 4.03 4.00 4.05 4.05 3.96 3.82
B 3.45 3.66 3.56 3.82 3.34 3.28
C 3.58 3.80 3.80 3.31 3.21 3.10
D 4.00 3.97 3.98 3.85 3.59 3.11
E 3.34 3.90 3.81 3.09 3.24 2.77
F 3.30 3.68 3.86 3.84 3.70 3.38
G 3.77 3.88 3.87 3.07 3.83 3.24
H 3.71 3.94 4.11 4.06 4.00 2.92
I 4.00 4.53 4.56 4.11 4.41 4.07
J 3.57 3.96 4.00 4.14 3.52 3.29
K 3.38 3.50 3.31 3.75 3.42 3.00
High Need 1.00-2.50Moderate Need 2.51-3.75
Low Need 3.76-5.00
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findings: organizational capacity
Integrated Care
Readiness
Interdisc. Team
Cohesion
Interdisc. Role Clarity
Inter-Agency Coordination
of Care Protocols
Inter-Agency Network
Participation
Physician-Provider Comm.
Inter-Agency Comm.
Agency Agency Mean Score by Domain
A 3.86 4.04 3.92 4.21 4.05 3.94 3.79
B 3.36 3.90 3.66 3.50 3.66 3.49 3.37
C 3.38 3.65 3.68 3.80 3.77 3.76 3.67
D 3.57 4.00 3.91 4.03 4.05 3.82 3.70
E 3.73 3.75 3.60 3.65 3.42 3.43 3.30
F 3.18 3.34 3.50 3.63 3.78 3.76 3.39
G 3.92 3.93 3.73 3.77 3.54 3.73 3.57
H 3.09 3.75 3.67 3.81 4.00 3.54 3.00
I 4.14 4.28 4.26 4.22 4.17 4.59 3.70
J 3.79 4.21 4.05 4.00 4.00 3.81 3.75
K 4.08 3.33 3.56 3.25 3.38 4.11 3.67
High Need 1.00-2.50Moderate Need 2.51-3.75
Low Need 3.76-5.00
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findings: training needs
Screening and Assessment
Client Engagement Care Coordination Agency Technical
AssistanceAgency Agency Mean Score by Domain
A 3.20 3.34 3.31 3.49
B 3.11 3.38 3.30 3.62
C 3.29 3.12 3.24 3.59
D 3.33 3.21 3.10 3.61
E 3.28 2.94 3.31 3.68
F 3.33 3.02 3.19 3.50
G 3.54 3.25 3.17 3.45
H 2.78 3.44 3.13 3.60
I 3.95 3.05 3.04 3.33
J 3.21 3.14 3.14 3.56
K 3.33 3.75 3.67 3.81
High Need 3.50-5.00Moderate Need 2.25-3.49
Low Need 1.00-2.24
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High Need Priorities:
Interdisciplinary Team Process - 10
Screen. & Assess. of Med. & BH - 9
Care Coordination Functions - 8
Providing Continuum of Care - 8
Medication Management - 8
Enhance EMR/EHR - 8
Integrated Treatment Plans - 7
technical assistance needs
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interdisciplinary communication
client engagement
information-sharing strategies
program evaluation techniques
training needs
behavioral health conditions
medical conditions
building reciprocal relationships
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needs assessment
findings• training and technical
assistance needs identified
organizational TA
• formalization of interdisciplinary roles and responsibilities
• referral and information sharing processes
implications & recommendations
professional development
& training
• pharmacotherapy• medication management• screening BH and medical conditions• client engagement strategies• integrated treatment planning
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part IV: next steps
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Next Steps: Technical Assistance Launch
Community
• Understanding Rights to Privacy & Confidentiality vs. Providers’ Ability to Coordinate Care
• Centers of Excellence in Integrated Health Services
Contracted Acute
Providers
• Integrated Care Management Plans & Process
• Access to Continuum of BH Services
• BH Screening Tools
Behavioral & Integrated
Health Agencies
• Therapies & Medications
• Clinical Documentation• Coordinating Care with
Acute Providers• Screenings & Patient
Engagement Strategies
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Next Steps: Multiple Modalities for Training
ONLINE, STATIC CONTENT“Introduction to” Modules: Care Coordination, Integrated Care Management Plans, Screening Tools for mental illness and substance use, Accessing BH Resources
ONLINE, INTERACTIVESkill Development Modules: Motivational Interviewing, Screening Implementation, some Integrated Care Treatment Planning
IN-PERSON, INTERACTIVEModels of Care Modules: Interdisciplinary Care Teams, Substance Use Assessment, Population Health Intervention Design, Clinical Documentation, Integrated Care Treatment Planning and Care Coordination, Pharmacotherapy & Medication Mgmt
EDUCATIONAL HANDOUTCondition-specific Population Health and Health Outcome Improvement recommendations for: BH Case Managers; Primary Care Behavioral Health Coordinators; BH Medical Practitioners; Acute Care Providers; Hospital EDs
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Questions?
contact information: [email protected]
for more information visit our website: www.cabhp.asu.edu