integrated behavioral health presentation at american psychological association practice leadership...

Independent Practice and Integrated Care

PLC Legacy Sponsor2017 CE Technology

2017 Pre-Conference WifiPLC Gold Sponsor

2017 Conference Wifi

Kevin D. Arnold, PhD, ABPPOwner and President

Center for Cognitive and Behavioral Therapy &The Assoc. of Practices for Evidenced Based CBT (APEB)

Columbus, OHwww.ccbtcolumbus.com

[email protected] Faculty, Ohio State University

Dept. of Psychiatry and Behavioral Health

http://www.ccbtcolumbus.com/

PLC 2017 Sponsors

• Various Models in Various States• Varies by Setting (Hospital, Hospital

Owned PCP, Independent PCP)• SAMSHA/HRSA Definitions

http://www.integration.samhsa.gov/integrated-care-models

What is Integrated Care?

Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013

PLC 2017 Sponsors

• PCP Integrated BH models in Hospital Systems• Most Systems Owned by Hospitals• Employees of Hospital Systems• Early Adoption of Value-Based

Integration • Independent PCP Practices are Often

Stand-Alones Using Code Based Fee for Service• Not Much Interest in Integration Re:

Cost

Experience in Central Ohio

PLC 2017 Sponsors

• Aggressive Pursuit of Integration• Approached Large Non-Hospital Based PCP Network (50+ Offices)• Sought Integration • Was Offered Co-Location • Needed to Prove Clinical and Business Value• Obtained Better EHR (Valant)—Meaningful Use Certified/Inter-

operable to Create Integration Potential for EHR • Value Markers: Patient Experience, Timeliness of Referral

Process, Quality of Care, “Free” Integration (Warm Hand-Off Available, On-going Mutual Valuation (including Patient Messaging)

Experience For CCBT

PLC 2017 Sponsors

• Met initially with Director of Adult and of Pediatric Medicine and the COO

• Met with the Medical Staff at the First Location• Launched about 8 months after Initial Meeting• Payment Currently CPT Code Based• Add Location to FTID to Avoid Problems Later• Negotiate Co-Location Agreement• Set Up Additional Informed Consent Form

Central Ohio Primary Care

Central Ohio Primary Care Physicians

• Founded in July 1996 11 Offices/33 Physicians• 2017 - 320 Physicians in 58 locations.• Four Counties: Franklin, Delaware, Union, Fairfield• 60% Internal Medicine (70 Dedicated Hospitalists)• 20% Family Practice & 20% Pediatrics• Subspecialties Endocrinology, Rheumatology, ID,

PMR• 325,000 + Active Patients in Metro Columbus• 100% Physician Owned and Governed• COPC is 27% of the Central Ohio Primary Care

Market

COPC Network Coverage

COPC

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• Access to PMPM Payment Models• Reduced PCP Time during Encounter• Positioning for Future Private Payer PMPM

Models or Value Based Contracting

Future Values

PLC 2017 Sponsors

• Did Literature Research on Health Care Costs and Cost Reductions

• Built Triple Aims Capacity (Patient Experience Measure)

• Saw Payers as Partners• Prepared White Papers• Approached Carriers• Negotiated First VBC in 2017

Value Based Contracting

PLC 2017 Sponsors

“Not surprisingly, depression has been shown to increase medical costs in patients with these problems by 50% to 70%, according to recent research published in the Archives of General Psychiatry. In that study, when nurse care managers monitored patients diagnosed with depression and either diabetes or heart disease, the patients had lower mean outpatient costs of $594 per person and 114 more depression-free days compared with patients who received usual care.” (http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/affordable-care-act/integrating-primary-care-and-mental-health-key-im?page=full)

“Primary prevention efforts will be needed to address common risk factors for comorbid conditions, such as adverse health behaviors and substance use, in their social and environmental contexts. Secondary prevention should include screening for common mental disorders in primary care settings and for common medical health conditions in specialty medical settings.” (http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf69438/subassets/rwjf69438_1)

Basics of Behavioral Health Value

PLC 2017 Sponsors

• In a Milliman Research Report (Melek and Norris, 2008), the authors reported that patients with chronic medical conditions and depression were 2.1 more likely to eat healthy less than 1x per week, and 1.3 times more likely to eat more than 6 high fat foods per week. (Melek, S. & Norris, D. (2008). Chronic Conditions and Comorbid Psychological Disorders. Seattle: Milliman.]

• Primary Prevention Through Early Intervention—Target Highly CoMorbid Medical Dx at Time of Dx

• Secondary Prevention—Screenings (e.g., PHQ-9, Vanderbilts) at Well Visits, Referral for Diagnostic Consult and Tx Planning for Early Treatment, Stabilization, and Sx Reduction/Elimination

• Tertiary Prevention—Screenings and Diagnostics with CoMorbid Sx Presentation, Stabilization, Sx Management/Reduction/Elimination

• Use of CBT, EBTs that are a) Theoretically Modeled and b) Enjoy Strong Empirical Support

Basics of Behavioral Health Value (the CCBT Way)

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• Metrics• Not “BDI” outcomes• Is Health Outcomes

• Prevention Behaviors• Medical Compliance• Reduced High-Cost Utilization• Consults to PCPs re Med Management and Compliance• Relates Directly to Reduced Costs of Co-Morbidity

• QOL of Patient• Management of Health Care Services for Public Health

Improvement

Value Based Contracting

PLC 2017 Sponsors

• Prevention Models and Levels• IHI and Triple Aims• SAMSHA/HRSA• Innovation (Stand Still is Fall Behind)• Meaningful Use Certified EHR • Define Value-based Role in Health Care

(Redefine Independent Practice as Inter-dependent Practice)

Keys to Know

apapractice.org