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Department of Health and Human ServicesVenkata R. Jonnalagadda,MD,FAPA, Medical Director for the

Division of MH/DD/SAS

Principles of Integrated Care Navigation in a Changing System

Presenters:

Presenters:

Venkata R. Jonnalagadda, MD,FAPA, Medical Director for the

Division of MH/DD/SAS

Lisa Evans, VP Operations, Strategic Behavior Health

Victoria Jackson, Chief of Clinical Operation, Eastpointe

Kevin Parker, CCNC Access East

NAMI NC

• To share different access points of entry into the mental

health system

• Identify what is working in the current system

• Identify what barriers remain

• Engage in an open discussion on what access, opportunities,

challenges and how to go forward.

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Objectives

• The future system and changes are unknown.

• How we can meet the mental health care needs for the people

of North Carolina to insure access suited to the specific needs

of the individual remains the focus.

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Vision: health, safety, and choice

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• Cost

• Resources

• Providers

• Care centers

• Hospital beds

• Complexities of illness both mental health and physical

• MH – child and adult, geriatric

• SUD – opiates, the legalization of THC, comorbidity of trauma

• IDD – child, adult, and physical disabilities

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Barriers

• 56.5% of adults with a mental illness received no

treatment. Lack of access to treatment is slowly improving.

In 2011, 59% of adults with a mental health problem did not

receive any mental health treatment.

• One out of five (20.3%) adults with a mental illness report

they are not able to get the treatment they need.

• 22.94% of adults with a disability were not able to see a

doctor due to costs. The inability to pay for treatment, due to

high treatment costs and/or inadequate insurance coverage

remains a barrier for individuals despite being insured.

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Facts from Mental Health America

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Traditional MH Provider

Lisa Evans, VP Operations, Strategic Behavioral Health

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Access to care---

Responding to a need in a timely manner---our response is often delayed?

Determining the appropriate level of care needed.

Active partnering with other providers to increase the innovation of our collaboration

Limited service levels within the continuum of care----quantity not quality.

Care Coordinators are integrating into the facility based team

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Current State

| [PRESENTATION TOPIC OR TITLE]

The belief and practice: We provide an intensive level of service which is a treatment phase within a collaborative treatment plan

Engagement of the key treatment team members in a process which values all input and respects resources.

Providing evidence based treatment modalities.

Commitment to 72 hours follow up with all patients.

Measuring the effectiveness of treatment through outcomes research ---UNC at Wilmington

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What is working ?

| [PRESENTATION TOPIC OR TITLE]

Youth: 180 of 472 discharges were reached (38.1%), 89 (21.1%) attempted but not contacted. 30

(6.3%) refused to participate, 136 (28.8%) other including 43 step down to PRTF-SBH, 14 to PRTF-

other, 48 to DSS/GH/TFC, and 5 to juvenile justice

92.7% reported they knew MD appointment

91.6% reported they would keep the appointment

93.3% knew how to reach the MD

91.1% reported compliance with meds

94.4% reported they would keep therapy appointment

91.6% reported they knew what warning signs

2.2% reported thoughts of self-harm

1.1% reported questions about follow-up

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72 HOUR FOLLOW-UP: 1ST QTR 2016

Calling every single patient/resident within 72 hours post discharge

Discharge

Prevention

72 Hour follow-

up

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Case Management of those patients who are “super users”

Development of additional community based resources---what is needed? How do we fund?

Timely communication between the key stakeholders

Training and education of staff

“Shared risk” arrangements

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Opportunities for Increased Collaboration

To contact us:

Strategic Behavioral Health, LLC

8295 Tournament Drive., Suite 201

Memphis, TN 38125

(901) 969-3100 - Phone

(901) 969-3120 - Fax

lisa.evans@strategicbh.com

Visit our website: www.strategicbh.com

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Strategic Behavioral Health, LLC

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LME/MCO Access to Care

Victoria Jackson, Chief of Clinical Operations, Eastpointe MCO

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• An entry point into accessing behavioral health services.

• Conducts Screening, Triage, Referral 24/7/365

–TTY Capabilities for individuals who are deaf/hard of

hearing

–Language Interpretation

• Provides linkage to Crisis Services 24/7/365

• Provides Community Resources

• Care Coordination to link, intervene, follow up and

coordinate services for individuals who meets the eligibility

criteria.

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LME/MCO Access to Care

• Collaboration with community partners (i.e. CCNC, DSS,

Primary Care Physicians, etc.)

• Provider Network Management to ensure availability of a

comprehensive service array

• Provides outreach/ behavioral health educational activities

and anti-stigma efforts through Community Relations

• Quality Management is a key component to ensure standards

of care are being met and to provide health and safety

monitoring

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An entry point into accessing behavioral health services.

Conducts Screening, Triage, Referral 24/7/365

TTY Capabilities for individuals who are deaf/hard of hearing

Language Interpretation

Provides linkage to Crisis Services 24/7/365

Provides Community Resources

Care Coordination to link, intervene, follow up and coordinate services for individuals who meets the eligibility criteria.

Victoria Jackson

LME/MCO Access to Care

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An Integrated Practice Model Resource

Kevin Parker, CCNC Access East

• Integration Defined

–The care that results from a practice team of primary care

and behavioral health clinicians, working together with

patients and families, using a systematic and cost-effective

approach to provide patient-centered care for a defined

population. (Peek, 2013)

–This care may address mental health and substance abuse

conditions, health behaviors (including their contribution

to chronic medical illnesses), life stressors and crises,

stress-related physical symptoms, and ineffective patterns

of health care utilization. (Peek, 2013)

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The Current State of Integration: Primary Care (PC)/Behavioral Health (BH)

• CCNC 2015 Primary Care Integration (PCI) Survey (Medicaid Specific)

–Assessed current PCI variations across NC

–Where do people with Mental Health Disorders go for treatment?

(N=361,568)

•43% with at least 1 CCNC PCP visit ONLY

•13% with at least 1 BH Service billed to LME/MCO

•35% with BOTH

•9% with neither

–Survey Response (N=425)

•76% routinely assess for BH conditions using a validated screening

tool

•65% referring to outside community BH specialist

•42% referring to in house BH specialist

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The Current State of Integration: Primary Care

(PC)/Behavioral Health (BH)

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• Integration exists on a continuum–Co-Location and Reverse Co-Location

–Programs vs. Models

•Programs are usually practice specific and not necessarily based on

evidence

•Models are programmatic and based upon evidence. Examples

include: PCBH, SBIRT & Collaborative Care

–Horizontal Integration vs. Vertical Integration (Curtis &Christian,

2012)

•Horizontal covers a wide population and includes global

assessment, intervention, monitoring and education by an

integrated team.

•Vertical covers a specific population but still inclusive of an

integrated team.

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The Current State of Integration: Primary Care (PC)/Behavioral Health (BH)

• The Future:

–From volume to value

–Treating the whole-person

–Improved quality of care

–Lower acute care utilization

–Billing structure

–Partnerships/Relationship

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The Current State of Integration: Primary Care (PC)/Behavioral Health (BH)

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National Alliance on Mental Illness

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• Founded 1979 in Madison, Wisconsin

• Headquarters in Arlington, Virginia

• NAMI is the largest consumer- and family- run advocacy

organization in the country.

• 1100 Affiliates in 50 States,

Washington D.C. and Puerto Rico

• NAMI North Carolina has 34 affiliates across the State and

over 2000 members; Formed in 1984

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About NAMI

•Provide support, education, advocacy, and

public awareness so that all affected by

mental illness can build better lives

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NAMI NC Mission

• Mental Illnesses are illnesses like any other

• Stigma is real and has terrible consequences

• Consumers and families alike are essential to the recovery

process

• Family and consumer education and support make

substantial differences in outcomes

• With appropriate treatment and services, people can and do

recover from mental illness

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Central Beliefs

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• People with mental illness want what all citizens want

–Stable and safe housing

–Access to healthcare

–Access to education and employment

–Meaningful relationships & purpose

–Connection to their communities

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Central Beliefs

• NAMI’s website ~ www.nami.org

•receives over 5.4 million visitors a year

• NAMI’s Toll-free HelpLine ~ 1 (800) 950-6264

•serves over 50,000 callers a year (staffed by a dedicated team of volunteers)

• NAMI North Carolina website ~ www.naminc.org

•Receives over 52,500 visitors a year

• NAMI NC HelpLine ~ 1 (800) 451-9682

•serves over 4,500 callers a year

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Public Education and Information Activities

• Beginning to see LME/MCO being able to respond to local

community needs, assessing their networks, and being

innovative with services while showing savings

• Crisis Intervention Training (CIT)

• Telepsychiatry

• A clear thoughtful & engaged dialogue by policymakers

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Strengths

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• Reform, Reform, Reform

• Money not following into the community

• Lack of coordination

–No case management function in MI

–LME/MCO not acting as navigator

–No transition out of prison or follow up

• Our service array is crisis based not addressing the core

symptomology/issue based

• Access to right service at the right time

• No consistency from Murphy to Manteo

• Workforce capacity

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Areas of Growth

• An increase in consumer and family thoughtful input/voice

• Supportive Housing & a Housing 1st Philosophy

• Employment – IPS

• Moving from a Fee for Service to an outcomes based system

with intention on integration with primary medical care

• Serving those in the gap between Medicaid eligibility &

private insurance

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Opportunities

• Without funding – this is moot

• Ensure that if privatization becomes the norm that there is

some form of public accountability and transparency

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Threats

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Contact NAMI NC

Jack Register, MSW, LCSW,

LCAS, CSI

919.788.0801

jregister@naminc.org

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In Conclusion

• Primary Care Integration

• Early Intervention

• Law Enforcement Collaboration

• Improving Insurance Benefits

• Critical Care

• http://www.forbes.com/sites/toriutley/2016/01/24/improving-

the-state-of-mental-health-care-in-2016/#671baee3194c

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Good things to help:

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• Arizona passed housing legislation that created a trust fund offering

rental assistance for individuals with serious mental illnesses.

• Minnesota passed a bill allowing the state to supplement federal dollars to

support evidence-based First-Episode Psychosis (FEP) programs.

• Utah passed a bill requiring collaboration between state departments of

corrections and mental health, leading to better services offered within

the criminal justice system.

• Virginia passed legislation requiring both public and private health

facilities to report psychiatric inpatient beds at least once per day, which

will help patients in crisis find care faster.

• Washington passed legislation to combat the shortage of mental health

professionals through leveraging telehealth services.

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Here are the five bills the National Alliance on Mental Illness (NAMI) reported as the most influential in 2015

• Virginia passed legislation requiring both public and private

health facilities to report psychiatric inpatient beds at least

once per day, which will help patients in crisis find care

faster.

• Washington passed legislation to combat the shortage of

mental health professionals through leveraging telehealth

services.

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• Anti-Stigma

• Integration of Care

• CIT Training

• Mental Health First Aid

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North Carolina

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1: Increase Prevention, Treatment, and Recovery Services

2: Expand the Mental Health Workforce

3: Widen the Use of Health Information Technology

4: Educate the Public

5: Invest in Research

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http://www.samhsa.gov/priorities

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Time for Discourse