where & how behavioral health can be integrated into the patient-centered medical home (pcmh)
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Where & How Behavioral Health can be Integrated into the Patient-Centered Medical Home (PCMH). *Originally adapted from PCPCC’s Behavioral Health Task Force Slide Deck. Last updated September 2014. - PowerPoint PPT PresentationTRANSCRIPT
Where & How Behavioral Health can be Integrated into the
Patient-Centered Medical Home (PCMH)
*Originally adapted from PCPCC’s Behavioral Health Task Force Slide Deck. Last updated September 2014.1
PCPCC 2014. All Rights Reserved.
Purpose of Slide Deck• To allow users to adapt these slides for your own
presentations. Please see the notes sections for more detailed information.
• This slide deck is focused on the “where” and “how” behavioral health is being integrated into the patient-centered medical home (PCMH).
• You may also pull slides from Deck 1 to learn about the “why” behavioral health should be integrated into the PCMH.
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PCPCC 2014. All Rights Reserved.
Slide Deck Outline1. Where Integrated Behavioral Health Models are Happening
2. Models for Integrating Behavioral Health in the PCMH– Coordinated Care Models
– Col-Located Models
– Integrated Models
3. Resources & Acknowledgements
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PCPCC 2014. All Rights Reserved.
Where Integration is Happening
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Source: AHRQ, The Academy Integration Map. Accessed September 2014. http://integrationacademy.ahrq.gov/ahrq_map
Models for Integrating Behavioral Health in the PCMH
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PCPCC 2014. All Rights Reserved.
Integration: An Evolving Relationship
6 Source: http://uwaims.org
PCPCC 2014. All Rights Reserved.
Based on Population Needs & Required Systems
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Source: Mauer BJ (2004). Behavioral Health / Primary Care Integration: The Four Quadrant Model and Evidence-Based Practices. National Council for Community Behavioral Health. www.mcpphealthcare.com
PCPCC 2014. All Rights Reserved.
Collaborative Care
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Collaborative care optimizes all behavioral health resources
Source: http://uwaims.org
PCPCC 2014. All Rights Reserved.
Relationship Between Medical & Behavioral Health Services (Collaboration for Same-Day Access)
• Coordinated (shared costs) = Behavioral services by referral at separate location via synchronous (real-time) or asynchronous (later) information exchange
• Co-Located (separate funding sources)= By referral processes at primary care location (behavioral health visit in referral office)
• Integrated (same funding resource) = At primary care location (face to face with behavioral health team or by virtual synchronized telemetry)
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Source: Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems & Health: 21, 121-134.
PCPCC 2014. All Rights Reserved.
Coordinated Care• Coordinated care elements:
– Appointment arrival notification – Clinical information exchange protocols – Coordinated treatment planning and/or problem
solving for complex patients or as needed• Expect communication to go both ways.
– Mental health clinicians are healthcare professionals who should be knowledgeable about the patient’s health issues.
• Ask about the person’s health behavior goals and consider them in treatment planning.
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PCPCC 2014. All Rights Reserved.
Coordination Plus – Specialty Mental Health as a Consultant to Primary Care• Massachusetts Child Psychiatry Access
Program• For adults in NC, Medicaid pays for time of
primary care physician and psychiatrist as patient visit rates (for consultation about a patient) whether the psychiatrist has met the patient or not.
• When behavioral health clinicians are working in primary care, referrals to specialty care for patients in need of longer-term work is more likely to be successful.
11 Source: Center for Integrated Primary Care, UMass Medical School
Co-Located Behavioral Health (Helps Reduce Stigma!)
Advantages
• Access greatly improved • Improved patient &
provider satisfaction • Cost effective• Improved clinical outcomes
Challenges
• Referrals don’t show• Case-loads fill up• Slow primary care physician
learning curve• Communication still difficult
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• Behavioral health in the same space with primary care • Involvement by referral • Separate behavioral health and medical treatment plans
PCPCC 2014. All Rights Reserved.
Integrated Primary Care: Behavioral Health Consultant
Source: Center for Integrated Primary Care, UMass Medical School13
• Management of psychosocial aspects of chronic and acute diseases
• Application of behavioral principles to address lifestyle and health risk issues
• Consultation and co-management in the treatment of mental disorders and psychosocial issues
PCPCC 2014. All Rights Reserved.
Models of Integrated Behavioral Health
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The models are beginning to converge:
Source: Center for Integrated Primary Care, UMass Medical School
PCPCC 2014. All Rights Reserved.
Integrated Primary Care: The IMPACT Treatment Model
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• Stepped protocol in primary care using antidepressant medications and/or 6-8 sessions of psychotherapy (PST-PC)– Treat to target
• Collaborative care model includes:– Care manager: Depression Clinical Specialist
• Patient education • Symptom and side effect tracking• Brief, structured psychotherapy: PST-PC
– Consultation / weekly supervision meetings with • Primary care physician• Team psychiatrist
Source: Center for Integrated Primary Care, UMass Medical School
Fully Integrated Primary Care The System
Source: Center for Integrated Primary Care, UMass Medical School
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PCPCC 2014. All Rights Reserved.
Substantial Improvement in Depression (≥50% Drop on SCL-20 Depression Score from Baseline)
Source: Center for Integrated Primary Care, UMass Medical School
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0
10
20
30
40
50
60
3 6 12
pe
rce
nt
month
Response (≥50% drop on SCL-20 depression score from baseline)
Usual care Intervention
Resources & Acknowledgements
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PCPCC 2014. All Rights Reserved.
• AHRQ Academy for Integrating Behavioral Health and Primary Care: http://integrationacademy.ahrq.gov/
• AIMS CENTER: http://aims.uw.edu/• Center for Integrated Primary Care: http://www.umassmed.edu/cipc/• Collaborative Family Healthcare Association: www.cfha.net• Evolving Models of Behavioral Health Integration in primary Care.
Milbank Memorial Fund 2010. http://www.milbank.org• Lexicon for Behavioral Health and Primary Care Integration. AHRQ
2013: http://integrationacademy.ahrq.gov/sites/ default/files/Lexicon.pdf
• National Alliance on Mental Illness. Integrating Mental Health & Pediatric Primary Care Resource Center: http://www.nami.org
• SAMHSA/HRSA Center for Integrated Health Solutions: http://www.integration.samhsa.gov
Selected Resources
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PCPCC 2014. All Rights Reserved.
• Case Study: Colorado’s Advancing Care Together. http://www.advancingcaretogether.org/
• Video: AIMS Center. Daniel’s Story: An Introduction to Collaborative Care. http://aims.uw.edu/daniels-story-introduction-collaborative-care
• Webinars: University of Colorado’s Department of Family Medicine Policy Channel. http://www.youtube.com/CUDFMPolicyChannel
• PCPCC Online Resource: Successful Examples of Integrated Models. http://www.pcpcc.org/content/successful-examples-integrated-models
Case Studies & Videos
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PCPCC 2014. All Rights Reserved.
• Special thanks to:– PCPCC’s Behavioral Health Group– PCPCC’s Behavioral Health Advisory Team
• Alexander Blount, EdD, University of Massachusetts• Parinda Khatri, PhD, Cherokee Health Systems• Benjamin Miller, PsyD, University of Colorado• George Patrin, MD, Serendipty Alliance• CJ Peek, PhD, University of Minnesota• David Pollack, MD, University of Oregon
– Erik Vanderlip, MD, University of Oklahoma
Acknowledgements
*Originally adapted from PCPCC’s Behavioral Health Task Force Slide Deck. Last updated September 2014.21