Integrating Behavioral Health into Primary Care: Focus on Depression Screening

Transcription

1 Integrating Behavioral Health into Primary Care: Focus on Depression Screening April 20, 2017 Presented by Edwin D. Boudreaux, PhD, Behavioral Health Consultant 3/23/17 1

2 Opening Remarks Purpose Welcoming Dr. Ed Boudreaux Q&A Dr. Adrienne Mims Vice President & Chief Medical Officer

3 Free Technical Assistance Alliant Quality can offer the following technical assistance to help your primary care practice improve screening rates: Expertise in billable screening tools, treatment approaches and referral processes Process design and linkages to referral programs Training in quality improvement methodologies Opportunities to participate in Learning and Action Networks Education on best practices, shared successes and lessons learned

4 Depression Screening Codes The following clinicians are eligible to bill for the services listed below: General Practitioners; Family Practitioners; Internists; Geriatricians; Nurse Practitioners; Certified Clinical Nurse Specialists; Physician Assistants. G Initial Preventive Physical Examination NC ($175.95); Atlanta ($183.14); Rest of GA ($174.20) G0438 Annual Wellness Visit NC ($181.05); Atlanta ($188.64); Rest of GA ($179.13) G Annual Depression Screening, 15 minutes: NC ($18.98); Atlanta ($19.99); Rest of GA ($18.65)

5 Integrating Behavioral Health into Primary Care: Focus on Depression Screening April 20, 2017 Presented by: Edwin D. Boudreaux, PhD, Behavioral Health Consultant 3/23/17 5

6 Featured Guest Speaker Edwin D Boudreaux, PhD Behavioral Health Consultant

7 Introduction What is integrated primary care? How are the levels of integration defined? How does level of integration relate to screening for depression? How can we keep up to date in this rapidly evolving field?

8 Purpose Following this presentation, you will be prepared to determine the level of behavioral health integration present in a primary care practice and you will know where to go if you want to rapidly access the latest information related to integrated primary care, with a particular focus on understanding depression screening.

9 Descartes, Healthcare Systems, Insurance Descartes: the mind is the seat of consciousness and is nonsubstantial; the brain is the seat of intelligence and is substantial. Medical healthcare is provided by medical doctors in medical settings; psychological healthcare is provided by mental health providers in mental health settings.

10 Descartes, Healthcare Systems, Insurance Even the payers are segregated! Medical care is paid for by primary insurance; psychological care by carve outs.

11 Descartes Was Wrong, the System is Broken Nearly half (48.2%) of all deaths are accounted for by a limited number of largely preventable behaviors (modifiable risk factors) Patients with mental illness are more likely to have medical problems and highrisk health behaviors, like smoking ://

12 Primary Care, Mental Illness, Substance Abuse DISORDER PREVALENCE Lifetime Primary Care Depression 21% 24% Anxiety 29% 20% Alcohol 15% 17% Any MH Disorder 46% 52%

13 The Solution: Integrated Care

14 Integrated Care Levels Source:

15 Key Points for Depression Screening The current state of integration is likely to be associated with the acceptability of routine screening The lower the level of integration, the less likely screening will be embraced, because of Pandora s Box effect Now that I know, what do I do?

16 Key Points for Depression Screening Regardless of integration, structured clinical protocols are important to support screening Who will perform the screening? How will the screening be performed? Where and when will it be performed? What will happen if the person is positive?

17 Key Points for Depression Screening Electronic health record should be used to support protocols whenever possible Integrate the screeners into the EHR Build best practice alerts and clinical decision support tools Build patient resources

18 Key Points for Depression Screening Lower levels of integration Primary care clinician can provide more first line treatment Develop a mental health and substance abuse treatment referral list, including information on local selfhelp resources like 12-step groups Resources are highly dependent on insurance, so lists should ideally be organized accordingly Provide referral and helplines where possible

19 Key Points for Depression Screening Higher levels of integration Focus on efficiency of referring, communication, clarifying roles and responsibilities, and financial sustainability MH providers need specialized training May have experience with depression

20 Example of Depression Protocol h"p:// G1_ResourceGuide_ _V4_ _FNL.pdf

21 Screeners for Depression: Patient Health Questionnaire (PHQ) 2/9 Positive screen: Sum >=3 Positive screen: Sum >=3 Positive screen: Sum >=3

22 Screeners for Depression: Patient Health Questionnaire (PHQ) 2/9

23 Screeners for Depression: Patient Health Questionnaire (PHQ) 2/9 uploads/.phq-9-review-kroenke pdf

24 High Yield Resources: SAMHSA Center for Integrated Health Solutions About the Center for Integrated Health Services (CIHS) Integrated care overview Standard framework/levels of integration Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf Interactive flowsheet/quick start guide for integrating BH into primary care slideshow

25 High Yield Resources: AHRQ s Integration Academy About AHRQ s Integration Academy Map of integration: Lexicon EHR Case Studies 20HIT%20for%20Behavioral%20Health%20Integration

26 High Yield Resources: Academy Guidebook A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration (The Academy)

27 Summary An individual primary care practice may fall along a spectrum of integration, which will likely be an important factor in the practice s willingness to embrace depression screening Regardless of level, it is important to build clinical practice protocols to standardize the particulars surrounding screening and handling positives SAMHSA and AHRQ sponsor fantastic websites with detailed, current information that make it easy to keep up with this evolving field * G1_ResourceGuide_ _V4_ _FNL.pdf

28 Closing Thank you! For more information, please contact: Dr. Edwin Boudreaux

29 Contact Information Adrienne Mims, MD MPH,FAAFP, AGSF Vice President and Chief Medical Officer

30 This material was prepared by NCC and adapted by GMCF, for Alliant Quality, the Medicare Quality Innovation Network Quality Improvement Organization for Georgia and North Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW-GMCFQIN-G