Integrated Care in Colorado. Pat Steadman February 21, 2017

Transcription

1 Integrated Care in Colorado Pat Steadman February 21, 2017

2 Behavioral + Physical Health 19% of the population is estimated to have a mental illness; 4% have a serious mental illness 50% of people with substance use disorders also have a co-occurring mental illness 68% of people with mental illness also have at least one other chronic, co-morbid physical health condition

3 What is Integrated Health Care? SAMHSA says: the systematic coordination of general and behavioral healthcare. Integrating mental health, substance abuse, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple healthcare needs.

4 The APA says: Integrated health care, often referred to as interprofessional health care, is an approach characterized by a high degree of collaboration and communication among health professionals. What makes integrated health care unique is the sharing of information among team members related to patient care and the establishment of a comprehensive treatment plan to address the biological, psychological and social needs of the patient. The interprofessional health care team includes a diverse group of members (e.g., physicians, nurses, psychologists and other health professionals), depending on the needs of the patient.

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6 Video: Intro to BH in PC Introduction Video(2:35)

7 From a Medical Perspective: Physical and behavioral health conditions have high rates of cooccurrence, with unmet behavioral health needs frequently complicating treatment for medical practitioners.

8 Source: Substance Abuse and Mental Health Services Administration

9 Co-occurrences

10 Patients with type II diabetes mellitus, for example, are twice as likely to experience depression as the general population, and those patients with diabetes who are depressed have greater difficulty with self-care. No physical health without mental health: lessons unlearned? Kavitha Kolappa,a David C Hendersona & Sandeep P Kishore Bull World Health Organ 2013

11 More than half of all behavioral health treatment occurs in the general medical system and 70% of primary care visits are related to psychosocial issues. Association for Behavioral Health and Wellness HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT July 2015

12 Up to 50% of cancer patients suffer from a mental illness, especially depression and anxiety, and treating symptoms of depression in cancer patients may improve survival time. No physical health without mental health: lessons unlearned? Kavitha Kolappa,a David C Hendersona & Sandeep P Kishore Bull World Health Organ 2013

13 Depression and other MH/SUD are associated with high health care costs. In fact, the top five conditions driving health care spending are: depression; obesity; arthritis; back/neck pain; and anxiety, in that order. Association for Behavioral Health and Wellness HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT July 2015

14 The interaction between a person s psychiatric status and health is dramatic: one in three patients who go to the emergency room with chest pains is actually experiencing panic disorder or depression. Association for Behavioral Health and Wellness HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT July 2015

15 From a Behavioral Health Perspective: Adults with serious mental illness die an average of 25 years earlier than the general population, largely because of co-occurring chronic medical conditions. Association for Behavioral Health and Wellness HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT July 2015

16 In patients who are depressed, the risk of having a heart attack is more than twice as high as in the general population further, depression increases the risk of death in patients with cardiac disease No physical health without mental health: lessons unlearned? Kavitha Kolappa,a David C Hendersona & Sandeep P Kishore Bull World Health Organ 2013

17 People with SUD have a range of health conditions that are directly related to those disorders, e.g. cardiomyopathy, gastritis, and liver disease, as well as a greater risk of congestive heart failure and pneumonia. In the United States, a baby is born with symptoms of opiate withdrawal every hour, with neonatal healthcare costs exceeding hundreds of thousands of dollars. Association for Behavioral Health and Wellness HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT July 2015

18 Physical Health for People with Mental Health Issues Physical Health and Mental Health Video (3:44)

19 What is SBIRT? Screening Brief Intervention Referral to Treatment

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22 Psychological or Medical? Every time a patient comes into your office there is a very real possibility that what seems to be a psychological problem is caused by some physical illness. The depressed patient may have an under active thyroid gland. The patient with panic attacks may have a pheochromocytoma, a tumor that secretes epinephrine. And the patient, whose personality change and increased irritability is thought to be caused by his marital problems, may actually have a brain tumor causing the personality changes and exacerbating longstanding marital issues. Psychiatric Presentations of Medical Illness: An Introduction for Non-Medical Mental Health Professionals Ronald J Diamond M.D. University of Wisconsin Department of Psychiatry

23 Psychotherapy seldom begins with a complete physical. Yet research suggests that about half of all psychiatric patients have an undetected physical illness. This illness may or may not be the cause of the mental symptoms, but it must be taken into consideration. Missing The Diagnosis: The Hidden Medical Causes of Mental Disorders William Matteson, Ph.D..

24 Colorado Medicaid Population

25 Accountable Care Collaborative

26 ACC Accomplishments

27 ACC 2.0 Goals & Objectives

28 Timeline

29 Medicaid Block Grants?

30 Patients need assistance with behavior change: Diagnoses such as Diabetes, Obesity, Hypertension, Heart Disease, Smoking often involve issues with: Eating behaviors Exercise behaviors Motivation Addiction

31 Health Behaviors Psychologists, Counselors and Social Workers promote health behaviors through cultural competency and best practices: Motivational Interviewing Cognitive Behavioral Therapy Trauma-Informed Care

32 A behavioral health provider, either working with primary care on-site or by referral, can improve patient outcomes through health behavior change. Using evidence-based practices, behavioral health providers can help patients learn self-management strategies to deal with their chronic health conditions, such as diabetes, cardiovascular disease and cancer, and adjust to the emotional impact of health problems and situational stress. American Psychological Association

33 Group Therapy Example Video(6:35)

34 Behavioral health providers can also assist patients in managing stress. In fact, stress, which negatively affects current and future health, plays a key role in an estimated 75% of primary care visits. American Psychological Association

35 What it s like for providers in integrated care? Testimonials(3:33)

36 Referral to you for behavioral health concerns, Behavioral collaboration on medical treatment, updates on progress Primary Care Provider Your Practice Referral from you for possible medical concerns, routine physical exams, collaboration on treatment and updates on progress

37 Co-location is one option Co-location increases communication across practitioners and significantly increases the likelihood of referrals from primary care to behavioral health. Two-thirds of PCPs report that they are not able to access behavioral health treatment for their patients, and 30% to 50% of individuals with referrals from primary care to behavioral health do not make the first appointment. Association for Behavioral Health and Wellness HEALTHCARE INTEGRATION IN THE ERA OF THE AFFORDABLE CARE ACT July 2015

38 Summary Behavioral health issues impact physical health outcomes AND physical health issues impact behavioral health outcomes. Medical problems can mimic behavioral health problems AND behavioral health problems can look like medical problems. Over 50% get their behavioral health issues treated by primary care. Incorporating physical health into your practice provides whole person care. Primary care doctors want behavioral health in their office, or at the very least, a good, reliable clinician to refer their patients to.

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