New York State Collaborative Care Initiative Thursday, January 24, 2013

Transcription

1 New York State Collaborative Care Initiative Thursday, January 24, 2013

2 Lloyd Sederer, MD Medical Director New York State Office of Mental Health

3 Key Components of Collaborative Care Jürgen Unützer, MD, MPH, MA

4 Why Integrate Behavioral Health into Primary Care? 1. Access Serve patients where they are 2. Patient-centered Treat the whole patient 3. Effectiveness Better clinical outcomes when implemented well

5 Medicaid and Behavioral Health Medicaid Claims for Behavioral Health Care in Washington State Dually Eligibles David Mancuso, PhD; Senior Research Supervisor; WA DSHS Research and Data Analysis Division February 17, 2011

6 Primary Care is De Facto Mental Health System National Comorbidity Survey Replication Provision of Behavioral Health Care: Setting of Service General Medical 56% No Treatment 59% 41% Receiving Care MH Professional 44% Wang P et al., Twelve-Month Use of Mental Health Services in the United States, Arch Gen Psychiatry, 62, June 2005

7 Mental Disorders are Rarely the Only Health Problem Chronic Physical Pain Cancer 10-20% 25-50% Smoking, Obesity, Physical Inactivity Mental Health / Substance Abuse Neurologic Disorders 10-20% 40-70% Heart Disease 10-30% Diabetes 10-30%

8 Services Poorly Coordinated, not Patient-Centered Primary Care Community Mental Health Centers Alcohol & Substance Abuse Treatment Social Services Vocational Rehab Other Community Based Social Services

9 Depression Care 1/10 see psychiatrist 4/10 receive treatment in primary care ~30 Million with an antidepressant Rx but only 20% improve 2/3 PCPs report poor access to mental health for their patients

10 Good ideas that DON T WORK Screening in primary care without adequate treatment / follow-up 20 years of negative studies Provider education Knowledge is not enough Providers need systems and help to do the right thing Telephone-based disease management 16 negative studies with ~300,000 Medicare recipients McCall N, Cromwell J: N Engl J Med 2011;365: Peikes D et al: JAMA. 2009;301(6):

11 What DOES work? Over 80 randomized controlled trials (RCTs) demonstrate that Collaborative Care more effective than care as usual Gilbody S. et al. Archives of Internal Medicine; Dec 2006 Thota AB, et al. Community Preventive Services Task Force. Am J Prev Med. May 2012;42(5): Archer J, et al. Cochrane Collaborative. Oct 17, 2012.: 79 RCTs with a total of 24,308 patients Collaborative Care also more cost-effective Gilbody et al. BJ Psychiatry 2006; 189: Unutzer et al. Am J Managed Care 2008; 14: Glied S et al. MCRR 2010; 67:

12 Collaborative Care Model Primary Care Practice with Mental Health Care Manager Outcome Measures Treatment Protocols Population Registry Psychiatric Consultation

13 Collaborative Care doubles effectiveness of depression care 50% or greater improvement in depression at 12 months % Usual Care IMPACT Unützer et al., JAMA 2002; Psych Clin NA 2004.

14 Co-Location is NOT Integration 50% or greater improvement in depression at 12 months % Participating Organizations

15 IMPACT Care Benefits Ethnic Minority Populations 50% or greater improvement in depression at 12 months Areán et al., Medical Care, 2005

16 IMPACT: Summary Less depression IMPACT more than doubles effectiveness of usual care Less physical pain Better functioning Higher quality of life Greater patient and provider satisfaction More cost-effective I got my life back THE TRIPLE AIM

17 Replication studies: Collaborative Care robust Patient Population (Study Name) Target Clinical Conditions Reference Adult primary care patients (Pathways) Adult patients in safety net clinics (Project Dulce; Latinos) Adult patients in safety net clinics (Latino patients) Diabetes and depression Katon et al., 2004 Diabetes and depression Gilmer et al., 2008 Diabetes and depression Ell et al., 2010 Public sector oncology clinic (Latino patients) Cancer and depression Dwight-Johnson et al., 2005 Ell et al., 2008 Health Maintenance Organization Depression in primary care Grypma et al., 2006 Adolescents in primary care Adolescent depression Richardson et al., 2009 Older adults Arthritis and depression Unützer et al., 2008 Acute coronary syndrome patients (COPES) Coronary events and depression Davidson et al., 2010

18 Principles of Effective Patient-Centered Integrated Behavioral Health Care Patient Centered Team Care / Collaborative Care Collaboration not co-location Team members have to learn new skills Population-Based Care Patients tracked in a registry; no one falls through the cracks Measurement-Based Treatment to Target Treatments are actively changed until the clinical goals are achieved Evidence-Based Care Treatments used are evidence-based Accountable Care Providers are accountable and reimbursed for quality of care and clinical outcomes, not just the volume of care provided

19 Principles of Effective Integrated Behavioral Health Care Patient Centered Team Care Collaboration not co-location Team members have to learn new skills Population-Based Care Patients tracked in a registry; no one falls through the cracks Measurement-Based Treatment to Target Treatments are actively changed until the clinical goals are achieved Evidence-Based Care Treatments used are evidence-based Accountable Care Providers are accountable and reimbursed for quality of care and clinical outcomes, not just the volume of care provided

20 Principles of Effective Integrated Behavioral Health Care Patient Centered Team Care Collaboration not co-location Team members have to learn new skills Population-Based Care Patients tracked in a registry; no one falls through the cracks Measurement-Based Treatment to Target Treatments are actively changed until the clinical goals are achieved Evidence-Based Care Treatments used are evidence-based Accountable Care Providers are accountable and reimbursed for quality of care and clinical outcomes, not just the volume of care provided

21 Principles of Effective Integrated Behavioral Health Care Patient Centered Team Care Collaboration not co-location Team members have to learn new skills Population-Based Care Patients tracked in a registry: no one falls through the cracks Measurement-Based Treatment to Target Treatments are actively changed until the clinical goals are achieved Evidence-Based Care Treatments used are evidence-based Accountable Care Providers are accountable and reimbursed for quality of care and clinical outcomes, not just the volume of care provided

22 Principles of Effective Integrated Behavioral Health Care Patient Centered Team Care Collaboration not co-location Team members have to learn new skills Population-Based Care Patients tracked in a registry; no one falls through the cracks Measurement-Based Treatment to Target Treatments are actively changed until the clinical goals are achieved Evidence-Based Care Treatments used are evidence-based Accountable Care Providers are accountable and reimbursed for quality of care and clinical outcomes, not just the volume of care provided

23 AIMS Center Role Pre-Launch Technical Assistance Implementation Planning & Team Building Training Clinical model and roles Clinical interventions for primary care Care Management Registry Demo will be provided Post-Launch Training & TA

24 AIMS Center Partner Institute for Family Health First healthcare organization in the country to implement IMPACT after research trial 8 years experience with clinical implementation in a variety of sites Virna Little Nationally recognized expert Trainer and technical assistance expert with AIMS Center for over 5 years

25 Virna Little, PsyD, LCSW-R, SAP Leader of Training and TA activities Tyler James, MPH Project Director A team of experienced nurses, PCP s, psychiatrists, care managers and trainers

26 Combination of in-person and webinars Initial Training and TA activities Kick-off webinar today In-person site visit within experts from IFH within next few weeks Introduction to Integrated Care training webinar Monday Feb. 25 9:30-11:00am

27 Additional Pre-Launch Training & TA will be provided Types of Activities and Schedule announced soon Tailored to each Innovator site As much or as little as needed to transform systems of care Separate from reporting requirements to funder

28 On-site introductory meeting Meet staff, see implementation site Discuss timeline, structure of TA activities Implementation planning On-site, webinar, phone Use Team Building tool to create detailed implementation plan Review clinical workflows, billing procedures Develop plan for registry and reporting

29 Onboarding Checklist o Review at initial on-site meeting o Use as a guide for planning pre-launch activities Pre-Launch Handbook o Overview of NYS-CCI o Overview of Collaborative Care o Describes Pre-Launch Training and TA activities o Provides variety of Pre-Launch planning tools developed to help other implementations o Expectations and terms of participation

30 Team Building Training Train facilitator at each Innovator site to use Team Building Tool Review clinical workflows, billing procedures Collaborative Care Training Collaborative Care model Clinical roles Clinical interventions for Care Managers Behavioral Activation, Relapse Prevention, etc. Problem-Solving Treatment

31 Tailored to each organization Resource for clinical team and administration Problem solve implementation challenges based on experience with similar organizations or workflows Including back end challenges like billing systems, electronic health records, etc. Devil in the details Phone and On-site check-ins Weekly immediately post-launch Decreasing when implementation stable

32 Timeline Schedule of events for life of project Guide for when actions should occur Gantt Chart Excel spreadsheet Depicts when specific trainings, webinars, other events will take place Onboarding Checklist Review during on-site meeting Use as a guide throughout planning phase

33 Active participation in Pre-Launch Training and Technical Assistance activities Meetings, webinars, trainings Team Building Development of implementation plan Active participation in Post-Launch Training and Technical Assistance activities Meetings, webinars, trainings Regular review of metrics and adjustment of program based on these metrics Maintain open lines of communication

34 Q&A now Any other time

35 Thank-you!