Featured Industry Partner

Transcription

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2 Featured Industry Partner

3 Concurrent Strategy Session October 7, 2015: 3:15-4:30 Making it Work: Integrating Mental Health Panel: Jürgen Unützer, MD, MPH, MA, Professor and Chair, Department of Psychiatry and Behavioral Sciences, University of Washington, Director, AIMS Center Donna Smith, MD, Vice President, Medical Director, Clinics, Virginia Mason Medical Center Connie Davis, MD, Chief Medical Officer, Skagit Regional Health

4 WSHA Annual Meeting October 8, 2015 INTEGRATED BEHAVIORAL HEALTH CARE Jürgen Unützer, MD, MPH, MA Professor and Chair Psychiatry and Behavioral Sciences University of Washington

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6 Mental Health and Substance Use Disorders cause 25 % of all disability worldwide. 10 % of Years Lived with Disability (YLD) from depression alone. 3x diabetes, 10x heart disease, 40x cancer Mental health and substance abuse problems are major drivers of underemployment, unemployment, homelessness, and involvement with the criminal justice system. Employers struggle with high health care costs (250% increase), absenteeism and presenteeism. In the US, one suicide every 15 minutes. In WA, 2-3 suicides / day. More than deaths from suicide than from motor vehicle accidents or homicides. Patients living with severe and persistent mental illnesses die years earlier, often from preventable causes such as untreated or poorly treated high blood pressure, diabetes, smoking or obesity. No family goes untouched.

7 MENTAL AND MEDICAL DISORDERS ARE TIGHTLY LINKED e.g., Depression & Diabetes

8 THE STATE OF MENTAL HEALTH IN AMERICA Source: Parity or Disparity: The State of Mental Health in America (2015), Mental Health America

9 CARE FOR THOSE LIVING WITH MENTAL ILLNESS 6/10 get NO formal care. 1/10 see a psychiatrist in any given year. 2/10 see any mental health specialist Even with insurance, the average wait time is 25 days. 4/10 get mental health services in primary care Only 1 in 4 improve. More than half of WA counties don t have a single licensed mental health professional. Primary care physicians complain about poor access to mental health care for their patients.

10 Of all people living with mental disorders

11 12% see a psychiatrist

12 20 % see any mental health specialist

13 40 % get mental health treatment in primary care

14 Most get no formal treatment.

15 HOW DO WE CLOSE THE GAP? Train more mental health specialists Integrated Care Psychiatry Training Program Leverage mental health specialists more effectively Partnerships (primary care, schools, community hospitals) Technology (e.g., telepsychiatry)

16 COLLABORATIVE CARE Primary Care Practice Primary Care Physician Patient + Mental Health Care Manager Psychiatric Consultant Outcome Measures Treatment Protocols Population Registry Psychiatric Consultation

17 BEHAVIORAL HEALTH INTEGRATION PROGRAM (BHIP) 20 % of UW Medicine Primary Care Patients have at least one visit with a MH diagnosis HMC 1 UWNC 4 UWNC 1 UWMC 1 UWNC 1 HMC UWNC 15 Participating Clinics Harborview Medical Center (HMC) Adult Medicine Family Medicine Pioneer Square Women s Clinic University of Washington Medicine Center (UWMC) General Internal Medicine University of Washington Neighborhood Clinics (UWNC) Belltown Shoreline Federal Way Issaquah Kent/Des Moines Factoria Northgate Woodinville Ravenna Ballard In 2016: Olympia, Arlington

18 WA STATE MENTAL HEALTH INTEGRATION PROGRAM (MHIP) Over 50,000 patients served. In Partnership with Community Health Plan of Washington & King County Public Health:

19 WALL STREET JOURNAL, SEPT 2013

20 WASHINGTON STATE GOVERNOR & HEALTH CARE AUTHORITY Washington State will fully integrate purchasing and delivery of behavioral health and medical services by th_2014.pdf A great challenge and also an opportunity for all of us.

21 OTHER CHANGES AHEAD FFS=> Value-based purchasing ACO & other contractual arrangements include metrics related to behavioral health access, quality, and outcomes 2016 NCQA HEDIS Health plans and patient-centered medical homes report on depression screening and remission rates (PHQ-9).

22 PRINCIPLES Client-Centered Collaboration. Primary care and mental health providers collaborate effectively using shared care plans. Population-Based Care. A defined group of clients is tracked in a registry so that no one falls through the cracks. Treatment to Target. Progress is measured regularly and treatments are actively changed until clinical goals are achieved. Evidence-Based Care. Providers use treatments that have research evidence for effectiveness. Accountable Care. Providers are accountable and reimbursed for quality of care and clinical outcomes, not just volume of care.

23 Integrating Behavioral Health Donna Smith, MBA, MD Virginia Mason Medical Center Medical Director Clinics

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25 Historically Primary Care/DOM/DOS Outpatient Psychiatry Inpatient Psychiatry Consults/ ED/ Hospital Refer to outpatient psychiatry Specialty consults & stable patients Demand > capacity Access challenged Reactive Challenging f/u planning 2014 Virginia Mason

26 One Team Behavioral Health Vision Virginia Mason is recognized for its behavioral health care, providing an integrated, proactive team approach that partners with communities to support and enhance our patients wellbeing Virginia Mason

27 Our Focus Mind/body Isolated Infrequent contact Reactive Shadow files Whole person Integrated/co-located Communication in flow Screening/early detection every visit Shared EHR 2014 Virginia Mason

28 Evolving to Future New Dx Unstable People Living w/ MI (stable) Consultative Psychiatry Primary Care Team: PCP, Care Mgr, SW, MHT & Pharmacist all in partnership with Psychiatry PRN All People Primary Care Team Routine Screening Motivational Interviewing re: Health Behaviors 2014 Virginia Mason

29 Shared Vision Understand Current Patient & Population Needs Patients Understand Resources Providers Data Surveys PSA s Psychiatry Primary Care Pharmacy Social Work Shared Vision Define Metrics of Success Tests of Change Align Resources & Incentives 2014 Virginia Mason

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31 Mental Health Integration Skagit Regional Health

32 Goal Integration of all Care Elements

33 Mind and Body Set the Stage for Skagit

34 Skagit Community Resources Compass Catholic Community Services Bywater ShifaHealth Skagit Behavioral Health Telecare - E & T Psychologists Therapists, MSW Counselors 5 Outpatient Psychiatrists

35 The Situation Mental Health Unit Number served 3/15 to 8/15 n=155, 85 F; 70 M Diagnoses Drug Induced mood Dis Schizoaffective dis Bipolar Manic Bipolar and Psychosis Psychosis Readmissions to us; 15/155 = 9.7% Day to first Appointment in Community over 2 weeks ED use No show high to PCP

36 Pediatric Situation Skagit NWESD representing 7 school districts 379 children with BH issues Top issues for school nurses

37 March February 2015, <18yo ED 246 Inpatient 6 Observation 8 Anxiety/Psychosis AGE 4 (0-3 yo) 3 (4-8 yo) 49 (9-13yo) 205 (14-17) Pediatric Situation: ED

38 The Situation Primary Care Not enough time to really talk about all issues Simple medications Complicated patients,usual medications not working Medication interactions Need backup Keeping in contact

39 The Situation Residency Clinic Patients with few resources Chemical dependency Seeking drugs Homeless No show rate Residents afraid, clinical skills need development, need coaching Safe space Folks from the jail

40 External Situation Accountable communities of health, partnerships Funds flow HCA focus on integration Disparities, health equity Care management key Data supporting: Outcomes - health, cost Engagement - self management

41 Process Forward Steps Community Resources LOS Readmits/why What do patients want Talk to providers PCP, residents, MH Look at our data - high needs areas Model evaluation Cost Space Risk Inpatient Unit Outpatient gaps Population Health Goals

42 Scope Goal Number to serve Who serving Metrics Resources Funding Space Technology Steps

43 Structure Model MSW Telepsychiatry Location Flow, same day access Case managers Professionals Refine Clinical Components Legal Steps

44 Questions?