1115 BEHAVIORAL HEALTH WAIVER PROJECTS: AN OVERVIEW Molly Lopez, - - PowerPoint PPT Presentation

1115 BEHAVIORAL HEALTH WAIVER PROJECTS: AN OVERVIEW

Molly Lopez, PhD Stacey Stevens Manser, PhD Texas Institute for Excellence in Mental Health School of Social Work University of Texas at Austin

Acknowledgements

• This project was supported through a grant by The

Meadows Foundation.

• Texas HHSC provided guidance on database structure

and facilitated communication with RHPs (HHSC did not sponsor or request the project).

• We want to thank Regional Health Partnerships for

reviewing elements of the database for accuracy.

The Why…

• The interest is great:
• Most significant funding increase for behavioral health services in

Texas in decades

• The projects chosen by regions provides insight on the needs of

local areas

• Provides for local innovation and development of best practices
• It will be critical to demonstrate good return on investment
• TIEMH’s goal was to document characteristics of the

projects undertaken in the state and to provide a useful database to Meadows, HHSC and other stakeholders.

• A report summarizing findings is available here:
• http://sites.utexas.edu/mental-health-institute/publications-and-reports/

The How…

• Behavioral health projects were identified initially by

HHSC and then additional projects added based on key word searches.

• Reviewers with behavioral health knowledge were trained
• n data definitions and coding and reviewed initial

proposals to reach adequate reliability.

• All proposals were scored and then received a secondary

review for reliability by a lead investigator.

• RHPs were provided a subset of data elements to review

for accuracy.

The What…

• Data is focused on the 395 CMS approved

projects.

• Providers may be doing more than is reflected in

the brief proposal and additional specification may have occurred during the planning year.

• Some data elements are more subjective. They

are coded when reasonable assumptions could be made.

Proportion of 1115 Projects with Behavioral Health Component

RHP Partnership Total # of BH Projects % of All Plans with BH Component Total BH Year 2-5 1 Anchor: University of Texas Health Science Center - Tyler 24 25.3% 72,631,848 2 Anchor: University of Texas Medical Branch at Galveston 30 40.0% 88,409,458 3 Anchor: Harris County Hospital District 46 30.1% 466,983,943 4 Anchor: Nueces County Hospital District 22 25.3% 76,429,216 5 Anchor: Hildago County (South Texas) 18 52.9% 104,893,535 6 Anchor: University Health System (San Antonio) 35 30.7% 233,777,884 7 Anchor: Healthcare District (Austin) 37 56.1% 216,131,309 8 Anchor: Texas A&M Health Science Center (Round Rock) 25 67.6% 50,009,524 9 Anchor: Dallas County Hospital District 21 18.3% 126,622,617 10 Anchor: JPS Health Network (Ft. Worth) 26 25.5% 232,185,601 11 Anchor: Palo Pinto General Hospital (Mineral Wells) 10 31.4% 20,677,393 12 Anchor: Lubbock County Hospital District 20 23.3% 68,410,788 13 Anchor: McCulloch County Hospital District (Brady) 11 31.4% 8,768,370 14 Anchor: Medical Center Health System (Odessa) 6 12.0% 24,238,242 15 Anchor: University Medical Center of El Paso 8 15.1% 61,159,723 16 Anchor: Coryell Memorial Hospital (Gatesville) 15 46.9% 36,092,630 17 Anchor: Texas A&M Health Science Center (College Station) 8 27.6% 18,207,725 18 Anchor: Collin County (Collin, Grayson & Rockwall) 16 69.6% 63,579,282 19 Anchor: Electra Hospital District 10 27.0% 11,753,709 20 Anchor: Webb County Indigent Health Care Services (Laredo) 7 50.0% 27,087,094 All All RHPs 395 30.9% $2,008,049,890

Approved RHP Projects by Category and Goal

Number Percent

Category 1 Projects: Infrastructure

191 48.4% Goal Number and Description 1.12 Enhance service availability to appropriate levels of BH care 58 30.4% 1.13 Development of BH crisis stabilization services 49 25.7% 1.9 Expand specialty care 29 15.2% 1.11 Implement technology assisted services to support or deliver BH services 21 11.0% 1.7 Introduce, expand, or enhance telemedicine/health 18 9.4% 1.14 Develop workforce enhancement initiatives to support access to BH providers in underserved areas 6 3.1% 1.10 Enhance performance improvement and reporting capacity 5 2.6% 1.1 Expand primary care capacity 4 2.1% 1.3 Implement a chronic disease management registry 1 0.5%

Approved RHP Projects by Category and Goal

Number Percent

Category 2 Projects: Program Innovation or Redesign

204 51.6%

Goal Number and Description

2.13 Provide an intervention for a targeted BH population to prevent unnecessary services in

• ther settings

90 54.4% 2.15 Integrate primary and BH care services 49 24.0% 2.18 Recruit, train, and support consumers of MH services to provide peer support services 15 6.4% 2.19 Develop care management function that integrates PH and BH needs of individuals 13 6.4% 2.17 Establish improvements in care transition from the inpatient setting for MH/SA patients 9 4.4% 2.9 Establish/expand a patient care navigation program 8 3.9% 2.2 Expand chronic care management models 4 2.5% 2.16 Provide virtual psychiatric and clinical guidance to PCPs delivering BH care 4 2.0% 2.6 Implement evidence-based health promotion programs 2 1.0% 2.1 Enhance/expand medical homes 1 0.5% 2.3 Redesign primary care 1 0.5% 2.4 Redesign to improve patient experience 1 0.5% 2.7 Implement evidence-based disease prevention programs 1 0.5% 2.8 Apply process improvement methodology to improve quality/efficiency 1 0.5% 2.12 Implement/expand care transitions programs 1 0.5%

Note: BH=behavioral health; MH=mental health; SA=substance abuse/use

Populations of Focus for Behavioral Health Projects

Populations Number of Projects Percent*

Targeted Age General adult population excluding children 235 59.5% General adult population and children 124 31.4% Children only 29 7.3% Older adults (65 and older) 11 2.8% Adolescents (12 to 17) 6 1.5% Transition age young adults (18 to 25) 2 0.5% Early childhood (0 to 5) 4 1.0%

Behavioral or Specialty Populations

Severe mental illness 263 66.6% Serious emotional disturbance 98 24.8% General mental health (non-SMI/SED) 129 32.7% Substance use problems 101 25.6% Medical populations 75 19.0% Intellectual or developmental disabilities 38 9.6% Autism 26 6.6% Homeless population 18 4.6% Criminal justice population 26 6.6% Veterans 7 1.8% High utilizers of emergency care (not specific to BH) 3 0.8%

Settings for Care

Service Setting # of Projects Percent*

Local Mental Health Authority (LMHA) 303 76.7% General Medical Hospital 59 14.9% Primary Care Clinic (non-FQHC) 54 13.7% General Medical Hospital – Psychiatric Unit 15 3.8% Federally Qualified Health Clinic (FQHC) 13 3.3% Mental Health Clinic (non-LMHA) 11 2.8% School 10 2.5% Psychiatric Hospital 8 2.0% Substance Abuse Clinic (non-LMHA) 8 2.0% Homeless Shelter/Facility 7 1.8% County Health and/or Human Services 4 1.0% County Jail 3 0.8% Inpatient Detoxification Facility 3 0.8% Ambulatory Detoxification Clinic 2 0.5% Mobile Clinic 2 0.5%

Note: *Total is >100% reflecting collaborations between more than one provider or service setting.

Types of New Staff / Providers Identified

Staffing Number

• f Projects

Percent Licensed Mental Health Practitioner (Psychologist, LPC, LMSW, LCSW) 115 38.0% Psychiatrist(s) 77 25.4% Nurse(s) 61 20.1% Administrative staff 60 19.8% Qualified Mental Health Practitioner 55 18.2% Peer Specialist 38 12.5% Physician(s) (non-psychiatrist) 31 10.2% Licensed Chemical Dependency Counselor 30 9.9% Advanced Nurse Practitioner 28 9.2% Community Health Worker or Promotoro/a 13 4.3% Certified Behavior Analyst 10 3.3% Patient Navigators or Care Coordinators 10 3.3% Health Information Technology or data analysis staff 7 2.3% Telepresenters 6 2.0% Law enforcement professionals 5 1.7% University faculty 5 1.7% Family Partner (parent peer support provider) 4 1.3%

Evidence-Based / Promising Practices

• 43.8% (n=173) of projects identified an EBP or promising practice.
• 19.1% (n=33) stated the practice would be selected during the

initial planning year.

• The 10 most commonly identified practices were:
• Cognitive Behavioral Therapy
• Cognitive Processing Therapy
• Supported Employment
• Applied Behavior Analysis
• Motivational Interviewing
• Wellness Recovery Action Planning
• Wraparound Planning
• Illness Management and Recovery
• Screening, Brief Intervention, and Referral to Treatment
• Collaborative Care

Integrated Care

Project Focus

# of Projects Percent* Mental health only 238 60.3% Co-occurring behavioral health and physical health 139 34.9% Co-occurring mental health and substance use 82 20.8% Unspecified behavioral health 65 16.5% Substance use disorders only 63 15.9% Co-occurring intellectual or developmental disorders and behavioral health 33 8.4% Intellectual or developmental disorders only 14 3.5% Co-occurring intellectual or developmental disorders and physical health 8 2.0%

Note: Some projects serve more than one quadrant.

Project Focus # of Projects Percent Co-occurring BH/PH N=139 Q1 (Low BH/Low PH) 34 24.5% Q2 (Hi BH/Low PH) 87 62.6% Q3 (Low BH/Hi PH) 39 28.1% Q4 (Hi BH/HI PH) 43 30.9% Project Focus # of Projects Percent Co-occurring MH/SA N=82 Q1 (Low MH/Low SA) 15 18.3% Q2 (Hi MH/Low SA) 44 53.7% Q3 (Low MH/Hi SA) 21 25.6% Q4 (Hi MH/Hi SA) 44 53.7%

Technology Projects

Technology Type # of Projects n=140 Percent

Telehealth 85 60.7% EHR – Primarily Medical 6 4.3% EHR – Primarily Behavioral Health 79 56.4% Data portals or data sharing platforms 20 14.3%

Crisis Services

Crisis Service Type

Number of Projects n=113 Percent Crisis respite 31 27.4% Mobile crisis outreach teams 28 24.8% Crisis stabilization programs 27 23.9% Crisis telehealth 27 23.9% Psychiatric consultation in emergency settings 8 7.1% Crisis triage or assessment centers 7 6.2% Psychiatric emergency centers or urgent clinics 7 6.2%

Reflections and Discussion

• Regional assessments revealed similar need
• Do workforce shortages create long term challenges

to success and do creative strategies provide remedies?

• Unprecedented opportunities for:
• Innovation
• Collaboration
• Evaluation
• Communication

Thank you.

Contact information: Molly Lopez, PhD mlopez@austin.utexas.edu Stacey Stevens Manser, PhD stacey.manser@Austin.utexas.edu http://sites.utexas.edu/mental-health-institute/