Achieve Quality Targets for Integrated Behavioral Health in Primary - - PowerPoint PPT Presentation

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Leveraging Population Health Analytics to Achieve Quality Targets for Integrated Behavioral Health in Primary Care

Kathleen Tatem, MPH Office of Population Health, NYC Health + Hospitals

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NYC Health + Hospitals:

• Largest Safety-Net health system in the

country

• Mandate to care for uninsured and

underserved New Yorkers

• 11 acute care hospitals, 6 diagnostic and

treatment centers, 5 long-term care facilities, 70+ ambulatory care centers, and correctional health services

• Over 1 million patients and 6 million visits

per year

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Integrated Behavioral Health in Primary Care

Patient

Registry

Consulting Psychiatrist

Provider

CC Nurse

• r Social

Worker

Population-based Collaborative Care Team Model Quality Performance Metrics

*Percent of patients enrolled 70+ days demonstrating clinically significant improvement (e.g. 50% reduction from baseline PHQ9 or PHQ9 less than 10)

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Data Challenges and Poor Outcome Metrics in 2015

• Quarterly depression improvement rate was 17.7%
• Data was not routinely entered in the registry
• Staff education/buy-in needed on the value of the

registry (e.g. patient tracking, and outcome assessment)

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Solution: Analytics Enabled Collaborative Care

1. Actionable & responsive data tools 2. Data transparency 3. Staff training and support

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• 1. Actionable & Responsive Data Tools

Weekly Patient Lists

• Workflow-driven
• Outreach List
• Psychiatric Consultation List
• Graduation List
• Delivered weekly to point-of-care
• User friendly – designed with

user in mind

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2: Data Transparency Monthly Dashboards

• Share data widely with

frontline staff and leadership

• Engage in continuous quality

improvement

• Connect patient care

workflows and treatment to data and metrics

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3: Staff Training and Support

• Provide education and support to frontline staff and leadership on the use and

benefits of data tools and metrics through…

On-the-ground trainings and support/coaching User guides and support material WebEx and online trainings Personalized emails and remote ‘Office Hours’

Image Credit: Arfan Khan Kamol from Noun Project

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Following Implementation of Analytic Support and Buy-In, Exceeded Quality Outcome Metric Target

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Transparent/Actionable Data and Stake Holder By-In is Key to Achieving Quality Patient Care and Quality Targets

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THANK YOU!

• Kathleen Tatem, MPH
• Office of Population Health, NYC Health + Hospitals

@ KathleenTatem