AIMS Center Introductions Sara Barker, MPH Assistant Director for - - PowerPoint PPT Presentation

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AIMS Center Introductions Sara Barker, MPH Assistant Director for - - PowerPoint PPT Presentation

Jan 25, 2023 157 likes •260 views

AIMS Center Introductions Sara Barker, MPH Assistant Director for Implementation Whole Person Care in a Behavioral Health Setting John Kern, MD Clinical Professor Phase 1 Webinar Series CPAA/AIMS Center Training Program January 15, 2019

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SLIDE 1

Whole Person Care in a Behavioral Health Setting

Phase 1 Webinar Series CPAA/AIMS Center Training Program January 15, 2019

AIMS Center Introductions

Sara Barker, MPH

Assistant Director for Implementation

John Kern, MD

Clinical Professor

Juliann Salisbury

Program Coordinator

Introductions

  • Organization, Team Member Names & Roles
  • What do you hope to get out of our training

year together?

AIMS Center Training Year at a Glance

Phase 1: Planning for Integration Phase 2: In Person Training Phase 3: Coaching & Training

  • Calls w clinic /org leaders to

determine key areas for planning and training

  • Develop or fine-tune

screening and treatment workflows

  • Orientation for providers

and staff to team roles

  • Assistance in choosing a

registry

  • Focus on nurse care

managers and case managers

  • Engaging clients and driving

active treatment to target

  • Using a registry to prioritize

and manage a caseload

  • Working with primary care

partners

  • Emphasis on practice and

active learning

  • New content introduced

through webinars and practiced in follow up case conference calls

  • Coaching calls for care

managers

  • Ad hoc support for work

flow course corrections

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SLIDE 2

Phase 1 and Phase 2 Announcements

  • Save the Date!

– All Day In-Person Training on May 7, 2019 – Olympia, WA – CEU Available

  • Monthly Webinar Series

– Third Tuesday of the Month, 10-11am

  • Site Planning Calls

– To schedule starting February – Frequency & length of calls flexible, monthly to start – For operations & clinical leadership

FOUNDATIONAL CONCEPTS FOR INTEGRATINIG PRIMARY CARE IN BEHAVIORAL HEALTH SETTINGS

Learning Objectives

By the end of this webinar, teams will:

  • Identify key health conditions that impact

people with serious mental illness and/or substance use disorders

  • Understand how to adopt core principles of

bi-directional integration and apply to their setting

New York Times Article: May 2018

https://www.nytimes.com/2018/05/30/upshot/mental-illness-health-disparity-longevity.html

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SLIDE 3

My Sudden Introduction to the Mortality Gap

  • Hard to pursue recovery goals when dead
  • No one else is doing it
  • Opportunity for frequent touches
  • Now part of our mission

Background: Life Expectancy in SMI

Short and NOT Improving p g

Bar 1 & 2: Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011 June;49(6):599-604 Bar 3: Daumit GL, Anthony CB, Ford DE, Fahey M, Skinner EA, Lehman AF, Hwang W, Steinwachs DM. Pattern of mortality in a sample of Maryland residents with severe mental illness. Psychiatry Res. 2010 Apr 30;176(2-3):242-5

Most Premature Mortality Due to Cardiovascular Disease (CVD)

  • Life expectancy 15

years shorter

  • CVD accounts for

60% of premature deaths among persons with SMI

  • Every CVD risk factor is more than twice as common

Prevalence of Current Smoking

Dickerson F, et.al,. Psychiatr Serv 2013; 64 (1): 44

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SLIDE 4

Impact of Antipsychotic Medications

*4–6 week pooled data (Marder SR et al. Schizophr Res. 2003;1;61:123-36; †6-week data adapted from Allison DB,Mentore JL, Heo M, et al. Am J Psychiatry. 1999;156:1686-1696; Jones AM et al. ACNP; 1999.

Estimated Weight Change at 10 Weeks on “Standard” Dose

6 Weight Change (kg) 5 4 3 2 1

  • 1
  • 2
  • 3

13.2 Weight Change (lb) 11.0 8.8 6.6 4.4 2.2

  • 2.2
  • 4.4
  • 6.6

†

*

What Can Reduce CVD Risk?

  • Meta-analysis for AHRQ: 33 RCTs from 1980-20121
  • 28 studies addressed weight
  • One weight loss study of Schizophrenia and Diabetes2
  • Comprehensive review for NIMH3 (80 of 108 studies

related to obesity)

  • Strong evidence for use of four interventions
  • Metformin for obesity
  • Lifestyle modification for obesity
  • Bupropion for tobacco cessation
  • Varenicline for tobacco cessation

1Gierisch JM, et al. J Clin Psychiatry. 2014 May;75(5):e424-40.; 2McKibbin CL, et.al. Schizophr

  • Res. 2006 Sep;86(1-3):36-44.; 3McGinty EE et al. Schizophr Bull. 2016 Jan;42(1):96-124.

Small Changes Big Difference

Cholesterol 10%

10% in cardiovascular disease

Blood Pressure 6mm/Hg

in cardiovascular disease 42% in stroke

Triglycerides 10 mm/L

5% in cardiovascular disease

HbA1c 1 pt

in diabetes related

deaths

in heart attacks in microvascular

complications

First Steps Towards Planning a Response

  • Team-based
  • Data-driven
  • How do you do it?
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SLIDE 5

Missouri CMHC Healthcare Homes

Year 5 | 2016

10 8.9

8.2 8.4 8.6 8.8 9 9.2 9.4 9.6 9.8 10 10.2 First Result Last Result For individuals with A1c > 9.0 at initial test result N = 909 First Result: 10 Last Result: 8.9

1.48points

Missouri CMHC Healthcare Homes Outcomes

Improving uncontrolled A1c

Current per member per month (PMPM) rate for CMHC Health Homes is $85.23 (Jan 2016)

Cost Savings

(2012-2015)

savings in millions

Over the first 4 years, CMHC Healthcare Homes produced a net savings of $98 million!

$

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% At-risk at Baseline Outcome Improved No Longer At-risk

Regional MHC 2015: Moving From ‘At-risk’ To ‘No Longer At-Risk’

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SLIDE 6

Principles for Evidence-Based Integration

Population-Based and Data-Driven

A defined group of patients or clients is tracked in a registry so that no one “falls through the cracks.”

Measurement-Based Treatment to Target

Treatment goals clearly defined and tracked for every patient. Treatments actively changed until clinical goals are achieved.

Team-Based and Person-Centered

Primary care and behavioral health providers collaborate effectively, using shared care plans.

Measurement-Based Care

“Involves the systematic use of symptom rating scales to drive clinical decision making.”

https://chp-wp- uploads.s3.amazonaws.com/www.thekennedyforum.org/uploads/2017/06/KennedyForum- MeasurementBasedCare_2.pdf

What is a Registry and How to Use It?

Integration of Care in Behavioral Health Needs Someone to Drive the Registry:

PCP Psychiatrist and /or PCP consultant Case Manager Patient Mental Health Center Primary Care Pat Pat Patien ien ie ent PCP Psychiatrist and /or PCP Partner Case Manager Patient Behavioral Health Agency Primary Care Nurse Care Manager / Registry Function

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SLIDE 7

Examples of Care Management Staff

  • Multiple staff can perform these functions with

different strengths/weaknesses – Behavioral health case managers

  • Used to coordinating care, interfacing with the outside world
  • Less medical background

– Nurses

  • More medical background
  • Sometimes less comfort with SMI population
  • More expensive!

– Peers

  • The benefit of lived experience
  • Less medical background

Addressing Physical Health in Pediatric Populations

  • Weight gain is severe and rapid in antipsychotic-

naïve patients treated not only with olanzapine but also with quetiapine, risperidone, and aripiprazole1

  • Child psychiatrists2

– Over 95% aware of all guidelines – Over 80% agreed with most guidelines – Less than 20% had adopted and adhered to most guidelines

  • 1JAMA. 2009;302(16):1765–1773.; 2Psychiatr Serv. 2017 Sep 1;68(9):958-961.

Action Items

1. Schedule team meetings and calls with AIMS Center 2. Complete Project Description Worksheet

– Overall Project AIM – Target Population – Measures

3. Email to Juliann (salisj2@uw.edu) by Friday, 2/15/19 4. Be prepared to share by Tuesday, 2/19/19

Training Website

https://aims.uw.edu/wastate/content/whole-person-care-training-program

  • Find webinar recordings, training resources & calendar
  • Share your best practice documents, workflows, or

presentations!

  • “None of us is as smart as all of us”
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SLIDE 8

Webinar Series Overview

  • Attend webinar, "Foundational Concepts for Integration in a Behavioral

Health Setting"

  • Project Description submitted before next webinar
  • 1. Foundational

Concepts for Integration

  • Attend webinar, "Team Roles and Readiness for Integrating Care" and share

final Project Description

  • AIMS Task List submitted before next webinar
  • 2. Team Roles and

Readiness for Integrating Care

  • Attend webinar, "Develop Your Clinical Workflow for Integrated Care" and

share team roles

  • Drafted workflow for screening or treatment of your target population

submitted before next webinar

  • 3. Develop Your

Clinical Workflow for Integrated Care

  • Attend webinar, "Population Management - Using a Registry to Track

Outcomes" and share workflow development

  • Finalize workflow and registry strategy
  • 4. Population

Management - Using a Registry to Track Outcomes

THANK YOU!