Behavioral Health Hom e Plus and Optim al Health James Schuster, - - PowerPoint PPT Presentation

Behavioral Health Hom e Plus and Optim al Health

James Schuster, MD, MBA CMO, Medicaid, SNP, and Behavioral Services UPMC Insurance Division

What is a Behavioral Health Hom e?

• A behavioral health home (BHH) is a service

delivery model that provides a cost-effective, longitudinal “home base” – Facilitates and coordinates access to behavioral health care, medical care, and community-based social services and supports for people with complex medical, behavioral health, and substance use disorders.

What is a BHH?

• The BHH is anchored in wellness

– “Wellness is not the absence of disease, illness and stress, but the presence of purpose in life, active involvement in satisfying work and play, joyful relationships, a healthy body and living environment, presence of happiness” -- Peggy Swarbrick, PhD

• Guided by the Triple Aim: Improving individual

experience of care, Improving population health, and Reducing per capita health care costs.

Key BHH Com ponents

• Comprehensive care management
• Care coordination and health promotion
• Comprehensive transitional care
• Enhanced engagement in primary care and other physical health

systems of care

• Individual and family support
• Community and social support services
• The use of health information technology to enhance population

management

Com m unity Care’s BHH Plus

• Community Care is

501(c)3 MCO, part of UPMC, 1,000,000 members in PA

• Successful early

collaboration with Community Care & BH providers in North Central region of PA to address wellness through BHH model in 2010

Behavioral Health Hom e Plus

• BHHP enhances the traditional BHH model by:

– Adding a Wellness Nurse to the existing team – Using wellness coaching to address self- management of modifiable lifestyle factors – Developing a health registry to track health needs and improvements – Improving health literacy and health navigation

Wellness Nurse

• Coordinates the BHHP team intervention including

the “virtual team” of community-based medical and social service providers

• Serves as a medical consultant to non-medical team

members and wellness coaches

• Guides the team in identifying and addressing gaps

in clinical care and coordinating care

• Develops a health resource library for the team

Wellness Nurse

• “Manages” the monthly registry of population-

focused data that identifies and stratifies individuals who have high-risk behavioral and medical indicators

• Reaches out to the highest risk individuals on

the registry to discuss doing a physical health assessment which helps to raise the individual's awareness of need

BHHP Outcom es: Optim al Health

• Optim izing Behavioral

Health Hom es by Focusing

• n Outcom es that Matter

Most for Adults w ith Serious Mental Illness (Optimal Health) Study

• A multi-stakeholder

collaboration to study the key components of the BHHP model

• Contract awardee:

– UPMC Center for High- Value Health Care

• Main partners include:

– Community Care – University of Pittsburgh – Stakeholder Advisory Board – BHARP, NC and Chester Counties and Providers

• Principal investigators:

– James Schuster, MD, MBA, Community Care – Charles (Chip) Reynolds III, MD, University of Pittsburgh – Tracy Carney, CPRP, CSP, Community Care

• Supported by the Patient-

Centered Outcomes Research Institute (PCORI)

CER to Exam ine BHH Models’ Im pact

• Patient Self Directed

– Wellness Coaches – Member Registry – Self Management Toolkits

• Provider Supported

– Wellness Coaches – Member Registry – Nurse focused on Wellness and Health

Study Methods and Design

• Cluster-randomized design with mixed methods approach
• Models implemented in 11 community mental health centers (CMHCs) over

2 years starting in 2013

• Research participant inclusion criteria:

– Medicaid-enrolled – 21+ years of age – Diagnosed with a serious mental illness – Receives services at community mental health center within Community Care’s network

• Institute for Healthcare Improvement’s Learning Collaborative Model used

to support implementation – Institute for Healthcare Improvement Breakthrough Series: http:/ / www.ihi.org

Learning Collaborative Process

Cre ate Chang e Pac kag e De ve lo p Charte r Se le c t T e ams Be g in Pre - Wo rk Ho ld L e arning Se ssio ns I mple me nt Ac tio n Pe rio ds Me asure Pro g re ss

Patient-Centered Outcom es & Data

PCOR I Optimal He alth Par tic ipants

He althChoic e s E ligibility Data

(Me dic aid e lig ibility)

Se lf-R e por t Me asur e s

(Patie nt ac tivatio n,** he alth status,** ho pe , quality o f life , func tio nal status, satisfac tio n with c are , so c ial suppo rt)

L e ar ning Collabor ative (L C) Data

(I mple me ntatio n info rmatio n)

Qualitative Data

(Se rvic e use r & pro vide r inte rvie ws)

**Primary o utc o me

Administr ative Data

(De mo g raphic info )

Be havior al He alth Claims

(BH diag no sis, utilizatio n)

Physic al He alth Claims

(E ng ag e me nt in primary/ spe c ialty c are **)

Pr imar y Data Sour c e s Se c ondar y Data Sour c e s

Phar mac y Claims

(Me dic atio n utilizatio n)

Prim ary Outcom es Findings

• Patient Activation:

– More rapid increase in provider-supported sites (with wellness nurse) than self-directed sites – Greater increase in activation for women in provider- supported; greater increase for men in self-directed

• Engagement in Primary/ Specialty Care:

– 36% increase in frequency of visits in both study arms

• Health Status:

– Small improvement in perceived mental health status – Small decline in perceived physical health status

Qualitative Findings: Patient View

• Shift in definition of health and wellness, away from vague to

more personalized

• Increased awareness of interconnectedness of mental and

physical health

• Overall favorable intervention experiences
• No major distinctions between arms – no evident differences

in engagement in or satisfaction with interventions

• Most important factor leading to intervention participation

was relationship with wellness coach

Qualitative Findings: Provider View

• High degree of agency support for wellness coaching
• Culture of wellness that benefitted both service users and providers
• Models integrated into routine practice
• Providers simplified/ casualized wellness coaching to increase

service user engagement

• Nurses often mentioned as most beneficial component of the model
• Robustly positive impact on service users’ health/ wellness
• Acute needs sometimes trumped wellness coaching
• Results published at

https:/ / www.healthaffairs.org/ doi/ 10.1377/ hlthaff.2017.1115

PCORI Award

• Contract Awardee: UPMC Center for High-Value Health Care in

collaboration with Community Care

• Purpose: Disseminate findings from our recently completed

PCORI-funded study to improve the overall health and wellness of

• ther priority and high-risk populations

– Residential Treatment Facilities (n=5) – Opioid Treatment Programs (n=7)

• Contract Duration: Two years (March 1, 2018 – February 2020)
• Principal Investigator: James Schuster, MD, MBA

– Co-Investigators: Tracy Carney, CPRP, CSP; David Dan, MSW, LCSW; David Loveland, PhD, MA

Specific Aim s

• Aim 1: Adapt BHHP for residential treatment for children

and methadone treatment program settings – Implement and assess the feasibility of using a Learning Collaborative approach to support RTF and OTP teams to deliver BHHP – Assess barriers and facilitators to Learning Collaborative participation and success

• Aim 2: Increase service user involvement and confidence in

managing their physical health/ wellness

• Aim 3: Examine change/ trends over time with BHHP

implementation on engagement in primary/ specialty care and unplanned health care utilization

JS7

Slide 18 JS7 We see an important aim of this project as being adapting BHHP for and implementing it in a new setting. If you agree, helpful to state explicitly.

Joanna Siegel, 5/15/2018

BHHP in RTF and OTP

• The project team has

developed additional materials to create tailored BHHP implementation manuals for RTF (residential treatment) and OTP (methadone program) service providers – Family-centered wellness coaching – Group wellness coaching

Im plem entation Challenges

• Physical health and wellness often seen as

“foreign” by BH practitioners

• BH practitioners did not know many PCPs and

vice versa, services were “siloed”

• Members often not engaged in routine,

preventive care

• The idea of “guideline based” care was novel to

many case management providers

Supportive Interventions

• Buy in by agency leadership
• Structured learning collaborative process
• Provider “share and steal” approach to work with

each other

• Learning community for wellness nurses
• Extensive technical assistance from Community

Care

Project Update

• Received approval from the UPMC Quality Improvement

Committee

• Engaged Advisory Boards

– Family of Child and Youth Members Board – State Recovery Member Board

• Conducted Wellness Coaching Training with RTF and

OPT staff

• Completed RTF and OTP Learning Collaborative kick-off

sessions and initial webinars

Contact Inform ation

Jam es Schuster, MD, MBA Chief Medical Officer of Medicaid, SNP, and Behavioral Services VP, Behavioral Integration UPMC Insurance Services Division schusterjm@upmc.edu

Thank You!