Bridging the Gap: Integrating Primary and Behavioral Health Services - PowerPoint PPT Presentation

Bridging the Gap: Integrating Primary and Behavioral Health Services Brie Reimann, MPA, Director, CIHS Andrew Philip, PhD, Deputy Director, CIHS

National Council for Behavioral Health w w w . T h e N a t i o n a l C o u n c i l . o r g 2900 Behavioral Health Organizations • Advocacy • Education • Technical Assistance: SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) 2

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Group Learning Experience: Regional and Online Learning Communities Cross-site TA Trainings and Peer Learning Tools: Web-based Tools and Resources 22% Issue Briefs 2 .M 4.5% Webinars Curated Content Integration Edge Individual Technical Assistance: Phone and video consultations, e-mail, site visits

Integrated Care Defined The care that results from a practice team of primary care and behavioral health clinicians working with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population.

In the US, about: • 1 in 5 adults experiences mental illness • 18% experienced an anxiety disorder • 7% experienced one major depressive episode • 1 in 25 adults experiences a serious mental illness • 2.6% of adults live with bipolar disorder • 1.1% of adults live with schizophrenia • 1 in 5 youth aged 13–18 experiences a severe mental disorder at some point during their life • Among the 20.2 million adults who experienced a substance use disorder, 50.5% had a co-occurring mental illness National Alliance on Mental Illness (NAMI)

Current Issues and Trends • The Opioid Epidemic will shine light on BH services • Certified Community Behavioral Health Centers (CCBHC) demonstration is underway • Medication Assisted Treatment • Trauma Informed Care • Financing Reform

Primary Care Settings High prevalence of a range of People with common medical behavioral health conditions disorders have high rates of co-morbid behavioral health • Anxiety, conditions • Depression, • Substance use in adults • Diabetes, • Anxiety, • Heart disease, • ADHD, • Asthma with depression • Behavioral problems in children (Worse outcomes and higher costs if both problems aren’t addressed) (Prevention and early intervention opportunity)

The Need for Integrated Care • 60% of adults and 70% of children get • 1/2 of all care for common psychiatric NO MH care disorders happens in primary care settings • Depression is the 3rd most common reason for a visit to a health center after • Populations of color are even more likely diabetes and hypertension to seek or receive care in primary care than in specialty behavioral health • Suicide is a major public health issue settings • Visits to emergency rooms involving the • Primary Care and ED settings are not misuse of prescription drugs have prepared to adequately address mental doubled in the last five years health disorders • Mortality rate is increasing among people • Achieve the Triple Aim: lower costs: with serious mental illness to 20-25 years improve health outcomes and improve earlier than general pop. patient satisfaction

BH Integration in Primary Care Includes: • Universal Screenings (MH/SU/Suicide/Trauma) • Clinical teams with embedded behavioral health clinicians • Prescribing with Psychiatric consultation • Medication assisted treatment for substance use disorders • Treatment plans that include mental health/recovery goals • Wellness services • Quality Improvement Measures • Community Linkages

What can integration look like? • Behavioral Health Consultants (BHCs) work alongside primary care providers (PCP) and make recommendations to the PCP. • Immediately accessible for both curbside and in-exam room consults, same-day visits (15 – 30 minute consultation), prevention education/ anticipatory guidance. • Shared records: Chart in the medical record using a SOAP note format. • No office, No Caseload, No “no shows” Robinson, P.J. and Reiter, J.T. (2007). Behavioral Consulta=on and Primary Care (pp 1-16). N.Y.: Springer Science + Business Media.

Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, SAMHSA-HRSA Center for Integrated Health Solutions. March 2013

The Case for Integration: Cost Savings • Numerous studies have revealed cost savings with regard to decreased use of ED and admissions (Lute & Manson, 2015; 10.1007/978-3-319-19036-5_2) • 19% reduction in ED visits and overall reduction in number of primary care visits (Institute for Healthcare Improvement, October 31, 2008) • Individuals participating in primary care depression management experienced a reduction in workplace absenteeism by over 28% (Smith & Dickinson, 2004)

The Case for Integration: Improved Functioning • Nearly all individuals experience an increase in functioning across studies • Also six studies found improvements in: • Anxiety • Depression • PTSD • Sleep • Tobacco (Hunter, 2017; DOI: 10.1007/s10880-017-9512-0)

The Case for Integration: Satisfaction • Patients in integrated primary care behavioral health settings have reported high levels (e.g., 97%) of satisfaction and increased functioning (Angantyr, 2015; https://doi.org/10.2224/sbp.2015.43.2.287; Runyan, 2004; https://doi.org/10.1089/109350703322425527) • Team-based primary care-behavioral health care has also been shown to improve provider satisfaction and decrease provider burn-out (Blount, 2003; 10.1037/1091-7527.21.2.121)

Integration Tools and Resources (CIHS) CIHS’ Standard Framework for Levels of Integrated Healthcare helps primary and behavioral healthcare provider organizations improve outcomes by helping them understand where they are on the integration continuum. There are a number of assessment tools designed to help provider planning. Lexicon for Behavioral Health and Primary Care Integration. Agency for Healthcare Research and Quality Integration Academy Four Quadrant Model: This model describes levels of integration in terms of primary care complexity and risk and MH/SU complexity and risk.

Integration Tools and Resources (CIHS) Quick Start Guide to Behavioral Health Integration is an interactive flowchart to walk you through some of the questions to consider when integrating behavioral health care. The Core Competencies for Integrated Behavioral Health and Primary Care provide organizations and individual professionals a “gold standard” for the skill set needed to deliver integrated care. Customized Billing and Financial Worksheets for each state to help identify existing billing opportunities for services provided in integrated healthcare settings Lessons Learned - Check out the eSolutions on Lessons Learned from Integration Pioneers or view the webinar to hear from SAMHSA Primary and Behavioral Health Care Integration (PBHCI) grantees who have taken on the task of integrating primary care into their services.

CIHS Tools and Resources Visit www.integration.samhsa.gov or e-mail integration@thenationalcouncil.org

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