Integrated Care: A psychiatrists perspective Mark Viron, MD - - PowerPoint PPT Presentation
Integrated Care: A psychiatrists perspective Mark Viron, MD Director of Health Home Services Massachusetts Mental Health Center Assistant Professor of Psychiatry Harvard Medical School DMH Research COE Conference | March 29 th , 2018
DMH Research COE Conference | March 29th, 2018
Mark Viron, MD
Director of Health Home Services Massachusetts Mental Health Center Assistant Professor of Psychiatry Harvard Medical School
Colton 2006, DRC 2006
DMH 2013
Most (60%) of these early deaths are from?
The #1 cause of death?
Heart Disease
Parks 2006 & 2008, Saha 2007, Newcomer 2007, DMH 2013
Obesity
23.6%
#2 Smoking
13.6%
#5 Diabetes
9.3%
#14 Hypertension
29.6%
#12 High cholesterol
34.5%
#10
Americashealthrankings.org (2017)
Obesity
47%
Smoking
47%
Diabetes
20%
Hypertension
46%
Dyslipidemia
59%
Poor quality of care Lifestyle Environment Mental Illness Medications
Poor quality of care Lifestyle Environment Mental Illness Medications
Integrated Intake Assessment
(Psychiatric assessment & general health screen)
Mental Health Services WaRM Center (Wellness
and Primary Care Services) Clozapine / Injection / Well-being & Medication Clinics
Primary care services Tobacco Treatment Exercise / Nutrition Health screening (including dental and vision) Preventive care, including vaccines Self-management
2011 Onsite Primary Care (BWH) 2014-16 MA AGO Behavioral Health Grant 2015-19 SAMHSA PBHCI Grant
Milestones in WaRM Center development
Wellness Check-in Get Fit Together Whole Health Action Management Nutrition group Smoke Free Program Yoga
Fitness, nutrition, tobacco cessation, self-management
*Outreach *Engagement *Assessment
Personalized Plan Services Follow-Up
1, 3, 6, 9, 12 months
Care Coordination Education 1:1 Cessation Counseling Peer coaching Cessation medications Groups
Quitline referrals Let’s Talk about Smoking Website
experience & based on principles from existing evidence-based disease self-management programs
manage physical and mental health conditions
integration.samhsa.gov 2016
accompany participants on activities chosen by the participant
20 40 60 80 100
BP BMI Waist CO A1C HDL LDL
Percent
Wellness participants vs non-participants
20 30 40 50 60
Baseline 12-month
Percent at Risk
Blood Pressure
Non-Participant Participant
Wellness participants vs non-participants
20 30 40 50 60
Baseline 12-month
Percent at Risk
Tobacco use (CO level)
Non-Participant Participant
2 4 6 8 10 12 14
# of cigarettes/ day
Averge daily use of cigarettes: group mean 12 24 32 Months
Carbon Monoxide Levels in Primary Care 5 10 15 20
Baseline 6 months 12 months 18 months* Heavy smoker Light smoker Non-smoker ppm
Blood Pressure 60 80 100 120 140
Baseline 6 months 12 months 18 months*
Systolic Diastolic WaRM PCP Non-WaRM
mmHg
Medical Hospitalizations
0.2 0.4 0.6 0.8 1 1.2
Rate Hospitalizations per person per year 17% Non-WaRM WaRM PCP
“Getting Better Together”
the last 6 months
the last 6 months
Treatment Planning
– #18 of 21: Food security, nutrition, wellness, and exercise
include, but are not limited to:
– Providing health education, coaching and symptom management – Education on how to reduce high risk behaviors and health risk factors, such as smoking, inadequate nutrition, and infrequent exercise – Assistance in linking to health promotion activities such as smoking cessation and weight loss – Assistance in setting health and wellness goals
and well-being including, but not limited to, healthy eating, physical activity and relaxation techniques
factors for early morbidity and mortality, including smoking, nutrition and physical activity, such as standardized screening and assessment tools, MI, SoC, WHAM, and/or other evidence-based interventions
Relevant proposed quality/performance measures
ACOs
Screening and Intervention
assessment
BHCPs
Collaboration
ED Visits BHCPs
diabetes
care visit ACCS
care visit
appropriate for our population?
generation?
services?
DMH 2013