Integrated Health Care Initiative Collaborative Quarterly Meeting - - PowerPoint PPT Presentation

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Integrated Health Care Initiative Collaborative Quarterly Meeting - - PowerPoint PPT Presentation

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Integrated Health Care Initiative Collaborative Quarterly Meeting November 14th, 2018 www.mhahouston.org Collaborative Introductions www.mhahouston.org Today we www.mhahouston.org HOPE Clinic Demonstration Project Rodolfo Orna, M.A.

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www.mhahouston.org

Integrated Health Care Initiative Collaborative Quarterly Meeting

November 14th, 2018

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www.mhahouston.org

Collaborative Introductions

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Today we…

www.mhahouston.org

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HOPE Clinic Demonstration Project

Rodolfo Orna, M.A. LMFT, Behavioral Health Director & Shahrzad Afshin Yakta, Behavioral Health Consultant

www.mhahouston.org

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Mission To provide quality healthcare without any prejudice to all people of greater Houston in a culturally and linguistically competent manner

Rodolfo Orna, LMFT Director of Behavioral Health

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Main Clinic West Clinic Alief Clinic

BHS PSYCHIATRY OB -GYN ADULT PEDIATRICS OPTICAL DENTAL

Visits & Encounters 2017 104,000 Visits 17,898 Patients (BH 3,271 visits)

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25%

Asian

25%

African American

29%

Hispanic

1%

Multiracial

20%

Caucasian

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OUR PATIENTS AGE DISTRIBUTION

45-64 20-44 65+ 0-4 5-12 13-19

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Main Clinic Primary Care West Location Primary Care Alief Location Primary Care

BHS PSYCHIATRY 2 BHC

Child

Child

Adult Adult Child/A

Adult

PCP BHS BHC

Psych

BH Coordinator MA/Front Office

BHC=Behavioral Health Consultant BHS= Behavioral Health Specialist

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Main Clinic Primary Care

BHC: Pediatrics BHC: Adult & OB-GYN

PCP

Visits triggered by: Screening PHQ-9 Edinburgh PSC-17 CAGE PCP referrals

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Integrated Primary Behavioral Health Care Flow Chart

MA Triage + PHQ-9 or Edinburgh Screening Behavioral Health Consultant Behavioral Health Specialty: Psycho- therapy(Counseling) and/or Psychiatry Medical Provider

Follow Crisis Protocol to determine Hospitalization

MEDICAL Visit Completed Coordinates discharge and referrals to BH Specialty Active Suicidal, Homicidal or Psychosis

  • Health outcomes
  • Emotional

disturbances

  • Mental Health

Crisis Additional Screenings: PSC-17, CAGE,DAST, TRAUMA,

Consult ation

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Main Clinic Primary Care HOPE West Clinic HOPE Alief Clinic

BHC: Pediatrics BHC: Adult & OB-GYN

PCP

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PROGRESS : LEVELS OF COLLABORATION/INTEGRATION

 LEVEL 4: Close Collaboration Onsite with Some System

Integration: Communications, Collaboration, Meeting, Roles  LEVEL 5: Close Collaboration Approaching an Integrated Practice: Treatment Delivery, Patient Experience,  LEVEL 6: Full Collaboration in a Transformed/Merged Integrated Practice: Facilities, Resources, EMR, Leadership Support,

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2018 CFHA Conference Takeaways

www.mhahouston.org

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www.mhahouston.org

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Practice Integration Profile

www.mhahouston.org

  • Organizational self-assessment survey

www.practiceintegrationprofile.com

  • Dimensions:

– Workflow – Clinical Services – Workspace – Shared Care & Integration – Patient Engagement

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In our practice…

1.…BH and Medical Clinicians regularly and actively exchange information about patient care. 2.…there are regular educational activities including both BH and Medical Clinicians. 3.…BH and Medical Clinicians regularly spend time together collaborating on patient care. 4.…patients with BH needs have shared care plans developed jointly by the patient, BH and Medical Clinicians and updated over time.

Practice Integration Profile

Dimension: Shared Care & Integration

www.mhahouston.org

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www.mhahouston.org

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CFHA 20th Annual Conference Session B1 Takeaways

www.mhahouston.org

  • “Dynamic Evolution of Integrated Behavioral Health:

Developing Data Management Systems for continuous Quality Improvement.”

  • Presented by the University of California San Diego
  • Presentation takeaways:

– National trends and needs – Program structure and background – Clinical & operational aspects – Measures of integration (tools) – Financing integration review

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Clinical Quality Report

Sample

www.mhahouston.org

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Provider Productivity Report

Sample

www.mhahouston.org

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Operational Report

Sample

www.mhahouston.org

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Measures of Integration

www.mhahouston.org

  • Practice Integration Profile (PIP)
  • PCBH-based Provider Adherence Questionnaire (PPAQ)
  • TCARE (Targeted Collaborative Assessment and Response Empowerment)

– UCSD’s real-time consultation EHR tool

  • Recommendation: Define/identify your approach  identify outcomes 

identify measures. Also, identify resources within department to partner with, to develop systems to input and extract data

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Individual Profit & Loss Report

Sample

www.mhahouston.org

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www.mhahouston.org

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CFHA 20th Annual Conference Session E6 Takeaways

www.mhahouston.org

  • “Integrated Behavioral Health at Mayo – Bringing Together

Mental Health Disciplines in Primary Care to Better Address a Population.”

  • Presented by the Mayo Clinic
  • Presentation takeaways:

– Program structure & team – Types of services provided – Challenges & recommendations – Tracking of outcomes

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The Multidisciplinary Team

www.mhahouston.org

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“You Are Not Alone!”

www.mhahouston.org

https://www.ruralhealthinfo.org/toolkits/services-integration/2/primary-care-behavioral-health

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www.mhahouston.org

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CFHA 20th Annual Conference Session E7a Takeaways

www.mhahouston.org

  • “The Validation of Ultra-Brief, Patient Feedback Measures

Intended to Improve the Care of Chronic Illnesses in Primary Care”

  • Presented by University of New England faculty and Peak Vista

Community Health Centers staff

  • Presentation takeaways:

– “Privileging the patient perspective” – Patient values & preferences as a key component of evidence-based practice – Partners for Change Outcome Management System (PCOMS) https://betteroutcomesnow.com/

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PCOMS – BH (Behavioral Health)

www.mhahouston.org

Outcome Rating Scale (ORS)

Individually: (Personal well-being) ____________________________________ Interpersonally: (Family, close relationship) ____________________________________ Socially: (Work, school, friendships) ____________________________________ Overall: (General sense of well-being) ____________________________________

Session Rating Scale (SRS)

I did not feel heard, understood and respected. We did not work on

  • r talk about what I

wanted to work on and talk about. The therapist’s approach is not a good fit for me. There was something missing in the session today. Relationships Goals and Topics Approach or Methods Overall I felt heard, understood and respected. We worked on and talked about what I wanted to work on and talk about. The therapist’s approach is a good fit for me. Overall, today’s session was right for me.

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  • PCOMS – WRS (Wellness Rating Scale)

– Personal Health, Relationships, Activities, Quality of Life – Scale from  to 

  • PCOMS – PAS (Provider Alliance Scale)

– Relationship, Communication, Partnership, Treatment – Example (Relationship) – I did not feel comfortable asking questions or

raising concerns about my health and treatment.  I felt comfortable asking questions and raising concerns about my health and treatment.

  • Peer-reviewed validation study:

http://link-springer-com-443.webvpn.jxutcm.edu.cn/article/10.1007%2Fs11136-018-1967-4

PCOMS – WRS & PAS Chronic Illness Measures

www.mhahouston.org

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Workgroups 2019 Projects Overview

MHA Staff

www.mhahouston.org

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2019 Work Group Projects

www.mhahouston.org

  • Service Delivery Work Group

– Screening to Treatment Roadmap White Paper – Public Education on Integrated Care – Educational Forums

  • Financing Work Group

– Sustainability Toolkit

  • Institutions of Higher Education

Work Group

– Institution Presentations – TMC Policy Institute IHC Course – Professional & Accrediting Association Presentations

  • Public Policy Work Group

– 87th Legislative Session Agenda Planning – 86th Legislative Session Advocacy Task Force

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Evaluation Pathway

www.mhahouston.org

Source: Collective Impact Forum. FSG. “A Framework for Performance Measurement and Evaluation of Collective Impact Efforts” We are here! Q3 2018

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10-Year Report

Accomplishments Q4 2025

Biennial Report

Progress to date Q4 2024

Biennial Report

Progress to date Q4 2022

Integrated Health Care Initiative Timeline

www.mhahouston.org

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Early Years (3) Middle Years (5)

18 Guiding Recommendations Developed

Q2 2016

IHCI Launched

Q2 2015

IHCI Report Published

Recommendations Q4 2016

Action Plans Finalized

Work Groups Q4 2018

Stakeholder Meetings

Q3 2015

Today

Collaborative Meeting Q4 2018 Late Years (2) Retreat Interviews Policy Project

Collaborative & Work Group Meetings

Q1 2017 – Q3 2018 Quarterly/Bimonthly

Collaborative & WG Meetings / Action Plans Implementation

2019 - 2025 Exact Milestones TBA

5-Year Report

Progress to date Q4 2020

Demonstration Projects / Learning Communities Launched

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  • Continuing:

– Quarterly Collaborative Meetings – Quarterly Networking Events – Monthly Work Group Meeting – Biweekly Resource Bulletin – In-depth Educational Events

  • Potential Opportunities:

– Learning Community Calls (Various Focus Areas)

Looking Ahead Into 2019!

www.mhahouston.org

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2018 CFHA Conference Takeaways

MHA Staff

www.mhahouston.org

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www.mhahouston.org

Thank You!