Primary Care and Behavioral Health Integration: Brief Overview of - - PowerPoint PPT Presentation
Primary Care and Behavioral Health Integration: Brief Overview of Massachusetts Efforts 6/13/2019 CONFIDENTIAL Do Not Distribute AGENDA Introduction and Overview of the Health Policy Commission Some Context and History: MassHealth
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▪ Data hub ▪ Independent state agency overseen by a
Council chaired by the Secretary of Health and Human Services
▪ Duties include:
– Collects and reports a wide variety of
provider and health plan data
– Examines trends in the commercial health
care market, including changes in premiums and benefit levels, market concentration, and spending and retention
– Manages the All-Payer Claims Database – Maintains consumer-facing cost
transparency website, CompareCare
Center for Health Information and Analysis (CHIA)
▪ Policy hub ▪ Independent state agency governed by an 11-
member board with diverse experience in health care
▪ Duties include:
– Sets statewide health care cost growth
benchmark
– Enforces performance against the benchmark – Certifies accountable care organizations and
patient-centered medical homes
– Registers provider organizations – Conducts cost and market impact reviews – Holds annual cost trend hearings – Produces annual cost trends report – Supports innovative care delivery investments
Massachusetts Health Policy Commission (HPC)
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INVESTIGATE, ANALYZE, AND REPORT TRENDS AND INSIGHTS
MONITOR AND INTERVENE WHEN NECESSARY TO ASSURE MARKET PERFORMANCE
BRING TOGETHER STAKEHOLDER COMMUNITY TO INFLUENCE THEIR ACTIONS ON A TOPIC OR PROBLEM
ENGAGE WITH INDIVIDUALS, GROUPS, AND ORGANIZATIONS TO ACHIEVE MUTUAL GOALS
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1 “Participating Practices”. Massachusetts Patient Centered Medical Home Initiative, Executive Office of Health and Human Services. http://www.mass.gov/eohhs/gov/commissions-and-initiatives/healthcare-reform/pcmhi/about/participating-practices.html 2 Harris, Julian. “Transition to Alternative Payment Methods: From Patient Medical Homes to the Primary Care Payment Reform Initiative”. MassHealth, Executive Office of Health and Human Services, December 18, 2012. http://www.mass.gov/anf/docs/hpc/pcmhi-and-pcpr-presentation-to-the-hpc.pdf 3 Henriquez, Claudia. “Lessons Learned in Primary Care Payment Reform and Practice Transformation”. MassHealth, Executive Office of Health and Human Services, June 2017. https://www.masspartnership.com/pdf/PCPRandPracticeTransformation-June2017.pdf 4 “MassHealth Accountable Care Organization (ACO) Models: Questions and Answers”. MassHealth, Executive Office of Health and Human Services. September 30, 2016. https://www.mass.gov/files/documents/2016/09/pn/aco-models-questions-and-answers.pdf
demonstration project aimed at promoting adoption of the patient-centered medical home model
year transformation plan with goal of applying for NCQA PCMH Recognition
PMPMs for medical home activities, and upside-only shared savings
practices integrated BH care through coordination, co- location, or full- integration
readiness for accountable care through experience with risk, care coordination, building PC infrastructure
primary care services with
quality performance incentive, and shared savings/risk for non-PC spending
care across domains such as BH and LTSS and additional emphasis on SDH
through primary care physicians
quality of care through a variety of prospective payment and shared savings/risk models
PCMH model, e.g. the BH/LTSS CP program aims to improve care coordination
investment in primary care
Patient-Centered Medical Home Initiative1,2 Primary Care Payment Reform Initiative2,3 Accountable Care Organization program4
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“The commission, in consultation with the office of Medicaid, shall develop and implement standards of certification for patient-centered medical homes. In developing these standards, the commission shall consider existing standards by the National Committee for Quality Assurance
the commission shall be based on the following criteria:
(1) enhancing access to routine care, urgent care and clinical advice though means such as implementing shared appointments, open scheduling and after-hours care; (2) enabling utilization of a range of qualified health care professionals, including dedicated care coordinators, which may include, but not be limited to, nurse practitioners, physician assistants and social workers, in a manner that enables providers to practice to the fullest extent
(3) encouraging shared decision-making for preference-sensitive conditions such as chronic back pain, early stage of breast and prostate cancers, hip osteoarthritis, and cataracts; provided that shared decision-making shall be conducted on, but not be limited to, long-term care and supports and palliative care; and (4) ensuring that patient-centered medical homes develop and maintain appropriate comprehensive care plans for their patients with complex or chronic conditions, including an assessment of health risks and chronic conditions. (5) such other criteria as the commission deems appropriate.”
Commonwealth of Massachusetts, Legislature. An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation. Chapter 224 of the Acts of 2012, 6 August 2012.
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Massachusetts residents reporting any mental illness (AMI), 46.2% did not receive mental health treatment or counseling.1
increase total health care costs, and complicate disease management.2
patients with both depression and diabetes have twice the average healthcare spending as patients with diabetes alone. 3
conditions into primary care visits may help reduce the need for higher-cost behavioral health care and additional medical care, and lead to better health outcomes
1Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Massachusetts, 2015. HHS Publication No. SMA-16-Baro-2015-MA. Rockville, MD: Substance Abuse
and Mental Health Services Administration, 2013. http://www.samhsa.gov/data/sites/default/files/Massachusetts_BHBarometer.pdf
2Mental Health Financing in the United States, A Primer, April 2011. The Kaiser Commission on Medicaid and the Uninsured. Data based on SAMHSA Spending Estimates Project, 2010.
https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8182.pdf
3Unutzer, Jurgen et al. The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes. Health Home: Information Resource Center. Brief May
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Starting January 1, 2016, practices achieved HPC’s PCMH PRIME certification by demonstrating enhanced capacity and capabilities in behavioral health integration (BHI). Practices entered the Pathway to PCMH PRIME and were certified on a rolling basis.
Pathway to PCMH PRIME (up to 18 months)
2011 Level 2 NCQA 2011 Level 3 NCQA 2014 NCQA 2017 NCQA HPC/NCQA Assessment of Behavioral Health Integration (PRIME)
PCMH PRIME Certification
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# Criteria (practice must meet ≥ 7 out of 13)
1 The practice has at least one care manager qualified to identify and coordinate behavioral health needs. 2 The practice has at least one clinician located in the practice who provides medication-assisted treatment, and provides behavioral therapy directly or via referral, for substance use disorders. 3 The practice works with behavioral healthcare providers to whom the practice frequently refers, to set expectations for information sharing and patient care. 4 The practices integrates behavioral healthcare providers into the care delivery system of the practice site. 5 The practice tracks referrals to behavioral health specialists and has a process to monitor the timeliness and quality of the referral response. 6 The practice conducts a comprehensive health assessment that includes behaviors affecting health, and the mental health/substance use history of patient and family. 7 The practice conducts developmental screening using a standardized tool for patients under 30 months of age. 8 The practice conducts depression screenings for adults and adolescents using a standardized tool. 9 The practice conducts anxiety screenings for adults and adolescents using a standardized tool. 10 The practice conducts alcohol use disorder or other substance use disorder screenings for adults and adolescents using a standardized tool. 11 The practice conducts postpartum depression screenings using a standardized tool. 12 The practice implements clinical decision support following evidence-based guidelines for care of mental health conditions and substance use disorders. 13 The practice establishes a systemic process for identifying patients who may benefit from care management, and criteria that include consideration of behavioral health conditions.
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HPC partnered with National Committee for Quality Assurance (NCQA) to: Program design consulting support Communications about PCMH PRIME
Evaluation of practices for PCMH PRIME
Training for practice applying for PCMH PRIME
PRIME and the application process
1 2 3 4
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Increase the capacity of primary care practices to identify and treat behavioral health conditions, in coordination with behavioral health providers as appropriate Increase the number of PCMH PRIME certified practices in the Commonwealth Increase the number of PCMH PRIME criteria that practices are able to meet Facilitate knowledge transfer between “leading” practices and those newer to implementing behavioral health integration Support primary care practices that may vary in geographic location, setting, primary care model, patient population, and other characteristics (including those serving special high-risk populations) to achieve PCMH PRIME certification Identify areas of need for further behavioral health integration support among primary care practices in the Commonwealth
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Eligible Entities All MA primary care practices; some TA for Pathway or PCMH PRIME Certified practices only TA Contractor HPC contracted with Health Management Associates to design and deliver PCMH PRIME TA Content Behavioral health integration: collaborative care model and PCMH PRIME criteria Structure
In-person sessions to facilitate peer-to-peer learning on behavioral health integration best practices HMA practice coaches provide telephonic or
proposal to request up to 20 hours of practice coaching for a BHI project of their choice. 7 pre-recorded webinars on how to
available to all Pathway or PCMH PRIME Certified primary care practices.
~4 knowledge sharing sessions in 2018 Individualized practice coaching Access to 7 pre- recorded webinars
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Virtual Learning Community Participants
LC 2 LC 1
“[Practice coach] was instrumental in helping us think about population managing our behavioral health patients and giving us the tools needed to advocate for the resources needed to do so.”
learnings
“TA helped add to the processes that were in place and also help prioritize what other criteria need to be reviewed to attain PCMH PRIME.”
PRIME cohort 1 participants
after completing TA
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PCMH PRIME NCQA Distinction in BHI
Eligibility
NCQA PCMH Recognized practices (MA
NCQA PCMH Recognized practices (all states)
Certification/ recognition period
3 years 1 year; after initial application, practices submit abbreviated documentation to maintain distinction
Total number of criteria
13 criteria 18 criteria
# of criteria needed to pass
Any 7 criteria 13 criteria, including all 11 “core” criteria and any 2
Overview of standards
care
including BH screenings (6 criteria)
management
needs
model such as brief interventions, consultative relationship with a BH provider, and monitoring BH symptoms and adjusting care
behavioral and physical health
taking action to improve performance
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Current PCMH PRIME program sunseted on April 30, 2019 NCQA Distinction in Behavioral Health Integration now qualifies practices for HPC PCMH Certification HPC is exploring new ways to support behavioral health integration:
Telehealth Tools Outcomes- Oriented Measurement BH Prescribing In Primary Care
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