Primary Care Setting A Solution for Western New York Judith A. - - PowerPoint PPT Presentation

Integrated Behavioral Health in a Primary Care Setting

A Solution for Western New York Judith A. Feld, MD, MPH, MMM ACHP Meeting; April 28th-29th, 2014

Overview

• The new Primary Care: The Primary Connection
• Identifying the problem and potential solutions
• Pilot and Prototype Development
• Pilot Overview
• Program Goals/Expansion

The Primary Connection

• 29 community based practices, 189 physicians in a collaborative, shared

savings reimbursement model

• Governance: dedicated Physician Leadership Council made up of

community physicians and community leaders

• Strong collaboration between primary care physician practices and other

health care providers

• IH as facilitator: resources and programs to assist in practice

transformation and care delivery

• Founded on the principles of the Triple Aim

System Concerns

• 80% with a BH disorder will visit primary care at least 1X in a calendar

year1

• 67% with a behavioral health disorder do not get behavioral health

treatment2

• 30-50% of referrals from primary care to an outpatient behavioral health

clinic don’t make first appt3,4

• Two-thirds of primary care physicians (N=6,660) reported being unable to

access outpatient behavioral health for their patients. PCPs cited shortages of mental health care providers, health plan restrictions, and lack of coverage as significant barriers to mental health care access5

4

1. Narrow et al., Arch Gen Psychiatry. 1993;50:5-107. 2. Kessler et al., NEJM. 2005;352:515-23.

• 2. Fisher & Ransom, Arch Intern Med. 1997;6:324-333.
• 3. Hoge et al., JAMA. 2006;95:1023-1032.
• 4. Cunningham, Health Affairs. 2009; 3:w490-w501.

Provider Adoption Solutions

• Change how you provide

Train behavioral health ancillary professionals to deliver services as integrated members of the primary care team

• Change traditional treatment patterns

Basic behavioral care and mild/moderate mental illness and substance abuse will be treated in right setting at right time. High cost, scarce specialty mental health providers (psychiatrists) will work at top of license and service broad population needs

• Change how you pay

FFS hinders BH care delivery due to resource limitations. Move to “team reimbursement” and multi-payer agreement for psychiatric consultation.

6

Behavioral Health Developments

Independent Health Federal and State

For detail please see attached 1996 2016 Mental Health Parity Act (1996) Balanced Budget Act (1997) Mental Health Parity /Addiction Equity Act (2008) Affordable Care Act-Sec 1302 (2009) DSM-5 (2013)

• Reg. Behavioral

Health Orgs. (2011) Autism Mandate (2011) Health Homes (2012) HARP Initiative (2014-2016) Federal State PCMH Development (2009-2012) HEAL 17 Program (2011-2013) Impact Pilots (2011-2012) Primary Connection (2012-tbd) Amherst Peds Pilot (2012-2014) Proposed Integrated BH (2013-2016)

7

Requires multi-payer agrmnt to reimb. for pt case consult Trained BH professional, support regardless of payer

Building Upon Other Models

1 2 1 2

Pilot Development

• Partnership between Independent Health and Amherst Pediatric
• Built on success of national and local BH initiatives (Impact, Diamond, CAP

PC)

• Ideally supported by value-based reimbursement
• Reduce barriers to access behavioral health
• Improves BH access in a primary care setting
• Improve timeliness, quality and efficiency of care associated with BH

needs

• Conducive to scale and spread

8

Pilot Attributes

• Community Focus
• Promising prototype results
• Multi-payer potential
• Customized intervention - Focus on health behaviors (pain, obesity,

smoking cessation)in addition to mental health and substance abuse concerns

• Sustainable business model
• Builds on local community efforts

Initial Findings

• Clinical results

– Reduction in referrals to BH specialists – Reduction in use of ED for BH needs – Slight increase in pharmaceutical usage

• Financial results

– Estimated to reduce BH claims of $16,400 associated with IHA members – Return on Investment estimated at 2.18 to 1 during the pilot period (9 mos) – Potential to positively impact shared savings

• Practice experience / satisfaction
• Patient experience / satisfaction

10

11

Results

• Descriptive statistics suggest that the mental health integration model

may have contributed to a considerable increase in on-site diagnosis rate

• f mental health disorders in 2012.
• Additional findings:
• Overall mental health diagnoses decreased from 2011-2012, but on-site

diagnoses substantially increased

• Well visits declined and issue-focused/sick visits increased in 2012
• Mental health-related prescriptions increased in 2012
• Mental health-related ER visits declined modestly
• Overall visits to mental health providers declined
• Most of the decline is due to decreased visits to psychiatrists
• Visits to other providers declined very modestly

Model Benefits

Stakeholder Benefits

Primary Care Practices

• Improved competency in patient management
• Improve patient access, satisfaction and adherence
• Population management
• Cost containment
• Maintain NCQA recognition as PCMH
• Improve opportunities for shared savings, incentive awards
• Decreased stigma

Specialists

• Improved coordination and collaboration with referring physician
• Better medical outcomes
• Support participation in alternate reimbursement models (ACOs, Capitation)
• Improved patient satisfaction and adherence to care

Patients in Western New York

• Improved access to behavioral health care
• Convenience
• Decreased stigma
• Improved health outcomes
• Less out of pocket costs

Employers

• Decreased health care costs
• Better employee health
• Possible decrease in need for EAP

Payers

• Decreased health care costs
• Improved capacity to integrate disease management and case management activities

Program Expansion Goals

– Expand pilot demonstration – All patients to be seen – regardless of payer – Increase likeliness of adoption – Work to develop a common reimbursement model – Aligns with state’s interest in improving access to quality BH care for children and adolescents

13

Project Timeline

Planning (Mar-Apr ‘14) Recruitment (Q2 2014) Training (Q2 2014) Program Implement ation (July 2014 - May 2016 ) Evaluation (May '16- Aug '16) Expansion and Sustainability (May '16 -

• ngoing)