SIM PTO TRAINING MAY 23, 2018 9:00 AM Call Instructions: Please - - PowerPoint PPT Presentation

SIM PTO TRAINING

MAY 23, 2018 9:00 AM

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Call Instructions:

Please

• Mute your phone, microphone, and speakers on your computer/device
• Turn off the zoom video feature
• Enter your name/organization in the chat box feature for attendance
• Submit questions via the chat box feature
• Questions will be answered following the presentation
• Time to ask questions via audio will be offered for those on the phone

COLORADO SIM PTO TRAINING: MAC REVIEW – 6 MONTHS

MAY 23, 2018

Presenters:

Stephanie Kirchner, MSPH, RD Andrew Bienstock, MHA Marjie Harbrecht, MD

TRAINING OBJECTIVES

▪ Review COHORT 1 Preliminary Results ▪ Review COHORT 2 MAC Results @ 6-Months ▪ Next Steps

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COHORT HORT 1 FI 1 FINAL NAL SU SURVEYS VEYS PR PREL ELIMIN MINARY ARY ANAL NALYSES YSES

STEPHANIE KIRCHNER, MSPH, RD ANDREW BIENSTOCK, MHA

COHORT 1 - PRACTICE DEMOGRAPHICS

▪ 92 practices successfully completed SIM

▪ Private/solo or group practice – 42 ▪ FQHC or lookalike – 22 ▪ Hospital or health system owned – 24 ▪ School-based health center – 3 ▪ HMO – 1 __________________________ ▪ Family medicine - 38 ▪ Pediatrics - 19 ▪ Mixed primary care – 21 ▪ Internal medicine - 10 ▪ Nurse-led primary care - 3 ▪ Geriatrics - 1

ACCESS TO A BEHAVIORAL HEALTH PROVIDER

▪ Full time onsite - 58 ▪ Part time onsite - 21 ▪ Full-time telehealth - 1 ▪ Consult only - 4 ▪ No answer - 8 ▪ A total of 8 mentioned telehealth

ONSITE BEHAVIORAL HEALTH PERSONNEL (ONLY THE 79 WITH ONSITE)

ONSITE BEHAVIORAL HEALTH PERSONNEL (ONLY THE 79 WITH ONSITE)

▪ Licensed Psychologist (LP): 13 in 12 practices ▪ Licensed clinical social workers: 65 in 51 practices ▪ Psychiatric nurse (RN or NP): 6 in 6 practices ▪ Licensed professional counselor: 34 in 28 practices ▪ Licensed marital and family therapist: 5 in 4 practices ▪ Licensed addiction counselor: 5 in 5 practices ▪ Licensed behavioral health provider, PhD: 14 in 9 practices ▪ Licensed behavioral health provider, PsyD: 13 in 8 practices ▪ Licensed behavioral health provider, MD/DO: 8 in 4 practices ▪ Other behavioral health provider: 19 in 12 practices

WHAT DID PRACTICE DO TO IMPROVE BEHAVIORAL HEALTH?

▪ 64 implemented more aggressive screening and follow-up for targeted conditions ▪ 37 hired an integrated behavioral health provider (BHP) ▪ 37 implemented a registry for targeted conditions ▪ 25 developed a collaborative agreement with a community mental health center ▪ 22 added a care manager at the practice site ▪ 12 contracted for integrated BHP with another organization

WHAT PRACTICES DID

▪ 12 arranged for a co-located BHP for the practice site ▪ 12 arranged for telephone or online counseling services ▪ 11 developed a collaborative agreement with a psychiatrist ▪ 9 added telepsychiatry services at the practice site ▪ 6 added a health coach at the practice site ▪ 5 contracted for integrated BHP with a community mental health center ▪ 20 Other (wide variety, almost all tied to behavioral health)

WHAT DID PRACTICE DO TO IMPROVE BEHAVIORAL HEALTH?

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1 2 5 4 2 4 3 9 11 2 2 6 14 26 25 31 33 28 36 18 13 Final (n = 91) Midpoint (n = 92) Baseline (n = 92)

COHORT 1 NUMBER OF PRACTICES ACROSS IPAT LEVELS OF INTEGRATION

Level 0 Level 1 Level 2 Level 3 Level 4 Level 5 Level 6

Measure N for Comparison Q4 Mean (STD) Q8 Mean (STD) Average Difference (p- value) Asthma 35 71.9 (27.4) 78.2 (23.2) 6.3 (0.01) Depression 69 42.6 (28.7) 56.7 (30.0) 14.2 (<0.0001) Development 6 93.0 (5.9) 93.8 (6.0) 0.8 (0.92) HbA1c 61 31.6 (18.3) 25.7 (11.7)

• 6.0 (0.004)

Hypertension 53 66.7 (10.3) 64.1 (11.2)

• 2.6 (0.18)

Falls 23 52.5 (33.0) 72.3 (24.9) 19.9 (0.002) Maternal Depression 12 59.6 (29.7) 77.0 (21.7) 17.4 (0.07)

COHORT 1 CLINICAL QUALITY MEASURES: QUARTER 4, 2016, VS QUARTER 4, 2017

COHORT 1 CLINICAL QUALITY MEASURES: QUARTER 4, 2016, VS QUARTER 4, 2017

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Measure N for Comparison Q4 Mean (STD) Q8 Mean (STD) Average Difference (p- value) Obesity 60 48.1 (18.0) 50.2 (20.3) 2.0 (0.41) Substance Abuse 4 63.4 (43.7) 5.5 (10.6)

• 58.9 (0.12)

Adolescent Obesity 21 89.8 (16.9) 85.6 (18.6)

• 4.2 (0.17)

Adolescent Diet 19 51.2 (31.5) 61.1 (32.1) 9.9 (0.01) Adolescent Exercise 18 51.9 (28.5) 58.0 (30.4) 6.0 (0.13) Tobacco NA NA 99.8 (1.2) NA

COHORT 1 MILESTONE INVENTORY

N = 54 MILESTONES

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5 10 15 20 25 30 35 Baseline Midpoint Final

Cohort 1 Milestone Inventory Results

Series 1 Series 2 Series 3

GREEN = Well established workflows, YELLOW = Some established work done & room for improvement, RED = No work being done & room for improvement

RATE THE PRACTICE SITE CONFIDENCE LEVEL THAT CURRENT ARRANGEMENTS FOR PROVIDING BEHAVIORAL HEALTH SERVICES ARE MEETING THE NEEDS OF PRACTICE SITE PATIENTS (SCALE: 1 - NOT CONFIDENT AT ALL TO 10 - EXTREMELY CONFIDENT)

▪ Mean = 7.5

Practice Confidence in Behavioral Health Services

HUGE SUCCESS IN CULTURE CHANGE!!!

IS THE INTEGRATION OF AN ONSITE BHP AND THE PROVISION OF INTEGRATED CARE SERVICES FINANCIALLY SUSTAINABLE FOR THIS PRACTICE SITE? (ONLY THOSE WITH ONSITE BHP = 79)

▪ Yes - additional revenues available through current payment models cover the costs of providing integrated care – 23 ▪ Yes - although revenues from current payment models do not cover integrated care costs, the service can be sustained through other revenue – 22 ▪ No - additional revenue sources will be needed in order to continue providing integrated care – 25 ▪ Unknown - information related to costs and revenues is insufficient to answer this question – 9

WILL THIS PRACTICE SITE CONTINUE TO OFFER INTEGRATED CARE EVEN THOUGH THE REVENUES MAY NOT BE SUFFICIENT OR IS UNKNOWN? (ONLY THE 34 WHO ANSWERED THE PREVIOUS QUESTION NO OR UNKNOWN) ▪ Yes 24 ▪ Unknown 4 ▪ Undecided 5 ▪ No 1

MAC RESULTS BASELINE TO 6 MONTHS ACROSS COHORT 2

ANDREW BIENSTOCK, MHA

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COHORT 2 – MAC RESULTS BASELINE VS 6 MONTHS

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COHORT 2 – MAC RESULTS GOOD STANDING

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MAC RESULTS BASELINE TO 6 MONTHS PTO INDIVIDUAL PRACTICE REPORTS

STEPHANIE KIRCHNER, MSPH, RD

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COHORT 2 - MAC 6 MONTH PTO REPORT SIM ONLY EXAMPLE

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COHORT 2 - MAC 6 MONTH PTO REPORT SIM/CPC+ EXAMPLE

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ACTION STEPS

MARJIE HARBRECHT , MD

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COHORT 2 – SIM ONLY - REQUIRED MILESTONES FOR YEAR 1

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COHORT 2 – SIM/CPC+ - ADDITIONAL REQUIRED MILESTONES FOR YEAR 1

TOUCH BASE CALLS TO REVIEW PROGRESS AND NEXT STEPS

▪ JUNE 4TH & 5TH from 1 – 4 pm

▪ Please look for sign up genius request sent on Saturday, 5/19/18 ▪ Reach out with questions ▪ Discuss at future PTO Trainings

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PHASE 5 (JUNE 15 – SEPT 14, 2018) BB8 – PROMPT ACCESS TO CARE, INCLUDING BH BB9 – COMPREHENSIVE CARE COORDINATION FOR PRIMARY CARE / BEHAVIORAL HEALTH BB10 – FULLY INTEGRATED BEHAVIORAL HEALTHCARE TO PROVIDE WHOLE PERSON CARE

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PHASED APPROACH TIMELINE

WHERE TO START? PATIENT POPULATION ("ACTIVE" PATIENT PANEL)

POSITIVE BH/SUD

BB6 - RISK STRATIFICATION Year 2: Risk stratify at least 75% of population

LOW RISK MEDIUM RISK HIGH RISK

BB6 - CLOSELY MANAGE at least 75% of HIGH RISK PATIENTS

SIM COHORT 2 MILESTONE OPERATIONAL ALGORITHM (OVERVIEW)

COORDINATED and/or INTEGRATED CARE

EXPAND and MAINTAIN EFFORTS ALL PATIENTS CONTINUE BB1, BB2, BB4, BB5 BB6 - HIGH RISK PATIENTS Year 2: Risk stratify, use data to manage care gaps/track outcomes, develop care plans for 75% of high-risk patients PATIENTS WITH BH ISSUES BB8 - ACCESS TO BH CARE Year 2: Bi-directional data sharing BB9 - CARE COORDINATION TO REDUCE COSTS AND IMPROVE CARE BB10 - BH REFERRAL PATHWAY WITH 24/7 EHR ACCESS; CARE PLANS, TRACK BH PATIENT OUTCOMES USE REGIONAL HEALTH CONNECTORS TO ASSIST YOU WHEN POSSIBLE

BUILD INFRASTRUCTURE

BB1 - ENGAGED LEADERSHIP Year 1: Establish agreements with payers, set up budget, QI team, champion attends CLS, set vision for behavioral health (BH) integration and pathway UNDERSTAND THE MAKEUP OF YOUR POPULATION

• IMPROVE CONTINUITY

THROUGH EMPANELMENT

• SCREEN FOR BH/SUD
• USE DATA TO

CLOSE GAPS & IMPROVE CARE BB3 - EMPANEL AT LEAST 75% of PATIENT POPULATION ______________ BB7 - SCREEN UP TO 90% FOR BH/SUD Connect to BH/Community

Prevent Low and Medium Risk patients from becoming High Risk

STRATEGICALLY MANAGE YOUR POPULATION BY RISK STRATIFYING TO DETERMINE WHO NEEDS ADDITIONAL ATTENTION/SERVICES

• BUILD COLLABORATIVE

AGREEMENTS WITH BEHAVIORAL HEALTH (EITHER ONSITE OR OFFSITE) TO IMPROVE COORDINATION AND MANAGEMENT

Improve Quality of Care Reduce Costs Improve Experience for Patients & Healthcare Teams

BUILD INFRASTRUCTURE BB2 - USE DATA TO DRIVE CHANGE Year 1: Data, care gaps, CQMs, cost drivers BB4 - TEAM-BASED CARE Year 2: Workflows for three CQMs (at least 1BH) BB5 - PARTNERSHIP WITH PATIENTS Year 1: Establish PFAC Year 2: Shared decision-making aids and self-management support tools BB8, BB9 and BB10 - BEHAVIORAL HEALTH ISSUES Year 1: Start building infrastructure to address BH Year 2: Develop collaborative care agreements with BH providers

COLLABORATIVE LEARNING SESSION PEARLS

SELECT ONE “PEARL” THAT YOU LEARNED DURING THE CLS AND SEND IT TO: KELLYN.PEARSON@UCDENVER.EDU

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UPCOMING EVENTS

May 2018

▪ 5/24--SPLIT Office Hours 9-10 am June 2018 ▪ 6/12 – TCPi PTO Touchbase; Cost & Utilization Learning Lab –9-10 am ▪ 6/14 -PTO Training BH Integration Workshop 8am – 4 pm - REQUIRED ▪ 6/14 SIM Office Hours-10-11 am – CANCEL?? ▪ 6/19- CMGMA Practice Webinar-11-12 noon ▪ 6/19 –CHITA Learning Community-3-4 pm ▪ 6/20 –MGMA Practice Webinar –12-1 pm ▪ 6/ 21- Learning Features Call – CANCELLED due to BHI workshop ▪ 6/26 – Colorado QPP Coalition Office Hours webinar; Advancing Care Information Category; Overview of the requirements and scoring for this category in 2018 12- 1 pm ▪ 6/27 – SIM PTO Training - COHORT 3 PRIMER & PHASE 5: BB8.Y1 – Provide Prompt Access; BB9.Y1- Comprehensive Care Coordination; BB10.Y1- Provide Fully Integrated BH for whole person care 9-10 am ▪ 6/28--SPLIT Office Hours 9-10 am

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University Practice Innovation Team Contact Information

Practice Transformation – Stephanie.Kirchner@ucdenver.edu Learning Community - Kellyn.Pearson@ucdenver.edu CQMs & SPLIT/Data Related – support-split@ucdenver.edu ENSW & IT MATTTRs 2 – Daniel.Pacheco@ucdenver.edu TCPi - Kristin.Crispe@ucdenver.edu or Allyson.Gottsman@ucdenver.edu SIM – PracticeInnovation@ucdenver.edu Invoicing – Natalie.Buys@ucdenver.edu All Other Questions – PracticeInnovation@ucdenver.edu

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REFLECTIONS AND QUESTIONS