Download - Integrated Care: Where’s this going? Why?
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IBHP Grantee ConvocationSacramento, CA
September 12, 2008
Frank deGruy
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Integrated Combining dissimilar things into a coherent
whole that has meaning and value
Behavioral Health Mental disorders Substance use problems Health behavior change
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Mental Health Services Research NIMH AHRQ RWJ MacArthur
Substance Use and Criminality Quality Improvement Clinical Decisionmaking and EBM PBRNs
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Basic Design Issues Efficacy to effectiveness
Heterogeneous study samples Usual Care control groups Multilevel interventions Multilevel and mixed methods evaluations
Stepped Care Multistep interventions
QI “Research” PBRN methods
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Economic analyses Direct and Indirect Costs Cost Offset Cost Effectiveness Cost Benefit
Chronic Disease Management Registry Self management Care manager Care protocol Objective outcome measurement
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Prevalence and nature of the problems Depression & impairment, then the others Comorbidity Adequacy of treatment Health behavior change
Nature of primary care practices Patients are reluctant to fragment care Practices are overwhelmed: competing
demands Systemic nature of practice Easier to change than to sustain
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Nature of the partners Strange environment, different assumptions Different work styles Not used well Teamwork: new layer of overhead
Nature of supporting systems Commodification of clinicians and practices Carveouts More difficult to change Different priorities, incentives (incentives!)
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What is it? Probable defining context Behavioral/mental health integration at
risk for marginalization Mandate for MH resources to serve
multiple purposes Learn DM, Asthma, CAD literature Comorbidity
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System Issues Carveouts Reimbursement rules & productivity
incentives Benefits design
How to deal with carveouts Who pays for care managers? Specialty
consultants? Who “owns” them? Where do they live?
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Pilot Mentality Running assessment Midcourse corrections Emphasis on teamwork Vertical Integration