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INTRODUCTION TO
CARE PATHS
Geeta Aatre-Prashar, Psy.D.
Saint Louis Behavioral Medicine Institute
March 13, 2013
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Carepaths…
Sometimes know as:
Vertical Integration
Groups
Standing Orders
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Horizontal and Vertical
Integration
Horizontal Integration: Population
management
Vertical Integration: Targeted
services to a sub-population in need
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Horizontal & Vertical are
complementary approaches to
integration
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Rationale for Carepaths
Improve health outcomes of target
population
Decrease burden. High utilizing patients
present a significant burden and cost to
practices
Impact of high utilizers on PCPs
Impact of high utilizers on staff
Increase satisfaction of PCPs and patients
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Improve cost-offset (defined as decrease
in medical utilization as a result of
behavioral interventions)
Better address complex problem areas
Provide increased access for patients to
receive care
Provide more PCP-BHC collaboration
opportunities
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Starting a Carepath
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Questions to ask of your
clinic What does the clinic need?
What do the PCPs need most help
with?
What are the needs of the larger
community?
What are the most common/
prevalent diagnoses/problems at your
clinic or in your community?
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Once you have a target group,
consider types/models of
carepaths
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What model would best fit the
population?
Traditional care-path
automatic referral
part of system
care path is part of routine care
for that particular condition
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Program-style: Patient or PCP
referral to ongoing class
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Individual vs. Group
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Consider your resources
Are the PCPs all on board
with the plan?
Is space available?
Will systems support it?
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Consider criteria for
identifying patients
All receiving “x” diagnosis
All high utilizers
All meeting a specific criteria
eg. with a BMI over 30
Any exclusionary criteria?
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Review roles of team
members
PCP role
BHC role
Medical staff
Support staff
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Review flow procedures for
all members of team
How will patients be flagged?
Who will make the initial contact?
(i.e. contacting patients and offering
a series of classes in lifestyle
management, illness management,
building strengths, etc.)
What intro scripts will be used?
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Review and plan content of
your program
Include highly condensed, evidenced-based interventions tailored to fit the pace and flow of primary care.
Didactic, skill-based work; emphasize improving adherence, improving health, activation, skill acquisition and application (practical application)
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Class, not therapy
Good program will have education, behavioral activation, goal-setting, self-monitoring, coping tools
Potential carepath elements: classes (most common); BHC (1 on 1); follow-up phone calls; reading materials; handouts; self-monitoring; goal-setting; videos
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Things to keep in mind
Be flexible and persistent
Monitor progress/tracking of
patients
Program evaluation
Make changes based on feedback
Market and communicate well
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Stick with empirical-base
Use marketing at clinic and
community
Implement and master horizontal
program first (BHC comfort, PCP
comfort, good collaboration,
establish high pt satisfaction)
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Carepath Template
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Population
All patients with diagnosis of
_________ defined by ________
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Goals & Objectives
Goal: Reduce/increase _____
Objectives:
Increased awareness of _______
Improved adherence to ________
Pt starts _______
Pt stops _____
Pt continues ______
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Roles
PCP
Conducts exam, defines treatment
goals, reviews/adjusts medications
Helps identify appropriate patients by
_____ (eg. defining criteria, reviewing
patient list, referring patients)
Presents specific topics
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BHC
Identifies appropriate patients
Defines content
Coordinates with PCP and
other staff members
Markets carepath by ________
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Nurse Care Manager role
Medical Assistant role
Other staff member’s roles
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Structure
Contact1
Introduction to carepath
Define goals & objectives
Education about _____ (topic)
Set targets till next contact
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Contact 2 (define time frame) Review goals and objectives
Discuss barriers and successes (e.g. medication
adherence, exercise planning, diet change,
family issues, side effect issues, MH issues, etc.)
Further patient education regarding disease if
needed
Discuss progress and changes to patient’s goals
with PCP
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Plan for follow-up
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References
Robinson & Reiter. Behavioral
Consultation and Primary Care.
O’Donohue and colleagues.
Integrated Behavioral Healthcare
Susan McDaniel and colleagues.
Primary Care Psychology.