integrated primary care practice in a federally qualified health center: moving forward
DESCRIPTION
Session # Track H4a October 29, 2011 10:30 AM. Integrated Primary Care Practice in a Federally Qualified Health Center: Moving Forward. Andrea Auxier, Ph.D. Director of Integrated Services and Clinical Training Katrin Seifert, Psy.D. Associate Psychology Training Director - PowerPoint PPT PresentationTRANSCRIPT
Integrated Primary Care Practice in a Federally Qualified Health Center:
Moving ForwardAndrea Auxier, Ph.D.
Director of Integrated Services and Clinical TrainingKatrin Seifert, Psy.D.
Associate Psychology Training Director
Salud Family Health Centers, Colorado
Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Session # Track H4aOctober 29, 201110:30 AM
Need/Practice Gap & Supporting Resources
In a progressively complex and fragmented healthcare system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the country have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe the development of a working integrated primary care model being utilized in in a large community health center system in Colorado.
Objectives
1. Identify practice-specific and system-specific factors to consider when setting up an integrated practice
2. Describe how practice-based research can inform service-delivery and organizational protocols
3. Describe how a focus on training can be leveraged both financially and clinically
4. Identify a population-based model of integrated care being utilized in a large FQHC system
Expected Outcome
The purpose of the talk is to provide participants with a broad range of considerations to utilize when establishing integrated
practices.
The cost of doing something that may work is less than the cost of continuing to do something that definitely won’t.
In 2008, mental health conditions accounted for $72 billion in expenditures, making them the third most costly condition (along with cancer), exceeded only by heart conditions and trauma-related disorders. (AHRQ 2008)
75% percent of total health care spending in 2007 went towards the treatment of chronic diseases, such as diabetes and asthma. (CMS)
Healthcare costs are rising 6% a year. (Source: Congressional Budget Office)
Payment
• Carved out systems
• Fee for service vs. capitation
• We’ll pay you to do it there, but not there
Recommendations1) Create New Departments
Behavioral healthData managementEHR designPolicies, Procedures, and Training
2) Put people in charge of them3) Talk to each other!4) Balance executive decisions with democratic processes5) Dispense with the silos
• Diffusion of responsibility• Duplication of efforts• Inefficient processes• Unspoken expectations become breeding
grounds for resentment
Dispensing with the Silos
A necessary integration of previously divided sections of the organization
Medical
Behavioral
Dental
Education
Human Resources
Information Technology
Accounting & Finance
Facilities Management
Reporting
Client Services
Administrative Services Development
The New WayCare Coordination
Referral Tracking
Proactive Management of Targeted Patients
(e.g., asthma, depression, COPD, narcotics)
Self Management Goals
Collaborative Treatment Planning
Visit Summaries
THE SALUD STORYIdea to Implementation
FORT LUPTON 1970 FREDERICK 1978 MOBILE UNIT 1979
BRIGHTON 1980
LONGMONT 1979
COMMERCE CITY 1986
STERLING 2001
FT. COLLINS 2002
FT. MORGAN 1994
ESTES PARK 1992
Challenges
• Many patients, not so much money• Turf issues• Common goals vs. competing objecting
objectives– Internally– Externally
Collaboration Requirements• Are, at minimum, master’s level clinicians licensed in the state of CO• Are at least half time (.5FTE) • Adhere to Salud’s integrated care model • Do not discriminate by payer source or patient’s county of residence• Are part of the behavioral health department; attend departmental meetings • Are credentialed through Salud human resources prior to start date• Document patient encounters in Salud EMR only• Bill for patient encounters utilizing Salud Standard Operating Procedures for
behavioral health billing. Certain types of co-payments and third-party reimbursements can be collected by partner agency if agreed to and documented in a Memorandum of Understanding signed by both parties.
• Report to the Director of Integrated Services & Clinical Training• Are subject to formal evaluation processes
Estes Park.5FTE
Ft. Collins5 FTE
2 PT psychiatrists
Longmont2 FTE
1 PT psychiatrist
Ft. Morgan1 PT psychiatrist
Sterling
Frederick1 FTE Ft. Lupton
2 FTE1 Case Manager
Brighton2 FTE
Commerce City2 FTE
Non-Clinical Positions
Director of Integrated Services 1FTE
Associate Psychology Training Director 1FTE
North RangeBH
Centennial
Larimer Center
Health District
Mental Health Partners
Early Considerations
• Who are the patients?• What do they need?• What resources are there in the community?• When will we refer, and for what reasons?• Will the patients go?• Will they get in?• What will we do if they come back?
Service-Delivery
PCP Initiated
Consultation, Evaluation, & Brief Interventions
Patient Initiated
Therapy
BHP Initiated
Screening
A completely integrated primary care system that provides quality population-based care through
improved access
Adult Screening to Treatment Protocol
Referral to MHC/ Specialty Service
Referral to MHC/ Specialty Service
What we Know
• Depression: 35% • Anxiety: 35%• Trauma: 13%• Alcohol: 10%• Substances: 4%• Smoking: 30%• Safety of Living Environment: 2%
What it Means
It’s not just about depression
Disease-specific models are for people with specific diseases treated in systems that can accommodate disease-specific models
How we Pay for ItPatient Revenue
Copayments for therapy and testing
Leveraging the power of the mission statement
Comparative Effectiveness ResearchScalable Architecture for Federated Translational Inquiries Network
Workforce Development
Imagining a world without BHPs
Looking down the RoadMedical Home & ACOs
Successes• Staffing on a shoestring budget• A standardized service-delivery model• Behavioral health woven into the organizational fabric• Clinical Training Program• Relationships with outside agencies moving in
positive directions• 14,000 patients served/yr• Integration of comparative effectiveness research
efforts
Lessons Learned
Do what we can to do today to help us build the case for doing it tomorrow
Foster relationships – at ALL levels
Always look down the road (PCMH, ACO)
Be patient: Transformational change takes time
Remember What it’s Really About
Meaningful use of meaningful measures
Embrace the good enough principle
Do vs. think about doing whenever possible
Process informs evolution
Strategies trump models
Build the infrastructure to support the idea
September 2010 Goals
• Increase size of BH team• Expand training program• Increase health psychology services• Expand service delivery (child, addiction)• Research
Directions
• Promote clinically meaningful and organizationally feasible research
• Hire people to do what they’re trained (and love) to do
• Emphasize continuous quality improvement• Never stop growing!
Learning Assessment1) According to the Congressional Budget Office, healthcare costs in the Unites States are rising at a rate of what percent per year?:
a) 3% b) 6% c) 9% d) 12%
2) What percentage of an FQHC’s board must be comprised of patients?
a) 0% b) 10% c) 50% d) more than 50%
3) Which of the following is NOT a standardized screening tool
a) PHQ-9 b) PCL c) PDI d) DAST