Julia Beatty, MD, Assoc. Medical Director, The HealthCare ConnectionBrenda Coleman, MHPA, Principal, BJC HealthCare Consulting Tony Dattilo, MA, CEO, Greater Cincinnati Behavioral HealthJohn Francis, MSSW, Executive Director, Centerpoint HealthDolores Lindsay, MPA, CEO, The HealthCare Connection Edward Shelleby, PhD Psychology, Director of Special Projects and Quality Improvement, Central Community Mental Health Board

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Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session # G2October 28, 20112:15 PM

Faculty Disclosure

I/We have not had any relevant financial relationships

during the past 12 months.

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Learning Assessment

A learning assessment is required for CE credit.

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Need/Practice Gap & Supporting ResourcesPeople in Ohio with Severe Mental Illness (SMI) die

32.2 years earlier than the rest of the population (Miller, Paschall, Svendsen, 2006)

Studies show that 60% of patients with SMI die of preventable health conditions

Access to primary care is limited/a problem for SMI clients

By report a large percentage of SMI clients have poorly controlled chronic health problems, e.g., Diabetes, Hypertension

Care for SMI clients is fragmented–not coordinated. 4

Objectives1. Identify the key contributing factors for

the successful integration of primary care and behavioral health services

2. Articulate the reasons for setting realistic performance objectives. It’s A Journey!

3. Identify the pros and cons of partnering with a Federally Qualified Health Center (FQHC)

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Expected OutcomeAt the end of this session, participants will:

Understand the benefits of integrating care using the co-location model

Identify barriers and success factorsArticulate pros/cons of partnering with a

FQHCUnderstand the importance of setting

realistic performance expectationsRecognize and know: “Rome was not built

in a day.”6

OUR PARTNERSHIP CO-LOCATION MODEL

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Supervising PC Physician

MD & APN

Psychiatrist

Partnership’s Client Flow

MH intake

PC intake

Referral

Client

Behavioral Health Clinic SiteIndependent, Parallel Clinical Processes

Case Manager

Support Staff: LPN & MA

The PartnersThe HealthCare ConnectionFederally Qualified Health Center (FQHC)National Committee for Quality Assurance ,

Patient Centered Medical Home recognitionSeven locations serving 18,000 patients annuallyMission: Provide quality, culturally sensitive

and accessible primary care focusing on the medically underserved, underinsured and uninsured in northern Hamilton County Ohio and surrounding areas

Oldest FQHC in Ohio. Founded in 1967 www.healthcare-connection.org

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The PartnersCenterpoint HealthComprehensive behavioral health provider formed in

2008 through merger of three local community behavioral health agencies

Five office locations + four treatment sites serving 7,000 clients annually in Hamilton County, Ohio

Mission: Strengthen communities served by providing the best quality mental health care to children, adults and families

Services: Adult Outpatient, Child Case Management, Adult Case Management, Adult Support, and Crisis & Prevention, including the 24/7 suicide hotline for Hamilton County

www.centerpointhealth.org9

The PartnersCentral Community Health Board of Hamilton

County A Private, non-profit corporation founded in 1970.Provides comprehensive mental health and drug treatment, alcoholism referral services and HIV prevention services to Hamilton County, Ohio residents.Mission: Provide the best possible mental illness, substance abuse and HIV prevention and treatment services Services: Case management, psychotherapy, partial intervention, emergency and long-term residential, psychiatric , addictions and methadone treatment.

www.cchbinc.com 10

The PartnersGreater Cincinnati Behavioral Health Services A comprehensive mental health agency serving

adults with severe mental illness in the Cincinnati area.

300 care professionals serve over 4,000 adults annually

Rehabilitation services at 10 locationsProvides psychiatric, nursing, counseling, care

management, residential, vocational, day programs and others

SMI clients include the homeless, incarcerated, and those with many dual disorders.

www.gcbhs.com11

Key Factors for Successful IntegrationShared mission, goals, and be

comfortable with risk. Roles and responsibilities clearly defined (MOU) Handout 1

Committed boards, executives, and senior leaders

Mutually understanding the need to work to determine the right payer mix and be realistic about what it will take to achieve objectives (financial and service)

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Key Factors for Successful IntegrationManagement level “champion” in each

organizationThe “right” providers and staff in the

“right seats on the bus”Strong inter/intra organizational

communication systemsPrimary care office location easily

accessible to clients and psychiatristsHandout 2

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Pros of Partnering with a FQHC

Have similar missionsExperience serving underserved at-

risk populationsPrimary care billing system in placeHave a system approach to health

careAre familiar with public health policyFederal level support (i.e. funding

and enhanced Medicaid rate)

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Pros of Partnering with a FQHC

Shared client populations. May already serve SMI individuals at other locations

Federal level support (i.e. funding and enhanced Medicaid rate)

PCMH expectation and requirements closely mirror behavioral health accreditations (i.e. CARF)

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Cons of Partnering with a FQHC Learning curve. Operates in a different

world (billing, reimbursement, funding, clinical language)

FQHC not in service area FQHC not widely known or respected

in the community. Is this the right partner?

FQHC and behavioral health agency uncertain or lukewarm about establishing a relationship

Set Realistic Performance Measures/Objectives

Determine the right number and types of objectives. Measure what really matters. This will help in: Making administrative decisions Course correcting as needed Building success Finding/applying for new money

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Set Realistic Performance Measures/Objectives

Maintaining funding Clinical decision making Replication Maintaining focus

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Our Primary Care Performance Measures# Visits% Insured Visits# Visits/Work Day% Appointments Kept# Unduplicated Patients

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Our Primary Care Performance Measures% Insured PatientsNet Gain/LossRevenue/Visit as % of Cost/VisitCost/Patient

Handout 3

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Our Primary Care Performance Measures% Diabetic Patients with most recent

HgA1c < 8 % Hypertensive Patients with most

recent BP under 140/90

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Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!

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