Integrated Care A practice example from the ground

Integrated Care: A practice example from the ground up and lessons learned thus far Phyllis Platt, Ph. D, MSW. CEO, Shawnee Christian Healthcare Center, Inc. Shelia M. Cundiff, LCSW, LCADC Director of Behavioral Health , Shawnee Christian Healthcare Center, Inc. Sherita Vernon, CSW, MSSW BHC Shawnee Christian Healthcare Center, Inc. Jessica K. Beal, Psy. D. Integrated Care Program Manager Passport Health Plan 1

Objectives 1. Participants will understand the integrated care continuum, options for implementation of healthcare integration, rationale behind choices made by Shawnee Christian Healthcare and how they utilized Passport Health Plan’s consultative services related to integrated healthcare. 2. Participants will gain insight into the challenges associated with implementation of integrated care from the real life experience of Shawnee Christian in order to gain an understanding of how practice transformation can be successfully managed in the primary care setting. 3. Participants will learn some of the long term goals of the integrated program at Shawnee Christian and how they plan to measure success 2

Review of Integrated Primary Care 3

What is “Integrated” Care at the Highest Level? • A biopsychosocial approach to health care • Addresses whole person care; assesses and intervenes across all areas impacting overall health and well-being • Brings behavioral health care directly into the primary care setting (but is not limited to just the integration of behavioral health practitioners) • The behavioral health practitioner is member of the primary care treatment team and provides mental health triage and behavioral health intervention in consultation and collaboration with the rest of the treatment team • The behavioral health practitioner PARTNERS with the rest of the team on treatment planning, etc. 4

Integrated Care Models: Primary Care and Behavioral Health • • Collaborative Care Model (Co. CM) Primary Care Behavioral Health (PCBH) Hybrid Models Tools/Methods Associated with Integrated Care • Screening, Brief Intervention and Referral to Treatment (SBIRT) • Trauma Informed Care • Depression Screening (e. g. : PHQ 9) • Anxiety Screening • SDo. H Screening 5

AIMS Center Collaborative Care Model (Co. CM) PCP BHP/Care Manager Patient Psychiatric Consultant Additional Clinic or Outside Resources Other BH Providers SUD, School Services, CMHC’s, Health Department, Churches, etc. 6 Outside Resources

PCBH/BHC Model Behavioral Health Consultant PCP Patient Administrative Staff 7 Medical Support (RN/MA)

Integrated Care Continuum Coordinated Healthcare Co-Located • Minimal Collaboration • Basic Collaboration at a Distance • Basic On-site Collaboration • Close On-site Collaboration Healthcare Integrated Healthcare • Close collaboration approaching an integrated practice • Full collaboration in a TRANSFORMED/merged integrated practice Heath B, Wise Romero P, and Reynolds K. 2013; SAMHSA CIHS 8

Integration Trajectory for Clinicians Transdisciplinary integrates the natural, social and health sciences in a humanities context, and so that all providers transcend their traditional boundaries through understanding of the roles of the other disciplines as pertains to patient care Interdisciplinary Multidisciplinary analyzes, synthesizes and harmonizes links between different providers into a coordinated and coherent whole-whole team participates draws on knowledge from different disciplines but each provider stays within their boundaries-physician decides who participates 9 Choi and Park, 2006

Shawnee Christian Healthcare Center, Inc. An Integration Journey 10

Why Integrate Behavioral Health Into Primary Care? • Mission fit: “caring for the whole person” • Patient – centered medical home standard • Recognizing that neither behavioral health or primary care conditions happen in isolation • Strengthens the patient care team to more effectively increase patient engagement and impact health outcomes • Limited accessible community resources for behavioral health 11

SCHC’s Current Model Traditional BH Services co -located MD/ARNPs • Co-located same day services; traditional therapy co-located as well • Referral triggered by depression screen and SBIRT • Allows for some warm handoffs • Verbal care coordination • Integrated Billing/Scheduling/E MR; BH notes not accessible by PCP Behavioral Health Provider PCP Patient Medical Support (RN/MA) CEO is Transformation Champion 12 LCSW Primary with students Administrative Staff

Patient Clinic Care Visits • Allows the patient to schedule a single appointment and know that all their clinical and clinical support needs will be met same day • Allows for overlapping consultation with team members Scheduled Provider Patient (& Caregiver) Additional Scheduled Team Member(s) PRN Consulting Team Member(s) 13

SCHC’s Steps to Integration 1. Started with a volunteer LPCC one day/week providing counseling and referral to community linkage agreement partners. 2. Added MFT student interns in conjunction with a local university. 3. Hired Director of Behavioral Health Services. • Integrated Behavioral Health module into EHR 4. Added Behavioral Health Consultant with HRSA Supplemental Funding Next Step: January 2018 - add Health Psychology doctoral practicum student and Masters level Social Work interns as part of workforce development grant project with Spalding University. 14

SCHC’s Next Step Traditional BH Services co -located MD/ARNPs • Co-located • Referral triggered by behavioral health screens and BHC suggestion • Warm handoffs with BHC available for immediate triage • Care coordination/ daily huddles • Integrated Billing/Scheduling/E MR 15 LCSW Primary with students Behavioral Health Consultant PCP Patient Medical Support (RN/MA) Administrative Staff

SCHC’s Integration Goal • To improve patient health outcomes by delivering whole person care through the full integration of primary care, behavioral health, oral health and other preventive services. • To move from co-located model of integrated care focused on providing traditional behavioral health care to a fully integrated, PCBH model with psychiatry consult support by January 1, 2019. 16

SCHC’s Long Term Vision for Integration • • 17 Warm Handoffs to BHC; BHC for triage, brief interventions, chronic care coaching/health behavioral change Co-located for SUD with space for 30 min BH follow-up sessions; specialty MH colocated Co. CM for psychiatry; telepsychiatry All health staff daily huddles Team based care/Joint decision making Shared problem lists and treatment plans Shared EMR, etc. with PCP access to BHC note SUD Provider Ancillary Medical Staff Other Providers Community Resources SDo. H. Medical Provider Patient Care Manager Psychiatry Consult/ Telepsychiatry BHC Traditional BH Services co -located

SCHC - Passport Relationship • Passport and Shawnee have a shared vision for service delivery that addresses whole patient care and improves the overall health of the community they serve. • SCHC tapped into resources at Passport to provide initial consultation around integrated care • Passport continues to provide consultation as SCHC rolls out their model and moves the practice towards model fidelity • Passport is very pleased to have a partner like SCHC working towards a high fidelity model of hybrid integrated care and will be reviewing data pre/post implementation for improved health outcomes over time. 18

Challenges/Barriers to Date • Early on it was difficult to meet patient need with limited staff (volunteer provider and student interns) • No real structure to the program in terms of referral and tracking. • Co-location still creates a level of “separateness” between services and providers • Finding the right person to lead the program was challenging and took more time than expected (but worth the wait to get the right person!) 19

Lessons Learned • A champion at all levels is key: Board, Administration, Primary Care, Behavioral Health, Patient Engagement, Front Office • Education across the organization is important for understanding and buy-in. • Having the right Director is most critical to success. • Flexibility is key to manage performance improvement in a quick and timely manner to be most effective. • Linkage agreements are still essential, recognizing that BH staff can’t and shouldn’t handle all conditions. • Shared communication in the EHR important for care coordination and promotes medical provider buy-in and confidence in BH. 20

Q&A 21

Contact Information Phyllis Platt, Ph. D, MSW. CEO, Shawnee Christian Healthcare Center, Inc. Phyllis. platt@shawneehealthcare. org Shelia M. Cundiff, LCSW, LCADC Director of Behavioral Health, Shawnee Christian Healthcare Center, Inc. Shelia. cundiff@shawneehealthcare. org Sherita Vernon, CSW, MSSW BHC Shawnee Christian Healthcare Center, Inc. Sherita. Vernon@shawneehealthcare. org Jessica K. Beal, Psy. D. Integrated Care Program Manager, Passport Health Plan Jessica. Beal@passporthealthplan. com Cell: 502 -693 -6497 22