Overview of Presentation Overview of the VISN 16

Overview of Presentation § Overview of the VISN 16 PCMH Program § Description of PCMH models § VISN 16 PCMH program outcomes § The Rest of the Story

South Central VA Health Care Network—VISN 16

VISN 16 PCMH • • • All ten sites participated Implementation of PCMH in at least one clinic in each VAMC Option of implementing: • • • Care Management through TIDES Co-located integrated care Facilitation at the Network Level

Scope and Clinical Roles: Co-Located Integrated Model § § § § Usually consists of a prescribing provider and therapist team Same Day visits See All Comers – with few restrictions on diagnosis Become part of the Primary Care Team 15 -45 min structured assessment Medication and/or brief Psychotherapy Consultation with Primary Care Providers Chronic Severe patients referred to Specialty MH

Scope and Clinical Roles § Care Manager Model ▲ MDD, Alcohol Use ▲ Patient Education ▲ Symptom and Side Effect tracking ▲ Brief, Structured intervention § Consultation/Weekly Supervision ▲ Primary Care Physician ▲ Team Psychiatrist

Key TIDES Features Focus is on patients with depressive disorders § Mostly telephone § ▲ Much appreciated by patients § CPRS/Vist. A tools based § Emphasis on patient self-management support § Initial decisions and prescribing primarily in primary care § Strong ties to mental health supervision

VISN 16 PCMH Programs Mt Vernon CBOC Tulsa CBOC Ft. Smith CBOC Oklahoma City Little Rock Shreveport Jackson Care Manager Alexandria Co-Located Houston New Orleans Biloxi Pensacola CBOC

PCMH Provider Workload (June 2007 – May 2008) Site 502 520 564 580 586 623 635 Total 598 629 667 Total TOTAL Program Co-located Co-located Care Management Uniques 42 2, 208 1, 292 497 433 548 1672 6, 692 237 288 912 1, 437 Encounters 61 3, 443 2, 003 977 515 790 2813 10, 602 679 572 2, 087 3, 338 8, 129 13, 940

Uniques seen in PCMH 9% 91% 10% 90%

PCMH Uniques Monthly

MH Consults per Quarter

Program Evaluation § VISN 16 PCMH Program ▲ Received 5. 3% of the FTEE supported nationally ▲ Comprised 9. 44% of PCMH productivity to date