september 8, 2015 presentation to the ohio house healthcare efficiencies study committee
Post on 28-Dec-2015
216 Views
Preview:
TRANSCRIPT
Shawnee Family Health Center Behavioral Health & Primary Care Clinic Locations
Adams County – West Union Lawrence County – Coal Grove Scioto County - Portsmouth
Rural Health Clinic Locations Adams County – West Union Scioto County - Portsmouth
Employment Services – 13 Counties Adams, Brown, Clermont, Lawrence, Clinton, Gallia,
Jackson, Pike, Highland, Ross, Scioto, Hamilton, Fayette 6700 people annually (kids and adults) 128 Staff
Our Journey
2006Mortality Rates - NASMHPD Reconnect the mind with the body
1988De-institutionalization Case management; community
nursing; team based care
1973Worried Well Talk Therapy
1973 – 1987 The Early Years
Population: People with problems managing daily stressors – sometimes referred to as the “worried well”
Treatment: Outpatient therapy and some group therapy
Most people with SMI still in hospital 1960 de-institutionalization not too effective
The Ceramic Age
March 28, 1988 Mental Health Act Commitment from the State to address needs of people
with severe mental illness: Community based services Transition from state hospital to community Community Nursing & Team Based Care We became part of the safety net for those with mental illness
Transportation Housing & Food Psychiatric medications SSI/SSDI Emotional Support & Counseling Handling crises Drug and alcohol addiction assistance
Community Support Services
An array of services that are provided to:– help a person succeed in the community;– identify and access needed services– help a person succeed in school, work and family
despite MI– help person integrate within the community– help manage their psychiatric illness– Help deal with the functional impairments related
to mental health diagnosis
Our Journey
2006Mortality Rates - NASMHPD Reconnect the mind with the body
1988De-institutionalization Case management/CPST; community
nursing; team based care
1973Worried Well Talk Therapy
The Problem Increased Morbidity and Mortality Associated with Serious Mental Illness
(SMI)
Increased Morbidity and Mortality Largely Due to Preventable Medical Conditions Metabolic Disorders, Cardiovascular Disease, Diabetes Mellitus High Prevalence of Modifiable Risk Factors (Obesity, Smoking) Epidemics within Epidemics (e.g., Diabetes, Obesity)
Some Psychiatric Medications Contribute to Risk
Established Monitoring and Treatment Guidelines to Lower Risk Are Underutilized in SMI Populations
The BODY was being ignored
Mortality Crisis
US Life Expectancy 2008 = 78 years Serious mental illness = 53 – 57 years
Comparable to Cameroon, Gabon, Democratic Republic of Congo
Mortality Crisis
Biggest lifespan disparity in U.S.
Widest other disparity = Black males (8.9 years)
Top Causes of Death in U.S.
Cardiovascular Disease 3.4 X
Cancer Maybe lower rates except lung
Stroke 2x in age < 50
Respiratory disease 5x
Accidents higher Diabetes 3.4x
SMI = High Rates of Chronic Illness
• 70% SMI have a chronic health condition----Mostly pulmonary disease
• 50% have two or more
• 42% severe enough to limit function
• 34% HTN
• Hep B rates increased 5x; Hep C 11x
Reduced Use/Inefficient Use of Medical Services
Poverty
Social Isolation
Systemic Barriers to Ideal Health CareHealthcare systems and financing
Psychotropic medications
Individual health habitsSmokingInactivityObesity/poor nutrition
Factors Associated with Premature Death
The Journey
Mental Health & Primary Care are inseparable; any attempts to separate
the two leads to inferior care
Institute of Medicine 1996
Support for Integration – 1600s Mind-body as a "problem" is generally traced to
Rene Descartes, who asked how the immaterial mind (or soul) could influence the material body.
Would not the interaction between the two have to partake somehow of the character of both?
Responding to the Problem
The Problem What do we Need to Do?
People with MI are dying early
People with MI smoke more – related to early death
Deaths related to preventable Medical Conditions (Metabolic Disorders, Cardiovascular Disease, Diabetes Mellitus )
Psychiatric Medications Contribute to Risk
Providers are not using established Monitoring and Treatment Guidelines to Lower Risk
The BODY is ignored in BH
Educate staff
Address smoking
Screen people for HTN; Diabetes; Hyperlipdemia, etc)
Closely monitor medications that pose health risk
Modify medications if seeing signs of developing chronic illness
Develop wellness programming
Provide primary care to our clients
Vision To become a person-centered health home –
integrate BH & PC Provide behavioral health services Provide physical health services Coordinate care and non-medical needs for adults with
severe MI and for children with serious emotional disturbance
Challenges Funding Workforce readiness How do you integrate care?
Challenges - Funding BH Services:
No reimbursement for Care Coordination No reimbursement for health and wellness promotion No reimbursement for teaching a person with
schizophrenia how to monitor glucose No reimbursement for taking people to needed medical
appointments No reimbursement for getting people engaged in physical
activity.
Challenges - Funding
Grants:• Health Foundation of Greater Cincinnati
$300,000 ( 2007)
• SAMHSA - $2Million (2009)
• HRSA - $200,000 (2011) Health Information Technology
Challenges – Workforce Readiness
Does our workforce know how to deliver integrated care? Tobacco Cessation Prevention and interventions for high blood pressure Prevention and interventions for lipids How diabetes impacts depression
Shawnee in 2012 Primary care staff in all of our clinics
Nurse Practitioners LPNs Wellness coaches
PC & BH Same administrative structure – one corporation Staff occupy same building Share support & billing staff Integrated, shared electronic health record
Integration – The Missing LinkAbility for BH Professionals to Provide Care
Coordination & Focus on Whole Person
Health Home Service – October 2012
What is a health home – is it a building, or house or a hospital?
A health home is not a building of any kind. It is a team of people working together to make sure that medical and
non-medical needs are met.
Medical – physical and mental health
Non-medical – housing, transportation, child care, employment, social/recreational, educational, etc.
Health Home Service Comprehensive care management Care Coordination Health Promotion Comprehensive transitional care & follow-up Individual & Family supports Referral to community & social supports
CPST vs. Health Home
CPST Goals Health Home Goals Enhance person’s ability to
live in community Help person identify &
access needed services Improve functioning in
school, work, family Dev. skills to effectively
manage the mental illness/or impact of mental illness
Improve integration of physical and mental health;
Lower rates of ER use; reduce hospital admissions/readmissions
Reduce health costs Decrease reliance on long term
care facilities Improve experience of care &
quality of life for client Improve health outcomes
Fee-for-service Per-member-per-month rate
Future of Health Homes in Ohio BH Redesign will eliminate Health Homes as they
are now Disagregate Community Support & Health Home
Collection of services will be broken into separate, distinct services
Reimbursement structure unknown
BH Redesign - What do we need to do? Seek designation of people with SMI as both an at risk and
a health disparities population
Promote & Compensate BH provider systems to screen, assess and treat both mental health & general health issues
Establish coordinated mental health and general health care as a state health care priority – allow BH providers to provide and get paid for care coordination
Promote team based care- ALL licensed professionals to practice at the top of their license.
BH Redesign ExampleBH Service – Pharmacologic Management/Medication
Services
Current Providers: Physicians Nurse practitioners Physician Assistants R.Ns LPNs
50% of pharmacologic management services are provided by nurses (RNs & LPNs)
BH Redesign PlanBH Service – Pharmacologic Management/Medication
Services would be redefined to match CPT codes & Medicare regulations
Future Providers: Physicians Nurse practitioners & Physician Assistants
Nurses (RNs/LPNs) could provide limited, low-level service ($10.00)
Nurses could provide higher level of services IF a physician was in the suite/office – “incident to” service
BH Redesign Plan – Why this Would be a Problem Shortage of psychiatrists
Zero full-time on-site psychiatrists Tele-psychiatry
Contract Psychiatrist in Miami Part-time in Cincinnati
Redefining providers of this service will significantly decrease access to pharmacologic services – Can’t recruit psychiatrists Replacing nurses with psychiatrists too expensive
Tele-psychiatrists are not considered to be “in the suite/office” as defined by Medicare – our nurses could not provide incident to services – decrease in access
We’ve Come a Long Way…Whole Person Health
2015 Office & community care Screen for high risk health
conditions Prescribers screen for
medication related risk factors Person-centered care Medical providers available
under same roof - integrated Coordinate Care People with SMI living and
working in community
Age of Ceramics
1973 Office based care Relies on initiative of client No consideration of physical
health conditions No nursing presence in office No blood tests/screens The “doctor” knows best People with SMI in hospitals
Let’s Not Go Backwards
“Go back?" he thought. "No good at all! Go sideways? Impossible! Go forward? Only thing to do! On we go!" So up he got, and trotted along with his little sword held in front of him and one hand feeling the wall, and his heart all of a patter and a pitter.”
J.R.R. Tolkien, The Hobbit
top related