Assessing the integrated care capacity and technical assistance needs of the Health Choice Integrated Care Network

july 21, 2016

Michael S. Shafer, PhDNicole Janich, MSWTrever Davis, DBH, LAC

coming up

background

methodology

findings

next steps

part I: background

PPACA, 2010 Integration

Parity

Carving In

Federally Qualified Health Centers

Electronic Health Records

Health Information Networks

On the Arizona Front…

Medicaid Expansion

Pay for Performance

Dual Eligibles

Redesign of the Regional Behavioral Health Authority Contracts

HCIC needs assessment project -how we ended up here (Mike)

1. Baseline Assessment of Health Care Integration

2. Degree and Quality of Interagency Collaboration

3. Agency Readiness to Change

4. Training & Technical Assistance Needs

Four Critical Informational Needs

HCIC Model

• Integrated Care Managers – Co-Occurring Acute Conditions and Serious Mental Illness (SMI)

• Health Home Case/ Care Managers

• Acute Providers• Specialty Providers

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Systemic Changes 2015 & Forward

part II: methodology

collect agency level information: agency overview and history relationships with other agencies information technology integration statusworkforce regulatory environment financials technical assistance needs

identify challenges experienced in providing integrated care

site visits: purpose

site visits: logistics11 agencies in 2 months

Over 3,000 road miles

2 person site visit team

2 – 7 agency representatives from each agency

assess practitioners’ readiness to integrate BH and primary care

identify self-described proficiency and training needs

assess agency capacity and need for technical assistance

staff survey: purpose

• Screening & Assessment• Client Engagement & Early Intervention • Integrated Health Information/Technology • Interdisciplinary Service Delivery• Treatment & Care Planning• Care Managers• Care Coordination• Patient Access to Care• Pharmacological Approaches/Medication Management• Continuity of Care • Agency Culture

staff survey: domains

102 items totalsection 1: demographic and employment information section 2: 11 domains about integrated care

Four emails sent to agency CEO:1) Pre-survey email – 1 week prior to survey being

sent out2) Survey email – contained link to survey3) 1st Reminder email – 1 week later, to remind staff

to participate4) 2nd reminder email – 2 weeks after survey was sent

out

survey launched Nov. 2015, closed Jan. 2016 11 agencies participated (567 respondents)

staff survey: protocol

staff survey: respondentsEmployment Role

Behavioral Health

MedicalSupport Services

Administrative Total

Psychiatry 13 0 0 0 13Pharmacy 0 2 0 0 2

Care Coordination/Management 20 0 0 0 20

Case Management (non-clinical) 49 0 0 0 49

Counselors/Therapists (clinical) 70 0 0 0 70

Behavioral Health Technician 78 0 0 0 78Peer Support/Peer Recovery

Specialist28 0 0 0 28

General Medical Practitioner 0 40 0 0 40

Specialty Physician 0 6 0 0 6

Allied Health Professional 0 25 0 0 25Nursing 0 8 0 0 8

Administrative or Support Services

0 0 165 0 165

Other 0 0 0 28 28

Total 258 81 165 28 532

part III: findings

Conflicting & Duplicative Reporting Requirements

Guidance from RBHA

Reimbursement disparities Informality of

Interagency Processes

top provider challenges

EHR capacity

findings: personal capacity

Integrated Care Readiness

Early Intervention Proficiency

Behavioral Health

Screening Proficiency

Inter-Agency Comm.

Pharmaco. Knowledge

Treatment Planning

Proficiency

Chronic Health

Screening Proficiency

Agency Agency Mean Score by Domain

A 4.31 4.30 3.85 3.75 3.59 3.76 3.01

B 4.21 3.93 3.45 3.46 3.42 3.27 3.79

C 4.12 4.06 3.44 3.67 3.46 3.44 2.88

D 4.33 4.16 4.01 4.04 3.67 3.78 2.93

E 4.28 4.27 3.97 3.67 3.53 3.17 2.91

F 3.96 4.14 3.59 3.68 3.73 3.33 2.51

G 4.38 4.10 3.07 3.86 3.18 3.28 2.31

H 4.16 4.00 3.92 2.89 3.21 3.56 2.58

I 4.47 4.73 3.90 4.10 3.59 4.33 3.20

J 4.36 4.38 4.38 4.00 4.19 3.17 3.72

K 4.25 3.67 3.08 4.00 3.42 3.42 2.83

High Need 1.00-2.50Moderate Need 2.51-3.75

Low Need 3.76-5.00

findings: organizational capacity

Patient Access to

Care

Early Intervention Proficiency

Treatment Planning

Proficiency

EHR “Real Time”

EHR Documentation

Utility

EHR Integration

UtilityAgency Agency Mean Score by Domain

A 4.03 4.00 4.05 4.05 3.96 3.82

B 3.45 3.66 3.56 3.82 3.34 3.28

C 3.58 3.80 3.80 3.31 3.21 3.10

D 4.00 3.97 3.98 3.85 3.59 3.11

E 3.34 3.90 3.81 3.09 3.24 2.77

F 3.30 3.68 3.86 3.84 3.70 3.38

G 3.77 3.88 3.87 3.07 3.83 3.24

H 3.71 3.94 4.11 4.06 4.00 2.92

I 4.00 4.53 4.56 4.11 4.41 4.07

J 3.57 3.96 4.00 4.14 3.52 3.29

K 3.38 3.50 3.31 3.75 3.42 3.00

High Need 1.00-2.50Moderate Need 2.51-3.75

Low Need 3.76-5.00

findings: organizational capacity

Integrated Care

Readiness

Interdisc. Team

Cohesion

Interdisc. Role Clarity

Inter-Agency Coordination

of Care Protocols

Inter-Agency Network

Participation

Physician-Provider Comm.

Inter-Agency Comm.

Agency Agency Mean Score by Domain

A 3.86 4.04 3.92 4.21 4.05 3.94 3.79

B 3.36 3.90 3.66 3.50 3.66 3.49 3.37

C 3.38 3.65 3.68 3.80 3.77 3.76 3.67

D 3.57 4.00 3.91 4.03 4.05 3.82 3.70

E 3.73 3.75 3.60 3.65 3.42 3.43 3.30

F 3.18 3.34 3.50 3.63 3.78 3.76 3.39

G 3.92 3.93 3.73 3.77 3.54 3.73 3.57

H 3.09 3.75 3.67 3.81 4.00 3.54 3.00

I 4.14 4.28 4.26 4.22 4.17 4.59 3.70

J 3.79 4.21 4.05 4.00 4.00 3.81 3.75

K 4.08 3.33 3.56 3.25 3.38 4.11 3.67

High Need 1.00-2.50Moderate Need 2.51-3.75

Low Need 3.76-5.00

findings: training needs

Screening and Assessment

Client Engagement Care Coordination Agency Technical

AssistanceAgency Agency Mean Score by Domain

A 3.20 3.34 3.31 3.49

B 3.11 3.38 3.30 3.62

C 3.29 3.12 3.24 3.59

D 3.33 3.21 3.10 3.61

E 3.28 2.94 3.31 3.68

F 3.33 3.02 3.19 3.50

G 3.54 3.25 3.17 3.45

H 2.78 3.44 3.13 3.60

I 3.95 3.05 3.04 3.33

J 3.21 3.14 3.14 3.56

K 3.33 3.75 3.67 3.81

High Need 3.50-5.00Moderate Need 2.25-3.49

Low Need 1.00-2.24

High Need Priorities:

Interdisciplinary Team Process - 10

Screen. & Assess. of Med. & BH - 9

Care Coordination Functions - 8

Providing Continuum of Care - 8

Medication Management - 8

Enhance EMR/EHR - 8

Integrated Treatment Plans - 7

technical assistance needs

interdisciplinary communication

client engagement

information-sharing strategies

program evaluation techniques

training needs

behavioral health conditions

medical conditions

building reciprocal relationships

needs assessment

findings• training and technical

assistance needs identified

organizational TA

• formalization of interdisciplinary roles and responsibilities

• referral and information sharing processes

implications & recommendations

professional development

& training

• pharmacotherapy• medication management• screening BH and medical conditions• client engagement strategies• integrated treatment planning

part IV: next steps

Next Steps: Technical Assistance Launch

Community

• Understanding Rights to Privacy & Confidentiality vs. Providers’ Ability to Coordinate Care

• Centers of Excellence in Integrated Health Services

Contracted Acute

Providers

• Integrated Care Management Plans & Process

• Access to Continuum of BH Services

• BH Screening Tools

Behavioral & Integrated

Health Agencies

• Therapies & Medications

• Clinical Documentation• Coordinating Care with

Acute Providers• Screenings & Patient

Engagement Strategies

Next Steps: Multiple Modalities for Training

ONLINE, STATIC CONTENT“Introduction to” Modules: Care Coordination, Integrated Care Management Plans, Screening Tools for mental illness and substance use, Accessing BH Resources

ONLINE, INTERACTIVESkill Development Modules: Motivational Interviewing, Screening Implementation, some Integrated Care Treatment Planning

IN-PERSON, INTERACTIVEModels of Care Modules: Interdisciplinary Care Teams, Substance Use Assessment, Population Health Intervention Design, Clinical Documentation, Integrated Care Treatment Planning and Care Coordination, Pharmacotherapy & Medication Mgmt

EDUCATIONAL HANDOUTCondition-specific Population Health and Health Outcome Improvement recommendations for: BH Case Managers; Primary Care Behavioral Health Coordinators; BH Medical Practitioners; Acute Care Providers; Hospital EDs

Questions?

contact information: njanich@asu.edu

for more information visit our website: www.cabhp.asu.edu