integrated health: creating successful outcomes through technology innovations
TRANSCRIPT
Mary Jo Whitfield, MSW
VP Behavioral Health Services
Cheri DeBree, MC
Integrated Health Director
Robin Trush, MA
Director of Special Projects
Presentation ObjectivesGain insight into successful integrated health
programmatic elements: Clinical & Operational
Learn how the JFCS electronic health record (NextGen) assists in clinical decision making
Learn how to operationalize data and outcomes to manage program elements
Increase audience knowledge about technology advancements and the use of data exchanges
Why Integrate Physical andBehavioral Health Care?
• Behavioral and physical health care have historically operated in silos.
• Health care integration is designed to:• Improve patient access to care in a setting where
patients are most comfortable.• Reduce health care disparities.• Contain costs by promoting a whole health
approach.• Improve patient outcomes through coordination of
care.
Key Drivers of Integrated Health
• Patient Protection and Affordable Care Act
• State Health Insurance Exchanges
• Mental Health Parity
• Medicaid Expansion
National Driver: Affordable Care Act
• Health Insurance Exchanges
• Mental Health Parity
• Medicaid Expansion
Models of Integrated Care & Benefits
• Coordinated Care
• Co-Located Care
• Transformed/Full Integration
• Virtual Integration
Jewish Family and Children’s Services…Who are we?
• Outpatient Behavioral Health Provider - Maricopa County
• In operation since 1935
• JFCS is Currently serving 5,025 adults and 4,838 children and has about 90% Medicaid client population
• Our enrollment reflects the cultural diversity of our county
• Magellan Behavioral Health of Arizona
• Community Re-investment Grant
Integrated Health Program Data• Adult Program began May 1, 2012
• Children’s Program began August 1, 2013
• 1750 adult clients served
• 134 Child clients served to date
• 750 active clients in the program typically
• 2,800 Health Risk Assessments have been collected
• 60% opt in rate as new clients to JFCS
Integrated Health Program Data
•Collaborative relationship with MIHS since August, 2010, a Federally Qualified Health Center look alike
• 4 clinics across Maricopa County
• 11 Health Navigators
Integrated Health Client Demographics
Overall Gender BreakdownFemale 46%
Male 54%
Children’s PopulationGirls 32%Boys 27%
58%29%
10%2% 1%
Ethnicity of all Clients at JFCS
Ango/White
Hispanic/Latino
African American
Native American
Other 1%
Age 0-2
Age 3-5
Age 6-13
Age 14-17
Age 14 – 1730%
Age 0 -26%
Age 3 – 522%
Age 6 – 1342%
Children Only
Age
Demographics
Currently Serving 4,800 Children
4%13%
25%
18%7%
9%
23%1%
All Clients Age Demographics
Age 0-2Age 3-5Age 6-13Age 14-17Age 18-30Age 31-49Age 50-64Age 65 +
Mental Health Diagnosis Analysis For Children
26%
13%
16%
16%
7%
2%3%
10%
4%
3%
ADHD/ADDMood DisorderOtherNeglect of ChildBipolar DisorderAnxietyDepressionAdjustment DisorderAutismPTSD
Medical Conditions Analysis for
Children
No Known Medica
l
Asthma
Fetal A
lcohol/D
rug E
xposu
re
Neurologic
al Diso
rders
Overw
eight/O
bese
DiabetesOth
er0%
10%20%30%40%50%60%70%80%90%
80%
7% 4% 2% 2% 1% 4%
Integrated Health ObjectivesObjective 1: Assist behavioral health recipients in
establishing/maintaining an ongoing, lasting relationship with a primary care provider.
Objective 2: Facilitate improvements in the physical health of behavioral health recipients including EPSDT for children
Objective 3: Improve the mental health of behavioral health recipients.
Objective 4: Enable behavioral health recipients to increase control over their health.
Objective 5: Improve collaboration between behavioral health and the client’s medical team through the use of a health information infrastructure that includes an electronic medical record and shared health information.
PCP Relationship
• Investigate families current relationship with Primary Care Physician (PCP) and other medical providers
• Is client is satisfied with current PCP
• Maricopa Integrated Health System
• Assist client in changing PCP with AHCCCS
• PCP Notification – auto faxed from EHR
• Release of information with medical provider to share information
• Assist client in scheduling first appointment with MIHS
• Attend medical appointments with family as an advocate
• Assist foster families in retrieving medical history
• Explore families recent medical visits and history
• Satisfaction with current PCP
• Maricopa Integrated Health Systems
• EPSDT for children
• Nutrition Basics and for specific diagnoses
• Transportation to appointments if needed
• Compiling of medical records
• Medical decision making
• The importance of physical exercise
• Improved coordination and collaboration between medical and behavioral health through HIE and other efforts
Improving Physical Health
Educating families on the importance of taking care of
their physical health also improves their mental health and vice versa.
• Working with the BH teams
• The Bully Project• Nutrition for specific
mental health diagnoses• Relaxation• Medication reconciliation• Tobacco education
Improving Mental Health
“I have been a patient at JFCS for several years now and have received exceptional care. My life has improved since I first came here and I am grateful. However, since I was first introduced to Integrated Health by my peer navigator, the care I receive has become much more meaningful. Not just the behavioral health care, the physical health care I receive has improved as well. I say this because Adrienne has enlightened me to the fact that physical and emotional well being are inter-connected and cannot improve if either is neglected.“
- Anonymous satisfaction survey comment
Client Quote on Integrated
Care Services
• Teaching self management skills• Health education• Informed decision making skills• Health literacy skills equips the entire family to improve
ability to manage health• Empowerment and assertiveness skills• Nutrition, exercise, and self care Information • Resources• Social support development• Family and child only exercise programs• Flex funds for program related items, ie: karate
Increased Control in Overall Health
One of the most important
components of human resiliency is
social support. Research supports the importance of social supports in health outcomes.
Social Supports
Relaxation and Stress Management ClassesQuote from a enrolled client:
“The relaxation class helps me to cope with my problems better and helps me think in a more positive way. I really enjoy coming and being a part of this two days a week. I feel like it is empowering me, making me stronger as a person, more positive, and healthier in my lifestyle. This is a wonderful program.”
- SF, Adult Integrated Health Client
Nearly 60-90% of visits to healthcare professionals are
either caused or exacerbated by stress for adults.
The Relaxation Response
Research shows the Relaxation Response is an essential resiliency self-management skill that is as predictable as medication in immediately reversing the stress-induced
flight-or-fight response. -Benson, H. The Relaxation Response, William Morton and Company, 1975
Let’s Do It!
• Learning to help themselves and their family members, manage their own care
• Greater confidence in themselves
• Increases clients and parents understanding of the medical system
• Greater ability for the client to meet their own needs and/or the needs of their children
• Gives clients knowledge that they can share with others
Helping clients gain the knowledge, skills, and attitudes for coping with changes in lifestyle and circumstances
EMPOWERING CLIENTS
Continuity of Care Document: A patient summary containing data of the most
relevant administrative, demographic, and clinical information facts about a patient's healthcare, covering one or more healthcare encounters. It
provides a means for one healthcare practitioner, system, or setting to view all of the pertinent data
about a patient and forward it to another practitioner, system, or setting to support the
continuity of care.
1. Header/Document Identifying Information2. Patient Identifying Information. 3. Patient’s Insurance and Financial Information. 4. Health Status of the Patient 5. Care Documentation includes some detail on the
patient-clinician encounter history, such as the dates and times of recent and pertinent visits and the purposes of the visits and names of clinicians or providers
6. Care Plan Recommendation includes planned or scheduled tests, procedures or regimens of care.
Six Mandated CCD Data Elements:
Health Information Exchange JFCS
and MIHS
Sharing client data between JFCS and MIHS on two fronts utilizing the current CCD standard:
• JFCS can pull CCD from MIHS and bring in to EHR
• JFCS can pull CCD from our EHR and fax over to MIHS for inclusion in their client record
Yes ____
Did your child/youth have a different PCP before the one named above? Yes______ No ______
Name/ Date/Signature of BHMP:
Yes______ No ______
Does your child/youth have any of the following chronic medical conditions:
Legal system involvement
Concerns you have about child's/youth's health:
Yes Level no
Triglycerides:Fasting glucose:
Significant life events:
No ______
No ______
No ______
LDL:
Total cholesterol:
HDL:
To be completed by BHMP
Child Protective Services involvement
Death of family or friend
Yes______
Yes______
Yes______
Willingness to Participate:No ______Difficulties in school Yes______
Has your child/youth ever had blood work done?
Yes ______ No ______If yes, were any results abnormal?
List all current medications that your child/youth takes:Name of Medication Dose Frequency
Which ones were you told were abnormal?
Yes ______ No ______
Yes______
No ______
No ______
No ______
Anemia
Skin Problems Yes______ No ______
No ______Yes______
No ______ Yes______
Yes______
Yes______
Yes______ No ______
No ______
No ______
No ______
Eating Problems
Sleeping Problems
Obesity
Hearing Problems
Speech Problems
Yes______
PCP name and phone number:Date of last visit to primary care physician:
If yes, previous PCP name and phone number:
Asthma
Diabetes
Seizures
Heart disease
High blood pressure
No ______If yes, date faxed to PCP office: Have records been received from PCP? Yes______
Yes______
Yes______
Yes______
Yes _______ No _______Has your child/youth had a visit to a medical ER or hospital in the past 6 months?
Yes______ No ______
1 to 2 hours: _______
On average how much daily physical activity does child/youth get per week?
3+ hours: _______
Has your child/youth ever been the victim of bullying? Yes ______ No ______
Are all immunizations up to date? Yes_____ No_____
Does your child/youth have any allergies:
No____Does your child/youth have at least one friend he/she sees regularly?
Date completed: Printed Name Person completing form:
0 to 1 hours: _______
Vital Signs:
Height:
Weight:
BMI:
Blood Pressure (> 3 y.o.):
Pulse Rate:
Respiratory Rate:
In the next six months would you participate in a program that would help you improve your overall Yes______ No ______If available, would you like follow-up services and information to improve Yes______ No ______
Contact phone number:Parent/ guardian name providing info.:
Name: Date of Birth: Male ____ Age:Female ___
Has your child/youth ever been to the dentist? Yes______ No ______
No ______
Has a consent for records to include EPSDT form and laboratory tests been completed? Yes______ No ______
Has he/she seen a dentist in the last 6 months? Yes______
Are you aware of any unresolved dental issues (cavities, misalignment)?
No ______
HRA Report
HRA Comparison Report
Integrated Health Update Report
Client Caseload Tracker Report
Daily staff productivity reports
Billed services and unit reports
Appointments kept, no billing has occurred
Reporting
PCP Relationship Outcomes and Baseline:
• We have assisted 66% of clients needing a better relationship with their PCP
• 75% of surveyed clients reported IH Program helped them develop better PCP relationship
• 86% of surveyed clients reported better coordination of care amongst health providers
Improved Physical Health:
• We have delivered resources and information regarding health and wellness to 80% of our clients in the IH program
• 39% of clients needing screening or routine testing received it
• 55% Of clients walking in with untreated chronic medical disease, received medical appointment within 45 days of beginning the program
• 33% of clients that reported not managing their diabetes are now successfully managing it and have reduced their A1C levels to below 9%
• 77% of surveyed clients report they feel an improvement in overall physical health
Outcomes
PCP Relationship Outcomes and Baseline:
• We have assisted 66% of clients needing a better relationship with their PCP
• 75% of surveyed clients reported IH Program helped them develop better PCP relationship
• 86% of surveyed clients reported better coordination of care amongst health providers
Improved Physical Health:
• We have delivered resources and information regarding health and wellness to 80% of our clients in the IH program
• 39% of clients needing screening or routine testing received it
• 55% Of clients walking in with untreated chronic medical disease, received medical appointment within 45 days of beginning the program
• 33% of clients that reported not managing their diabetes are now successfully managing it and have reduced their A1C levels to below 9%
• 77% of surveyed clients report they feel an improvement in overall physical health
Outcomes
HITECH Act
Office of the National Coordinator (ONC)
EHR Interoperability: Data Set Selection
Electronic Health Records (EHR): Certification
Meaningful Use – Incentives
Privacy: HIPAA and 42 CFR Part 2
Heath Information Exchange: State Grants $16 M
Technology Landscape
Connects multiple organizations with data
Coordinates care through information exchange
Shares information real time and efficiently
Improves quality and costs of services
Avoiding duplication of tests
Improved decision making based on data availability
Improved experience for the individual: safety impact
HIE Benefits
Demographics
Diagnosis
Allergies
Prescribed Medications
Lab Results
**Documents: Progress Notes, Treatment and Crisis Plans, Summaries
HIE Data Items
State Adoption and Use Varies
Behavioral Health: Nebraska and AZ
Medical Provider Use – Who is Using an HIE?
Informed Consent
Opt In – Must opt-out, in HIE by default
Opt Out – Must opt – in, out of HIE by default
Community Education
Marketing Campaign
Education of Health Care Professionals
Education of Heath Care Recipients
Medical v. Behavioral Health Differences
Arizona Lessons Learned
Input from Audience
Education Strategies