integrated health: creating successful outcomes through technology innovations

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Integrated Health: Creating Successful Outcomes Through Technology Innovations

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Integrated Health: Creating Successful Outcomes Through

Technology Innovations

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%

Behavioral Health

Diagnosis Analysis

for Adults

Chronic Disease Analysis for Adults

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

Health

Risk

Assessment

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

HIE

Hospital

Lab

PharmacyPCP

Specialist

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

BHINAZ

Patient Portal

Psych Hospital

HIE

EROP BH Clinic

Crisis Provider

Pharmacy

http://www.healthit.gov

HIE Grants by State

Programs and Advisory Committees

Patient and Families Information

Resources