t. c. osner & associates continuum integration model
TRANSCRIPT
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Healthcare Synchronization:Healthcare Synchronization:a systemic integration a systemic integration
of of Behavioral Health Behavioral Health
across the Continuum of across the Continuum of Medical CareMedical Care
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I didn’t pick my illnesses I didn’t pick my illnesses
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To my endocrinologist, To my endocrinologist, I’m a diabeticI’m a diabetic
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To my PCP, To my PCP, I have Crohn's DiseaseI have Crohn's Disease
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To my OB-GYN,To my OB-GYN,It’s a recurring infection It’s a recurring infection
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To my Oncologist, To my Oncologist, I have breast CAI have breast CA
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To the hospitalist, To the hospitalist, I’m someone to stabilizeI’m someone to stabilize
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To the ED doctor, To the ED doctor, I’ve got panic attacksI’ve got panic attacks
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What’s the one thing they What’s the one thing they all have to deal with?all have to deal with?
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The reason I have to see The reason I have to see them more than I should?them more than I should?
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My depression . . .My depression . . .
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. . . . my social . . my social stressors . . .stressors . . .
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. . . and my addiction. . . and my addiction
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Partial solutions . . .Partial solutions . . .
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adding much needed services . . .adding much needed services . . .
Behavioral health inOncology
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. . . creating medical homes . . . creating medical homes
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But it’s a system’s problem . . . But it’s a system’s problem . . .
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Behavioral Health Behavioral Health integration, integration,
like healthcare, like healthcare, has been has been
stitched together stitched together into a monsterinto a monster
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““An arm here . . .An arm here . . .. . . a leg there . . . . . a leg there . .
..and last – and last – the brain ”the brain ”
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Silos of integration Silos of integration • IndependentIndependent• UncoordinatedUncoordinated• UncooperativeUncooperative• DuplicativeDuplicative• ProtectiveProtective• ““My program” mentality My program” mentality
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A philosophy of integration . . .A philosophy of integration . . .
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• Behavioral Health is inclusive of promoting Behavioral Health is inclusive of promoting well-being, preventing/intervening in well-being, preventing/intervening in harmful behaviors, and the treatment of harmful behaviors, and the treatment of mental health and addiction disordersmental health and addiction disorders
New assumptions:New assumptions:
• Behavioral Health is a primary service first, a Behavioral Health is a primary service first, a specialty service secondspecialty service second
• Behavioral Health engages all behavioral Behavioral Health engages all behavioral health matters regardless of locationhealth matters regardless of location
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• Treatment occurs at the site of the Treatment occurs at the site of the patient’s most numerous medical patient’s most numerous medical utilizationutilization
• Behavioral treatment is synchronized across Behavioral treatment is synchronized across the continuum of medical care the continuum of medical care
• The system engages with patients rather than The system engages with patients rather than patients engaging with departmentspatients engaging with departments
New assumptions:New assumptions:
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Behavioral Health Integration Behavioral Health Integration is defined on three levels:is defined on three levels:• Substance abuse and mental Substance abuse and mental
health treatmenthealth treatment• Internal integration of core Internal integration of core
traditional servicestraditional services• External integration into the External integration into the
continuum of medicinecontinuum of medicine
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Realigning and repurposing existing Realigning and repurposing existing resources to be FTE neutral resources to be FTE neutral
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All integration efforts, All integration efforts, both internal and both internal and
external,external, begin with the begin with the
developmentdevelopmentof the Hybrid Clinicianof the Hybrid Clinician
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Creating ethos Creating ethos
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As every Marine is a As every Marine is a rifleman . . .rifleman . . .
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. . . every clinician . . . every clinician is a hybridis a hybrid
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Hybrid Clinician profile: Hybrid Clinician profile: • Licensed Masters-level clinician in social Licensed Masters-level clinician in social
work, psychology or marriage/family work, psychology or marriage/family • Licensed or Certified Alcohol/Drug Abuse Licensed or Certified Alcohol/Drug Abuse
CounselorCounselor• Conceptual/systems thinkerConceptual/systems thinker• Flexible team playerFlexible team player• Strong diagnostic skillsStrong diagnostic skills
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Hybrid Clinician profile: Hybrid Clinician profile: • Experienced in different Experienced in different
levels of carelevels of care• Entrepreneurial Entrepreneurial • Desire to be more than “just Desire to be more than “just
a therapist”a therapist”
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Skillset of a Hybrid Clinician: Skillset of a Hybrid Clinician: • Knows the entire systemKnows the entire system• Functions at any level of careFunctions at any level of care• Crisis AssessmentCrisis Assessment• Interventionist: CBT/SFBT/MIInterventionist: CBT/SFBT/MI• High Risk Care ManagementHigh Risk Care Management• Utilization ManagementUtilization Management• Registrar Registrar
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• Versed in Lean PrinciplesVersed in Lean Principles• Certified in Primary Certified in Primary
Behavioral Health CareBehavioral Health Care
Skillset of a Hybrid Clinician: Skillset of a Hybrid Clinician:
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Financial sustainability Financial sustainability is achieved through existing payment mechanisms is achieved through existing payment mechanisms
and creative partnerships with payers and creative partnerships with payers
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Building an organic system:Building an organic system:• Embedding infrastructure Embedding infrastructure
rather than just a servicerather than just a service• Hybrid skillsets, i.e., case Hybrid skillsets, i.e., case finding/screening/assessment etc. become a finding/screening/assessment etc. become a centralized function as opposed to discreet centralized function as opposed to discreet disciplines or locations – “no wrong front door”disciplines or locations – “no wrong front door”
• Behavioral health treatment is Behavioral health treatment is synchronized and flows with the synchronized and flows with the patient through the continuumpatient through the continuum
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To engage with a Hybrid To engage with a Hybrid is to is to
have access to the continuumhave access to the continuum
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
Single Hospital SystemSingle Hospital System
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
Single Hospital SystemSingle Hospital System
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
SpeciallySpeciallyTrainedTrainedHybrid Hybrid
CliniciansClinicians
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
Single Hospital SystemSingle Hospital System
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
PreviouslyPreviouslyUnidentifiedUnidentified
Psych DriversPsych Drivers
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
Single Hospital SystemSingle Hospital System
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
PreviouslyPreviouslyUnidentifiedUnidentified
Psych DriversPsych Drivers
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
Single Hospital SystemSingle Hospital System
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
Integrate Integrate intointo
SystemSystemPCPs & PCPs &
SpecialtiesSpecialties
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
Single Hospital SystemSingle Hospital System
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
Integrate Integrate intointo
SystemSystemPCPs & PCPs &
SpecialtiesSpecialties
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• ““You can’t do that”You can’t do that”• ““Our system is too big”Our system is too big”• ““You can’t do this all at once”You can’t do this all at once”• ““HIPAA”HIPAA”• ““We can’t afford additional FTEs”We can’t afford additional FTEs”
Challenges/Hurdles:Challenges/Hurdles:
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First Steps: First Steps: • Diagnostic assessment of the existing system Diagnostic assessment of the existing system - infrastructure- infrastructure - culture - culture - continuum connectivity- continuum connectivity - nimbleness- nimbleness - current employees for goodness of fit- current employees for goodness of fit• ““Tell the story” – the gospel of the modelTell the story” – the gospel of the model
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First Steps: First Steps: • Identify administrator and physician championsIdentify administrator and physician champions• Identify/train 1Identify/train 1stst generation Hybrids and their generation Hybrids and their
leaderleader• Educate payers regarding the model and have Educate payers regarding the model and have
Hybrids credentialed on all panels Hybrids credentialed on all panels • Engage Finance for all proper supportEngage Finance for all proper support• Engage IT for all proper supportEngage IT for all proper support• Identify PCP/Specialty beta sitesIdentify PCP/Specialty beta sites
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First Steps: First Steps: • ““Tell the story”Tell the story”• ““Tell the story”Tell the story”• ““Tell the story” Tell the story” • Hybrids must know the Hybrids must know the
model chapter and versemodel chapter and verse
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First Steps are bothFirst Steps are bothsequential and simultaneoussequential and simultaneous
efforts efforts
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““Move fast slowly” Move fast slowly”
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Playing in old Playing in old Yankee Yankee
Stadium while Stadium while building new building new
Yankee Yankee StadiumStadium
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
The Integrated SystemThe Integrated System
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
The Integrated SystemThe Integrated SystemOne One
DepartmentDepartment
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
The Integrated SystemThe Integrated SystemOne One
DepartmentDepartmentOne IdentityOne Identity
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
The Integrated SystemThe Integrated SystemOne One
DepartmentDepartmentOne IdentityOne IdentityMultifaceteMultifacete
dd
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
The Integrated SystemThe Integrated SystemOne One
DepartmentDepartmentOne IdentityOne IdentityMultifaceteMultifacete
ddRevenue Revenue generatinggenerating
Across Across the the
Continuum of CareContinuum of Care
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
NoNoWrongWrongDoorDoor
The Integrated SystemThe Integrated SystemOne One
DepartmentDepartmentOne IdentityOne IdentityMultifaceteMultifacete
ddRevenue Revenue generatinggenerating
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ICU
PCP PCP
PCPPCP
PCPPCP
SpecSpec
SpecSpec
Spec Spec
SPECIALTYMED/SURG
EDBHU
SpecialtyMentalHealth
SpecialtyMentalHealth
A&RC.C.
The Integrated SystemThe Integrated SystemSupplemented by Supplemented by
billablebillableWeb-basedWeb-based
CBTCBT
Web-basedCBT
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What it is and what it does . . . What it is and what it does . . .
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What it is and what it does . . . What it is and what it does . . .
infrastructure, not just a service infrastructure, not just a service
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What it is and what it does . . . What it is and what it does . . .
infrastructure, not just a service infrastructure, not just a service coordination of systems rather than coordination of systems rather than
clinicians clinicians
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What it is and what it does . . . What it is and what it does . . .
infrastructure, not just a service infrastructure, not just a service coordination of systems rather than coordination of systems rather than
clinicians clinicians delivers treatment where the patients delivers treatment where the patients
are are
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What it is and what it does . . . What it is and what it does . . .
infrastructure, not just a service infrastructure, not just a service coordination of systems rather than coordination of systems rather than
clinicians clinicians delivers treatment where the patients delivers treatment where the patients
are are reduces stigma and impacts compliancereduces stigma and impacts compliance
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What it is and what it does . . . What it is and what it does . . .
infrastructure, not just a service infrastructure, not just a service coordination of systems rather than coordination of systems rather than
clinicians clinicians delivers treatment where the patients delivers treatment where the patients
are are reduces stigma and impacts compliancereduces stigma and impacts compliance
impacts costimpacts cost