Richard C. Veith, MD

Richard D. & Bernice E. Tutt Professor in the Neurosciences

Psychiatry & Behavioral Sciences

Adjunct Professor, Global Health

University of Washington

COLLABORATIVE CARE IN MENTAL HEALTH AND ASD

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DISCLOSURESEmployment: University of Washington

Richard D. and Bernice E. Tutt Professor in the Neurosciences

Chief of Psychiatric Services, UWMC

Professor, UW Psychiatry and Behavioral Sciences

Adjunct Professor, UW Global Health

Grant funding (current and recent)

HRSA Office for Advancement of Telehealth (Veith, RC - PI)

Enhancing Rural Primary Care Access to Mental Health and

Opioid Management Consultations in Washington Via Telehealth

$1,000,000; 9/2012-8/2016

2 R01 NR007755-06 (Mitchell, P - PI)

Psychosocial/Behavioral Intervention in Post-Stroke Depression

(PSD) $1,671,368; 7/2010-7/2014

Industry Sponsored Activities - None since 19982

PRESENTATION OVERVIEW

• Behavioral health workforce/access/treatment challenges in US

• Mental health care delivery in era of healthcare reform

• Collaborative care model – leveraging scarce resources

• ASD Education and Care Delivery Challenges• ? integrated care model

• ? telehealth

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HOW DO WE MEET THESE CHALLENGES?

• Poor access to mental health specialty careo Insufficient numbers and maldistribution of

specialists

o Those with greatest need have fewest resources

o Poor medical care access for those with chronic mental illness

• Poor utilization of evidence-based treatments

• Inadequate training of primary care providers

• Stigma

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US HEALTHCARE REFORM IS PROMOTING CHANGES

• Affordable Care Act – “Obama Care”o Triple Aim - better health; better quality;

reduced costs

• Focus on patient-centered ‘medical home’, integrated care, inclusion of mental health care

• Shifts in reimbursement priorities o Emphasis on comprehensive care and outcomes

• Innovative mental health delivery models developed at UW

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WHO DEFINITION OF HEALTH

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (1948).

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20 years of Research and Practice in Integrated Mental Health Care

DIVISION OF INTEGRATED CARE AND PUBLIC HEALTH

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UW CATCHMENT AREA -- WWAMIMI

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PRINCIPLES OF EFFECTIVE COLLABORATIVE BEHAVIORAL HEALTH CARE – J. UNÜTZER, 2011

Patient Centered Team Care• Team members collaborate effectively

Population-Based Care• Patients are tracked in a registry: no one ‘falls through the

cracks’Measurement-Based Treatment to Target• Treatments are actively changed until the clinical goals are

achievedEvidence-Based Care

• Treatments used are ‘evidence-based’

Accountable Care• Providers are accountable and reimbursed for quality care and

outcomes

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COLLABORATIVE TEAM APPROACHJ. UNÜTZER, 2011

General Medical

Practitioner

Patient

Behavioral HealthCare

Manager

Consulting Psychiatrist

Other Behavioral

Health Clinicians

CoreProgram

Optional Additional Clinic Resources

OutsideResources

Substance Treatment, Vocational Rehabilitation, CMHC,

Other Community Resources

New Roles

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DANIEL’S STORY

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WE CAN DOUBLE THE EFFECTIVENESS OF CARE

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8

Usual Care IMPACT

% with treatment response

Participating Organizations

Unützer et al., Psych Clin NA , 200412

CARE MANAGEMENT TRACKING SYSTEM ©

CMTS

• Access from anywhere• Population-based• Supports effective care• Keeps track of caseloads• Facilitates consultation• Allows research on highly representative populations• Licensed by UW C4C to 21 users in 14 states • Has supported care of over 80,000 patients

Caseload summaries help manage clinical productivity and quality improvement

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ACHIEVING THE TRIPLE AIM

Patient care experience

Clinical outcomes

Health care costs

“I got my life back”

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COLLABORATIVE CARE AT UW MEDICINE

3 HMC(CHPW MHIP)

2008 2010 2012 2013

1 UWNC

4 UWNC1 UWMC

1 UWNC1 HMC

BHIP Launch

11 Participating SitesHarborview Medical Center (HMC)Adult Medicine, Family Medicine, Pioneer Square, Women’s Clinic

UW Neighborhood Clinics (UWNC)Belltown, Federal Way, Kent/Des Moines, Northgate, Ravenna, Shoreline

UW Medicine Center (UWMC)General Internal Medicine

2014

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WASHINGTON STATE MENTAL HEALTH INTEGRATION PROGRAM

over 40,000 patients served

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UWNC PRIMARY CARE PHYSICIAN

“You have no idea how helpful it is for a provider to have a resource like you in the clinic. I practiced for 16 years without it and I will never go back! You are such a great support for all of us.”

Sept, 2013

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ASD: HOW DO WE ADDRESS THIS CHALLENGE?

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CDC: Surveillance Summaries. March 28, 2014 / 63(SS02);1-21

PROGRESS

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• Increased public awareness

• Improving health coverage

• Centers of excellence are advancing knowledge and training future workforce

• Expanding educational and vocational opportunities

CHALLENGES

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• How to disseminate knowledgeo Traditional educational venues

• Who will be the caregiver workforce?o What skills, training do they need?

• Would a ‘collaborative care’ model be effectiveo Do we have enough ‘experts’

o Who will serve as care coordinators

o How will this be financed and sustained?

• Can telehealth be employed for educational and consultation outreach?o Videoconference consultations

o Project ECHO – learning communities, case-based, capacity building

J a m e s D . R a l s t o n

Thank You

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