Integration of Behavioral and Primary Health Care

Helping Families. Supporting Communities. Empowering Individuals.

Integration of Behavioral and Primary Health Care

Diana Knaebe, President/CEO, Heritage Behavioral Health Center

Rhonda Mitchell, Interim CEO

Community Health Improvement Center (CHIC), Decatur, Illinois

dknaebe@heritagenet.org,217-420-4702

rmitchell@chealthctr.org,217-877-3290


Who we are... 

Heritage

  •  Est. March 1956
  • Funding
    • SAMHSA
    • Fee for Service
    • State & Local Grants
  • SMI and SA
  • Patient Base
    • Medicaid
    • Uninsured / Low income

CHIC

  •  Est. April 1972
  • FQHC
    • Federal grant
    • Enhanced Reimb
    • FTCA coverage
  • Primary Health Care
  • Patient Base
    • Medicaid
    • Uninsured/Underinsured

Previous Collaborative Efforts 

  • United Way Funded Collaboration
    • Primary Care at OASIS
      • Basic health care services at homeless shelter
    • Psychiatry services at CHIC
      • Medication management
      • Support and consult for primary care providers
  • Mental Health Bd Funded Project
    • Referral services at CHIC by Heritage BH Specialist for entry into Heritage services

Note:  Diagram of Rethinking the Format of Visions is contained in the attached PowerPoint


The SAMHSA Project

Heritage Behavioral Health Center received a SAMHSA Grant in September 2010 for its Primary and Behavioral Health Care Integration (PBHCI) program.

SAMHSA Program Goals

  • Health and Illness Background Information
    • Used both as a screening and as a means of documenting diagnoses (PH and BH) as well as important medical/health history variables SF-36 (short form)
  • Person Centered Healthcare Home Fidelity Scales and Protocols
    • Developed by our evaluator, TriWest
    • Based on the conceptual work of Barbara Mauer and collaborators
    • 2-day collaborative assessment process

Accomplishments

  • Established a Health & Wellness Suite, including a Primary Care Office at Heritage
  • Contracted with CHIC Primary Care Clinic to place a Primary Care Physician's Assistant on site - this is proving invaluable
    • Relationship with team members
    • Labs Drawn on Site - picked up = results available to Nurse Care Managers on-line quickly
  • Already seeing many positive health outcomes
    • Weight Loss; Blood Sugar Stabilization; Blood Pressure Improvement

Health and Wellness Activities

  • Food Pyramid Education weekly
  • Healthy Cooking Classes weekly
  • Chair Zumba twice per week
  • Modified Yoga weekly
  • Daily Walking Activity
  • Healthy Food Shopping As Needed
  • 1:1 Food Counseling and Review of Food Tracker as needed
  • Weekly Off Site Exercise

Health and Wellness Objectives

Our opportunity to provide Holistic Care

  • Extending Wellness Model throughout organization
  • Decrease smoking - clients and staff
    • Provide fully certified smoking cessation classes internally with clients connections with staff
  • Health Education, i.e., diabetes education, nutrition, and exercise
  • Have peer support/mentors as part of the program

Challenges

  • Electronic Health Record

    • Training time
    • Reduced productivity
    • Separate records / duplication of data
  • Cultural / Organizational

    • Communication obstacles between program staff - Time consuming and laborious
    • Supervision / Direction for Primary Care Provider
    • Streamlining processes in different organizational systems
    • Different funding streams
    • Internal "Marketing" Clients and Staff
    • Adding in number of hours from Primary Care PA
    • Productivity still not up to expectations
  • Larger Issues

    • Time required to get CIS approved with HRSA and Medicare / Medicaid enrollments for new site
    • Sustainability challenges with low productivity volume - grant imperative for start up
    • Unreimbursed costs - time required for administrative and support staff


Lessons learned……..

  • What worked well?

    • Existing partnership - top down driven
    • Shared patient base
    • Advantage of having most of BH services in one site and then integrating Primary Care into that site and working as a team
    • Took time to hire the "right" staff
    • Having positive client outcomes - part of RAND "drill down" for successes
  • What would we do differently?

    • Leader who was on staff every day (although current leader an excellent choice she wishes she was around more for the staff)
    • Conduct all-staff informational meetings and annual updates
    • Develop improved processes for patient reminders


Health Homes / Behavioral Health Homes

  • Timing is good

    • The Illinois Innovations Project has asked for health homes
    • Establishment of Managed Care and Case Coordination Entities
    • Affordable Care Act - Healthcare Reform
  • We are seeing some early positive clinical outcomes - indicators through our SAMHSA project

    • Weight loss - + BMI change
    • Blood Sugar Stability
    • Blood Pressure - hypertension rates much improved

Note:  Diagram of Heritage Behavioral Health Center's Person-Centered Healthcare Neighborhood is illustrated in the attached Power Point

Number Served

Number of Consumers Served - FFY12 Annual Goal Number Served % Received
Heritage 250 247  99%
64 PBHCI Programs Nationwide  22,727  21,532  94%

Note:Now up to 345 enrolled clients

Nights of Care Out of Home

Nights/Times in Trouble!

(past 30 days)

Baseline (n=65) 12 Months (n= 65)
% Any Mean Total nights % Any Mean Total nights
Nights Homeless 9.1% 2.18 144 3.1% 0,89 58
Nights in Hospital (for M.H.) 13.6% 1.18 78 7.7% 0.43 28
Nights in Detox 4.8% 0.32 21 3.1% 0.06 4
Nights in Jail 0.0% 0.00 0 0.0% 0.00 0
ER Visits 12.1% 0.27 18 1.5% 0.02 1
Total Nights* 27.3% 3.95 261 12.3% 1.4 91

*t(17)=2.84, p=.011


Note:  Diagram of Baseline vs. 12 Months:  Total Number of Nights Homeless, In Psychiatric Hospital, In Jail, In Detox, and in the Emergency Room in 30 Days prior to assessment (N-=65) is in the attached PowerPoint


Current Challenges…..

  • We are approaching smoking cessation much more aggressively. Each visit we will be asking if the client would like help with cutting down or smoking cessation.
    • Some are beginning to tell the team they want to decrease or have set a stop date
  • Experiencing some staff turnover.