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.
