Teasa Thompson, MPH Advancing Behavioral Health in Indiana May 13, 2016

Qsource - Who we are and What we do 2 We are Contracted by the Centers for Medicare & Medicaid Services (CMS) Change agents focused on three aims: Better care Smarter Spending Healthier People Partner with patients, providers, and practitioners across five states to conduct quality improvement activities that put patients first and equip providers to do the same.

Qsource - Who we are and What we do 3 Committed to: promoting effective prevention and treatment of chronic disease by promoting safe care that is patient and family-centered, reliable and accessible making care safer and reducing harm caused in the delivery of care promoting effective communication and coordination of care making care more affordable Skilled in: creating opportunities for providers to learn from each other, applying advanced improvement and analytical methods, structuring processes for sustaining positive change

QIN-QIOs Across the Country 4

atom Alliance Partners 5 Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies

6 The Process

Aims of the Behavioral Health Initiative Provide technical assistance and education interventions to: Increase rates of behavioral health screening Increase outpatient follow-up Reduce readmission Primary Care Practices: Increase physician/provider rates of behavioral health screening for depression and alcohol abuse Improve referral for behavioral health services Inpatient Psychiatric Facilities: Reduce 30-day readmission rate Increase follow up rate post discharge Goals: 10,000 practices will screen a majority of their Medicare population for depression and alcohol abuse 1.5 million beneficiaries will be screened by

Why is Advancing Behavioral Health Important? 8 Approximately 6.7 percent of American adults−about 14.8 million people−live with major depression. About 9.2 million adults have co- occurring mental health and addiction disorders. Additionally, challenges in effective care coordination for these and other behavioral health conditions contribute to high hospital readmission rates and problems with treatment adherence.

Why is Advancing Behavioral Health Important? 9 Physicians screen fewer than half of their patients for alcohol use disorders Roughly two-thirds of those with a behavioral health disorder do not get behavioral health treatment Depression is identified in fewer than half of primary care patients Depression and alcohol use disorder are common behavioral health conditions in adults, yet they are often under-identified in primary care settings.

Behavioral Health and Primary Care

68% of adults with BH conditions have medical and 29% of adults with medical conditions have BH

How We Will Advance Behavioral Health? 12 By Partnering with Primary Care Practices & Inpatient Psychiatric Facilities

Alliance Partner Participation 13

Behavioral Health Initiative in Indiana Statewide Primary Care Practices Over 280 Inpatient Psychiatric Facilities 14

Challenges? 15 The atom Alliance recognizes that there are challenges that practices face in the effort to integrate behavioral health in the primary care setting: limited BH referral resources lack of BH training competing priorities

atom Alliance can be part of the Solution! 16 Access to: Industry best practices Healthcare and Integration expertise Cherokee Health Systems (CHS) and Medical Decision Logic, Inc.© (mdlogix) Overall value to our partners

atom Alliance can be part of the Solution! 17 Partner with Primary Care Providers to implement and/or improve the use of depression and alcohol screeners in the primary care setting Provide technical and clinical assistance in the integration of behavioral screeners into the current HIT capabilities and practice workflows Provide verified depression and alcohol screeners (e.g. PHQ9, AUDIT C) in the practice’s chosen format (i.e. integrated into EHR, included in patient packet, etc.)

Screening Tools Evidence-based Common Examples: Alcohol Misuse Screening CAGE AID –5 items AUDIT-C –3 items Depression Screening Patient Health Questionnaire (PHQ) PHQ-2 –preliminary screening PHQ-9 –additional screening if PHQ-2 is positive 18

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atom Alliance can be part of the Solution! 20 Assess the practice’s Behavioral Health neighborhood to identify referral sources and build a robust BH referral network Provide ongoing educational and learning opportunities for practice staff including CEU’s Provide “office hours” for providers to call with questions

atom Alliance can be part of the Solution! 21 Return on Investment (ROI) Financial Access to experts, education, and resources paid for by CMS ROI average screening reimbursement rates are $16 per patient, multiplied by the number of patients seen per practices Qualitative- Improved patient care Protection for clinicians –Not knowing a patient has behavioral health or substance use risks can increase risk for the clinician, such as prescribing medications that may be contraindicated Access to data from atom Alliance

Technical Approach 22

Technical Assistance 23 Provide health literacy and educational tools for beneficiaries Offer LAN meetings where peer-to-peer learning of best practices and success stories can be shared Assist with processes and procedures that will increase quality across all Qsource/atom Alliance initiatives.

Stakeholder Participation Our BH community stakeholders are key partners in the work to advance integrated and coordinated BH care in our communities. atom Alliance’s stakeholder partners are involved in the work of advocating for patients, reducing the stigma of BH conditions and providing additional supports to the BH neighborhood. Our stakeholders bring to this task work expertise in various areas concerning BH and will enrich and enlighten the work that we do. In this collaboration it is our goal to provide mutual support and advance the shared goals that we have. 24

atom Alliance can be part of the Solution! 25 Building the Behavioral Health Neighborhood Care Coordination Communities: Implement evidence-based interventions to reduce hospital admissions and readmissions Track changes and progress using real-time and claims- based Redesign workflow, to improve care coordination between facilities Assemble, lead or contribute to care coordination communities

atom Alliance can be part of the Solution! 26 help communities by: Assisting facilities and communities in selecting measures for quality reporting Preparing data feedback reports and providing technical assistance Sharing collective tools and resources Supporting and promoting community meetings and care coordination activities Hosting on-site and virtual learning events

Other Qsource/atom Alliance Initiatives 27 Coordination of Care We are bringing together statewide communities to create powerful collaborations of change that promote the seamless coordination of care for older adults. Value-Based Payment, Quality Reporting & Physician Feedback We help healthcare providers assess clinical quality of care, care coordination, patient safety, and much more to meet CMS quality reporting and value-based payment requirements. Improving Immunization Rates Historically, immunization rates among adults have been low. atom Alliance aims to change that by working with practitioners, providers, and beneficiaries. Transforming Clinical Practice We collaborate to assist clinicians in changing the way they deliver care, to better position for success in the healthcare market for the future; one that rewards value and outcomes rather than volume. Improving Cardiac Health & Reducing Disparities We assist home health agencies, physician offices, clinics and others spread the use of evidence-based practices to promote the “Cardiac ABCS” and support the Million Hearts initiative. Reducing Disparities in Diabetes Care Diabetes Self management Education (DSME) is a proven intervention for empowering persons with diabetes to acquire the knowledge and skills necessary to improve the quality of their lives. Prevention Coordination through Meaningful Use We collaborate with Regional Extension Centers (RECs) to showcase proven interventions that result in primary care providers successfully meeting the requirements of the Medicare Electronic Health Record (EHR) Incentive Program. Reducing Healthcare-Associated Infections Using evidence-based strategies to prevent healthcare- associated infections (HAIs) can increase the quality of patient care, save lives and decrease healthcare costs. Reducing Healthcare-Acquired Conditions We are uniting nursing homes in a powerful collaborative to share tools, knowledge and experiences for improving resident safety and clinical processes and reducing preventable healthcare conditions.

Resources Helpful Links atomalliance.org/initiatives/behavioral-health/ mdlogix.com/ cherokeehealth.com/ integration.samhsa.gov/clinical-practice/screening-tools cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_ QuickReferenceChart_1.pdf cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS- QuickReferenceChart-1TextOnly.pdf 28

atom Alliance Behavioral Health Team 29

Contact Information Teasa Thompson, MPH Phone: (317) or Indiana Office: 911 E. 86 th Street, Suite 202, Indianapolis, IN

Questions 31