Session # H7 Experiences Using the AHRQ Academy Playbook - a web-based guide to integrate behavioral health in primary or other ambulatory care settings Nina Freed, MPH, Research Analyst, Westat Neil Korsen, MD, MS, Medical Director, Behavioral Health Integration program, MaineHealth Jonathan Muther, PhD, Director of Behavioral Health & Psychology Training, Salud Family Health Centers CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A. Collaborative Family Healthcare Association 12th Annual Conference

Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months. Collaborative Family Healthcare Association 12th Annual Conference

Learning Objectives At the conclusion of this session, the participant will be able to: Know where to find a web-based guide for integrating behavioral health care into ambulatory care on the AHRQ website. Utilize the self-assessment available through the Academy Playbook to learn where their organization stands with respect to all aspects of integration. Describe how the AHRQ Academy Playbook could be used by a practice wanting to implement integrated primary care. Collaborative Family Healthcare Association 12th Annual Conference

Bibliography / Reference Kathol, Roger G., and Bruce L. Rollman. "Value-based financially sustainable behavioral health components in patient-centered medical homes." The Annals of Family Medicine 12.2 (2014): 172175. Massachusetts Patient Centered Medical Home Initiative (2012). Behavioral Health Integration Tool Box: http://pcmhlearning.ehs.state.ma.us/atutor/login.php Melek, S. P., D. T. Norris, and J. Paulus. "Economic impact of integrated medical behavioral healthcare: Implications for psychiatry." Arlington VA: American Psychiatric Association (2014). Patient-Centered Primary Care Institute (2013). Primary Care Behavioral Health Toolkit: http://www.pcpci.org/sites/default/files/resources/PCBH%20Implementation%20Kit_FINAL.pdf Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral Health Integration. Phillips KE, Holt BS, eds. Seattle, WA: Qualis Health, MacColl Center for Health Care Innovation at the Group Health Research Institute, and the University of Washington’s AIMS Center; 2014. Collaborative Family Healthcare Association 12th Annual Conference

Learning Assessment A learning assessment is required for CE credit. A question and answer period will be conducted at the end of this presentation. Collaborative Family Healthcare Association 12th Annual Conference

The AHRQ Academy Integration Playbook A Guide to Integrating Behavioral Health Care in Primary & Other Ambulatory Care Settings Nina Freed, MPH Research Analyst, Westat October 15, 2016

Today’s Presentation Playbook overview and demonstration Resources in the Playbook Experiences using the Playbook Q & A

The Academy The Academy for Integrating Behavioral Health and Primary Care A national resource center for the integration of behavioral health and primary care Established in 2010 with AHRQ funding Taken shape with guidance from a national expert panel, the NIAC http://www.integrationacademy.ahrq.gov

Tools Overview Academy Portal Literature Collection Clinical Outcome Measures HIT Case Studies Lexicon Workforce competencies IBHC Measures Atlas Integration Playbook

Integration Playbook

Integration Playbook Purpose Intended audience Development To provide guidance on “how to integrate” Intended audience Practices working to integrate behavioral health in primary or other ambulatory care settings Development Team has included members from the National Integration Academy Council, UC Denver, Westat, and Informatics Studio

Guiding Principles Acknowledge that integration isn’t “all or nothing” Use the Academy’s Lexicon as the foundation Make it flexible Link users to resources on the Academy Web portal and external resources

Playbook Content Overview Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Self-Assessment Checklist

Playbook Content The “How To’s” Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community The “How To’s”

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Layout

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community Prepare Infrastructure Establish Protocols Track and Monitor Patients

Playbook Content Establish Operational Systems Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community Establish Operational Systems Secure Financial Support Collect & Use Data for QI Educate Patients & Families Obtain BH Expertise & Build Culture of Integration Prepare Infrastructure Establish Protocols Track and Monitor Patients

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community Establish Protocols to ID Patients Tailor the Care Team Develop a Shared Care Plan Build Patient Understanding of Setbacks & How to Deal Prepare Infrastructure Establish Protocols Track and Monitor Patients

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community Prepare Infrastructure Establish Protocols Track and Monitor Patients Track Patients & Monitor Outcomes

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Playbook Content Using the Playbook Self-Assessment Checklist Planning for Integration Implementing the Plan Observations from Exemplary Sites What Not to Do FAQs Connect with the Community

Check it out! The Playbook is live and available at: https://integrationacademy.ahrq.gov/playbook

The Playbook Team at Westat Garrett Moran GarrettMoran@westat.com (301) 294-3821 Josh Noda JoshNoda@westat.com Natalie Teixeira NatalieTeixeira@westat.com Nina Freed NinaFreed@westat.com www.integrationacademy.ahrq.gov/playbook AcademyPlaybook@westat.com

Playbook Resources Neil Korsen, MD, MS October 15, 2016

Patient Information

BHI Rack Card

Medical Provider Training

Warm Hand-Offs Concern presented, concept introduced Request BHC Warm hand-off to bhc Brief, focused treatment Providers debrief

Documentation Template

Experiences Using the Playbook Salud Family Health Centers Jonathan Muther, PhD Director of Behavioral Health & Psychology Training Salud Family Health Centers Clinical Integration Advisor, Farley Health Policy Center

Sequential or Customizable

Find Your Direction

Self-Assessment

Results from our Self-Assessment Salud Priorities: Financial Sustainability Track Patients and Monitor Outcomes Develop Shared Care Plans Health IT

Priority 1: Financial Support of BH

How do you do it? Payer Mix: Insurance Below Poverty line Medicaid Medicare Private CHP+ Uninsured Percentage 61% 52.5% 5.7% 13.0% 2.8% 26.0% Collaborative Family Healthcare Association 12th Annual Conference

How do you do it? Awareness of BH Carve-outs and Carve-ins:

How do you do it? Identify Payment Methodologies of your Payers: Current: Fee-for-service PMPM – Care Management, State Innovation Model Future: ??? ACC 2.0 Medicaid Carve-out is rumored to be going away APM’s

What Not to Do: Financial Maximize the license of the BH clinician

Priority 2: Track and Monitor Outcomes

How Do You Do It? Monitor Patients

How Do You Do It? Monitor Patients

Lessons Learned Don’t bite off more than you can chew It’s not always linear Ongoing self-assessment Share & learn from others

Session Evaluation Please complete and return the evaluation form before leaving this session. Thank you! This should be the last slide of your presentation Collaborative Family Healthcare Association 12th Annual Conference