Bi-Directional care integration Work Group Kyle Roesler, program manager july 31, 2018

Welcome and Introduction Introduce yourself: Name and Organization WELCOME

Agenda Mention pre-meeting updates Cowlitz Family Health Center Dian Cooper, CEO Implementation Plan Indicators to Track Progress Psychiatric Consultation Opportunity AIMS Center Bi-Directional Care Integration training program Next Steps

Cowlitz Family Health Center Behavioral Health Integration

Cowlitz Comprehensive Health Care Unique partnership of 3 nonprofits to provide integrated care – together we served over 50% of the low income population in Cowlitz County Cowlitz Family Health Center – primary care outpatient Columbia Wellness – specialty mental health outpatient Drug Abuse Prevention Center – residential and outpatient substance use disorder treatment

Goals Improved access to care; easier to navigate Reduction of stigma associated with mental illness Better communication More focused and streamlined referral process Improved matching of service to expertise More efficient use of limited resources Provider education (learning from each other) Insights into clinical, structural, funding models Improved customer service and job satisfaction improve medical outcomes, reduce health disparities, and lead to medical cost offset

What Worked Well Standardized screening tools used in primary care Behavioral Health Consultants and Psychiatric Nurse Practitioners added to the primary care team Patients able to access Psych ARNP at primary care clinic Referral and warm hand-off work flow between organizations improved Patient services and satisfaction improved Provider and team satisfaction improved

What didn’t Work as Well More patients screened positive for behavioral health conditions but not ready to accept treatment Patients were still lost between agencies Patients dropped out of treatment Integration of substance use disorder services Original goal of 3-way merger of the organizations never occurred

Projects and Studies that Supported the Alliance Integrated Comprehensive Intervention and Support Project (ICISP) – 2006 National Council for Behavioral Health Primary Care Collaborative Health Project - 2007 Health Systems Resource Grant, State of Washington, Department of Health - 2007 Health Systems Resource Grant, State of Washington, Department of Health – 2007 Re-thinking Care Initiative -2009

History 2004: CCH Concept is Born 2004: Business Associate Agreements 2004: Memorandum of Understanding 2007: Strategic Alliance 2011: Merger Evaluation 2012: No Merger-Strengthened Alliance

Cowlitz Family Health Care and Drug Abuse Prevention Center Merger CFHC started SBIRT screening in 2011 CFHC and DAPC began operating as an integrated organization in 2014 Integrated Boards of Directors and Merged in 2015 CFHC incorporated outpatient and residential substance use disorder treatment services to our service lines Columbia Wellness- stand-a-lone with strong inter- agency referral process

Substance Use Disorder Continuum of Services SBIRT in primary care Adult outpatient SUD assessment and treatment Adult residential intensive treatment Pregnant and Parenting Women long term residential treatment for pregnant and parenting women and their children Parent Child Assistance Program intensive case management for pregnant and parenting women and their children Phoenix House permanent supportive housing for pregnant and parenting women and their children Harm Reduction Program (SSP-Syringe Services Pgm) Medication Assisted Treatment

CFHC Integrated Care Today CFHC is a level 3 patient centered medical home – behavioral health staff are part of the care team Primary care patients are screened annually or more often if needed (AUDIT, DAST, PHQ, GAD, SBIRT) Behavioral Health Consultants take warm hand-offs and provide brief treatment Psychiatric nurse practitioners provide medication management and consultation Substance use disorder staff take referrals and provide treatment Harm reduction program includes syringe services, access to substance use disorder and MAT services, primary care and family planning services

? Questions ? Dian Cooper dcooper@cfamhc.org (360) 636-3892

Implementation Plan Due October 1, 2018 Key deliverable for CPAA Requires specific implementation information As an ACH, we have to submit a project implementation plan that is due October 1st. This is a key deliverable for CPAA to receive funding for year 2 of the Transformation, and will contain more specific information about the project work be implemented in the region. The HCA needs to understand our milestones, individual work steps, outcomes, how we are going to work with partnering providers, and our timeline for completing action steps and milestones. We are actively working on this right now. There is a detailed workbook and narrative portion to the plan. It will take a substantial amount of time to get right.

Key Indicators to Measure Implementation What are the key indicators used by the ACH to measure implementation progress by partnering providers? Patient-centered team care Population-based care Measurement-based treatment to target Evidence-based care Accountable care Review Measures Handout One of element of our plan is understanding key indicators to measure project implementation. Over the next few years, we have to measure progress for organizations either integrating primary care or behavioral health. The way I’ve been thinking about measuring progress is relying more on these 5 core principles of collaborative care, rather than a specific model. So, under each of these principles is a number of qualitative and quantitative indicators that I want us to review and consider.

Psychiatric Consultation Supports collaborative care team through regular consultation Advises prescribing medical provider Caseload review (registry) Treatment adjustments Consultation notes Questions How can he access their registry for consultation and would he also access the partnering provider’s EHR? Might take some time to set up. MAT and OUD potential Looking for around 15 hours per week of psych consultation in CoCM, starting in Nov-Dec Currently in community-based integrated care fellowship at UW Only interested in consultation at this point Preference would be to work in CoCM involving MAT Next steps Invite to a work group Develop proposed cost of contracting Is anyone interested in this?

Psychiatric Consultation Opportunity Psychiatrist in SW WA looking to fill psych consultation role Currently in Community-Based Integrated Care Fellowship at UW Preference to work in CoCM involving MAT and addiction medicine Questions How can he access their registry for consultation and would he also access the partnering provider’s EHR? Might take some time to set up. MAT and OUD potential Looking for around 15 hours per week of psych consultation in CoCM, starting in Nov-Dec Currently in community-based integrated care fellowship at UW Only interested in consultation at this point Preference would be to work in CoCM involving MAT Next steps Invite to a work group Develop proposed cost of contracting Is anyone interested in this?

AIMS Center Care Integration Training Program One year program but variable depending on practice readiness factors Three phases 1. Planning for whole person care 2. In-person training for integration 3. Virtual coaching and additional training CE credits Phase 2: in person Problem Solving Treatment and Behavioral Activation Training website

Enrollment Process Identify point of contact for training program Identify team members to participate in training program Participate in group phone call with CPAA/AIMS Center (optional) Complete CPAA/AIMS Center Commitment Form/packet Partners are grouped by organization type and start time AIMS Center will send out welcome letter/email and confirm POCs Gain access to AIMS Center training website Training program begins

UW AIMS Center – Summer 2018 Webinars

Summary and Next Steps Next steps Next meeting is August 28 Register for UW AIMS Center webinar series