Chesterfield CSB and Anthem Integrated Care Pilot Project 2016

Anthem/MHSS Integrated Pilot Program (2016) Goals: Delivering more “personalized” treatment inclusive of physical health care Informing and educating clients Closing gaps in care Taking real, measurable steps toward prevention Forging partnerships between public and private sector In order to execute this pilot we created a separate team of CM and Anthem provided a nurse to work with this team and we also had a behavioral Case Coordinator from Anthem assigned to the team. We began with a “deep dive” or case review on all 30 consumers who were assigned to this pilot. This included an independent PCP, RN and Care Coordinator from Anthem and the CSB’s CM team. From these meetings we established a treatment plan for each member. This Photo by Unknown Author is licensed under CC BY-SA

Standards of Care Physical Health Eye exams Breast Cancer Screenings Cervical Cancer Screenings Colorectal Screenings Comprehensive Diabetes Care Controlling High Blood Pressure Behavioral Health Antidepressant Medication Management Adherence to Antipsychotic Medications – Schizophrenia Diabetes Screening – Schizophrenia or Bipolar using Antipsychotics Diabetes Monitoring – Schizophrenia Cardiovascular Monitoring—Schizophrenia Follow-Up with Licensed Clinician within 7 days post discharge To measure our effectiveness – we used a subset of the HEDIS measures (Healthcare Effectiveness Data and Information Set) that most healthcare providers are measured by. We chose standards that directly relate to the comorbid deseases that are commonly associated with antipsychotic and antidepressant use - primarily Diabetes, High BP. We encouraged all participants to get Eye exams and cancer screening. Those with diabetes and hypertension received additional attention rel./ to eye and foot exams. And of course, all individuals in the pilot received comprehensive behavioral health care including preventative care and treatment of those vulnerable to diabetes and cardiovascular disease. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 94 measures across 7 domains of care. We also monitored medical and psychiatric hospitalizations, cost and staff hours.

Antidepressant Medication Mgmt. 100% of those in the pilot followed the standards of care for antidepressant medication management, adherence to antipsychotic medications, diabetes screening and monitoring, and cardiovascular monitoring. Not a big surprise as we are in the business of behavioral health.

This slide shows our success in meeting the optimal healthcare measures including comprehensive diabetes care and self management of high blood pressure in which we reached 100%. You can see we weren’t as successful for other participants. However, we did exceed Anthem’s general population for almost all the measures.

Exceeded Benchmark! This slide shows how the individuals in the pilot compared to all individuals whose health care is provided by Anthem. For example, 91% of those eligible in our pilot received a breast cancer screening, compared to 53% of all Anthem members. In the interest of time I won’t show all the measures - This comparison was similar across all the HEDIS measures.

Coordination of care meant more contacts and more time with the case mangers and the nurse. Over 1,500 hours were spent with those in the pilot (30) and almost 3300 services were delivered vs. 903 hours spent with similar individuals outside of the pilot who received just over 2,000 services from July 1st – March 31st – or ¾ of a year. To accommodate for this we reduced the caseload size of the integrated care clinician by 30-40%. What is not reflected in these numbers is a substantial amount of training time that direct care staff underwent. The nurse and program coordinator provided or coordinated numerous trainings on the various health care issues we were monitoring. For example, the local Community Health Program provided an excellent training on diabetes care to both consumers and staff.

Better Health…. Lower Costs Behavioral Health Hospitalizations by 41% Costs from $139,239 to $69,044 Readmission rate from 24% to 0% Medical Hospitalizations Hospitalizations slightly (3 to 4) Costs from $102,055 to $94,388 Better Health…. Lower Costs The results of the pilot were impressive. When comparing these same individuals from the previous year to the pilot year, the results were significantly improved. Psychiatric hospitalizations went down by 41%. Behavioral health care costs went down from $139k to $69k. And the psychiatric readmission rate dropped from 24% to 0. Medical hospitalizations increased slightly from 3 to 4 admissions, partly due to one individual being diagnosed with cancer during the pilot year but medical costs decreased from $102k to 94k.

We’ve all heard about individuals with no insurance using the ER as their PCP - we saw that our consumers even with insurance often used the ER as their first stop in obtaining healthcare. During the pilot year, ER visits dropped to 43 from 61

there were no gaps in care noted for these individuals on the behavioral health side during the pilot year.

Lessons Learned: Significant paradigm shift for case managers Flexible RN needed – we would advocate for a Bachelors or Masters prepared nurse. They will be doing a lot of education to both staff and clients and in our case, be leading the integrated care initiative along with the program manager. You may need to look at the structure of how nursing services are delivered within the agency. Much of the change for consumers comes in a 1:1 manner – through case manager’s and nursing contacts. Consumers are not eager to engage in groups to address health care issues. Lessons Learned: So we are now bringing this model to scale for the rest of the SMI and to a lesser degree the SUD program. We are trying to reduce caseloads and build the infrastructure with additional nursing staff (BA) level. We have created a Standards of Care assessment tool for all case manager’s to complete that provides a baseline of health care and will (where appropriate) instigate the inclusion of health care goals in the treatment plans.