Integrating Primary Care & Behavioral Health Care with eConsults: Progress Report on HPHC Quality Grant-funded Project Harvard Pilgrim Health Care 2018 Medical Directors’ Meeting September 12th, 2018 Thomas P. Meehan, MD, MPH Vice President, Research & Medical Education, ProHealth Physicians Executive Director, Connecticut Center for Primary Care

Project Overview Feasibility test and impact assessment of eConsults (electronic consultations) between behavioral health providers and ProHealth Physicians (PHP) primary care providers Target conditions: Major Depressive Disorder and Generalized Anxiety Disorder Collaborator: Connecticut Center for Primary Care (CCPC) Goals: Improve quality, cost, and access to care for patients with concurrent physical health problems and anxiety or depression Quantitative and qualitative data will be collected and analyzed to assess changes in: 1) quality of care, 2) utilization and cost, 3) patient experience, 4) provider satisfaction, and 5) barriers and success factors

Milestone Activities Orient PHP leadership to the project and gain their endorsement Contract with the eConsult vendor Determine technical EHR requirements and make necessary adjustments Recruit representative provider offices to participate in the project Determine staff workflow requirements and make necessary adjustments Collect and analyze baseline data form EHR, claims, and surveys

Progress and Lessons Learned PHP leadership was oriented to the project and view it as important to transform care delivery for value-based payment. Leadership is supportive of a feasibility test. Multiple current practice transformation and data initiatives remain top priority and challenge available resources. The eConsult vendor was hired after a prolonged contract negotiation. Ownership of professional liability was a sticking point which caused a 3 month delay. Technical EHR challenges were identified and successfully resolved over 2 months. Two-way transmission between EHR systems was predictably problematic. Starting with a low tech approach (faxing) while concurrently working on an EHR solution would have been more efficient.

Progress and Lessons Learned Six representative offices (2 IM, 2 FP, 2 Peds) have been recruited to participate. Recruitment took longer than expected because practices overwhelmed by multiple new initiatives and aggressive productivity demands were reluctant to volunteer. A standardized workflow for electronic consult requests exists but was found to be variably implemented. Office-specific workflow assessments and retraining of office staff are occurring. Data collection guides and analysis plans have been created and baseline data have been requested. Staff turnover in the IT, Claims, and Survey Departments present ongoing challenges.

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ProHealth Physicians’ Experience with Patient Ping Patient Ping (PP) is a national care coordination network that connects healthcare providers with real-time clinical event notifications. Current PP data includes primary admission diagnosis. In the future, PP data will include medications and discharge summaries. PP identifies short term high risk patients better than claims analyses because the data are more current. All hospitals in CT participate with PP except John Dempsey Hospital. Most SNFs and HHAs also participate. SNFs and HHAs have enhanced their capacity to care for sicker patients and have worked with hospital EDs and outpatient provider groups to prevent hospitalizations. Care coordination is critical for success in risk contracts, e.g. MSSP. PHP has successfully utilized Patient Ping to manage patient care by sharing data with partner organizations (SNFs, HHAs, hospitals) to identify opportunities for improvement and to jointly devise interventions. Successful utilization of PP requires a physician group to have an infrastructure for daily care management, a network of collaborating organizations, and agreed upon standards of care with collaborating organizations.

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