2. 2 PBM+ An Integrated Model for Behavioral Health Care Kiran Taylor, MD Chief, Division of Psychiatry and Behavioral Medicine Spectrum Health Medical Group

3. Access Parity or Disparity: The State of Mental Health in America 2015 Michigan’s overall ranking is 41st out of 51 states and districts in terms of prevalence of mental illness (high) and access to care (low) Greater than 70% of annual visits to PCP’s for chronic conditions have a primary behavioral health component. 3

4. 4 Medical Health Systems are the Gateway for PBM needs of patients Depression is the 3 rd most common reason for a visit to a medical health center after diabetes and hypertension 75% of patients with depression indicate a physical complaint as the reason they seek health care

5. 5 PBM + Care Triage Screening Interventions

6. PBM+ 6 Screening

7. PBM + 7

8. Comprehensive Screening Depression Anxiety Substance use Alcohol use 8

9. PBM+ 9 Care Triage (BHS)

10. PBM + Care Triage MildModerateSevereCrisis Depression PHQ-9 score 0-910-1920-27 Positive Harm Imminent Risk Anxiety GAD-7 score 0-910-1415-21 Positive Harm Imminent Risk SUD (Substance Abuse Disorder) ASSIST score 0-3 (substance) 0-10 (etoh) 4-26 (substance) 11-26 (etoh) 27 +Positive Harm Imminent Risk 10

11. PBM+ 11 Interventions

12. PBM+ MildModerateSevereCrisis Evidence Based (Interventions) Psycho- education to patient (handouts) Beat the Blues(BTB) online CBT PCP med management BTB Traditional face to face referrals Embedded provider Telepsych PCP med management SUD brief interventions Systematic Case Review (SCR) As in moderate Phone management triage/crisis line Safety planning/ disposition 12

13. 13 Customized PBM + Care Care Triage Screening High Needs Interventions Care Triage Screening Rising Needs Interventions Care Triage Screening Low Needs Interventions

14. 14 Population Stratification Population Stratification tool identifies patients likely to benefit from pro-active disease management Clinical Variables Prescriptions Lab Values Co-Morbidities Adherence (visits, Rx) Utilization ER Psychiatric acute care admissions Medical acute care admissions Demographics Age Ethnicity Gender Psychosocial Income Education Culture Social Support Environment

15. Population Segmentation 15

16. Population Segmentation 16 Clinical risk Other risks (determinants of health) Patient Activation Impactful Intervention

17. Population Segmentation Behavioral Health Risk Stratification Levels Level 1Healthy Level 2At Risk for Behavioral Health Level 3Behavioral Health, Low – Moderate Risk Level 4Behavioral Health, Moderate – High Risk Level 5Behavioral Health, high severity + at-risk and/or diagnosis of chronic medical disease 17

18. PHQ-4 Screening Rates 18 Sparta Family Medicine= 93% 1300 Internal Medicine and Peds= 82% Alpine Family Medicine= 64% note small population of patients in office Kentwood Family Medicine= 86%

19. Clinical Outcomes PBM+ Baseline and Current PHQ9 Scores Sparta Family Medicine Number of referred patients to PBM+: 290 19 Depression BaselineCurrent

20. Clinical Outcomes PBM+ Baseline and Current GAD 7 Scores Sparta Family Medicine Number of referred patients to PBM+: 290 20

21. Moving the dial on the Diabetic Population- Patients working with a Behavioral Health Specialist 21 Starting A1C valueCurrent A1C value 12.28.7 12.813.0 7.16.5 14.98.5 8.77.8 9.49.6 6.67.4 8.67.2 8.47.3 6.75.6 9.97.9 6.96.5

22. Lessons Learned Need to find innovative ways to reach patients who aren’t seeking care at all or in traditional ways The BHS role works best as a hybrid role requiring individuals who can multi-task well Patients want convenience and want to be treated as a whole person A collaborative health care team is essential

23. Expansion of PBM+ PBM+ is in 10 sites currently. 2/10 sites are Rural Health Clinics 3/10 sites have telepsychiatry available as an intervention option All sites will have access to SCR and lunch ‘n learns Expanding to ages 12-18 Semi-annual patient and provider satisfaction surveys Proactive targeting of patients 23

24. Sustainability and Scalability Clinical Outcomes Standardized Work Risk Stratification: Right care at the right time Payment System: Volume to Value V=Q/C Triple Aim +1 24