1. Date: March 10, 2017 Nelly burdette, psyD IBH Practice facilitator
IBH Pilot Lessons Learned Year 1 Care Transformation Collaborative of R.I.
Date: March 10, 2017
Nelly burdette, psyD
IBH Practice facilitator

2. Funding Partners

3. Overview IBH in Primary Care Overview
PDSA: High ED Utilizers with Behavioral Health
Challenges
Lessons Learned

4. IBH in Primary Care Overview
12 PCMHs to implement depression, anxiety and substance use screening for all patients over the age of eighteen in primary care across 2 years
Rescreened within 6 months if positive screening
Onsite IBH providers offer evidence-based treatment
Three PDSAs
Increase screening/rescreening rate
High ED utilization with behavioral health
Population health focus within behavioral health

5. 12 Practicing Sites
Cohort 1 (blue) February Cohort 2 (yellow) November 2016
Associates in Primary Care
East Bay Community Action Program (Newport and E. Providence)
Providence Community Health Centers (Chaffee)
Women’s Medicine Collaborative
Tri-Town Community Action Program
Affinity Family Medicine at Women’s Care
Coastal Hillside Family Medicine
Providence Community Health Centers (Prairie)
Providence Community Health Centers (Capitol Hill)
University Medicine
Memorial Family Practice
Wood River Health Center

6. Practice Facilitation Deliverables
Monthly one hour practice facilitation meetings with each practice implementation team and Dr. Burdette
Deliverables:
Hire and train Licensed IBH Provider ( FTE) to bill for and/or provide sustainable IBH services
Compact with Community Mental Health Center
Baseline assessment of IBH at beginning and end of pilot
Quarterly reporting of universal screening targets and patient-specific data, warm hand-offs, referrals to community partners
3 PDSAs cycles

7. PDSA 1: Increase Screening/Rescreening Rates

8. PDSA 1: Increase Screening/Rescreening Rates

9. PDSA 1: Increase Screening/Rescreening Rates

10. PDSA 1: Increase Screening/Rescreening Rates

11. PDSA 1: Increase Screening/Rescreening Rates

12. PDSA 1: Increase Screening/Rescreening Rates

13. Why focus on high ED utilizers with behavioral health overlap?
Treating people with multiple conditions can cost as much as 7 times more than treating those with only one illness 1
15% of total health care spending for people diagnosed with a behavioral disorder was attributable to behavioral health-specific care 1
85% of spending represents costs related to medical care for physical comorbidities 1
BOTTOM LINE: Depression + up to 4 chronic conditions, more = % of all costs 1

14. Medicaid Claims Data Community Care of North Carolina 2

15. CASE STUDY: PDSA (Plan)
Tri-Town Community Action

16. Tri-Town Community Action PDSA: DO
TASKS
PERSON RESPONSIBLE
WHEN
1. Review NCM High Utilizer Lists to determine if there are patterns between medical complaints and potential BH concerns
NCM/IBH Staff
11/30/16
2. Identify group of patients that may have similar complaints
3. Utilizer E-H-R to determine whether patients have had any recent IBH screenings , have had any BH involvement, or receive any outside BH supports
IBH Staff
12/9/16
4. Collaborate with providers to discuss the needs of specific patients on the list.
IBH Staff/NCM/Providers
12/16/16
5. Research available shared decision making tools.
By 12/16/16
6. Identify when the determined patients have upcoming appointments or call to schedule an appointment with patient.
By 12/30/16
7. Determine process for IBH Staff to meet with patient and review shared decision making tool.

17. PDSA (Do): Shared Decision Making Tool
Treatment Options
What are some reasons to choose this option?
What are some reasons not to choose this option?
What do I have to do?
How long do I need to make changes?
No treatment at this time
Anxiety may improve on its own.
For many, anxiety may continue or get worse without treatment.
No changes to what you are doing now.
Your provider may request a follow-up visit.
No Changes are being made.
Exercise, relaxation techniques and behavioral activation treatments
Can improve mild anxiety symptoms.
These techniques have few side effects.
May not be enough to treat moderate to severe anxiety.
Physical activity at least 3-4 times per week.
Learning and practicing relaxation techniques and deep breathing.
Until anxiety improves and then a maintenance program to keep anxiety symptoms reduced.
Therapy with a counselor
Therapy is highly effective in treating anxiety.
Requires 1- hour office visits either weekly or every other week.
Attend therapy sessions as scheduled.
Usually people see improvements in just 8-10 sessions.
Medication
*Studies show that the highest benefit comes when patients are also engaged in therapy.
SSRI’s have shown to be effective in reducing symptoms in most patients. (may take 4-6 weeks to see maximum benefits.
Some side effects:
Dry mouth
Fatigue, nausea, drowsiness, headaches.
Take medication every day.
For 6-12 months or ongoing for treatment of severe symptoms.
Other options (please write in)

18. Challenges Financial and Billing Data and Reporting
IBH Provider Culture and Training
Community BH Referrals

19. Lessons Learned Difficult to impact high ED utilizers with BH Timing
6 months to get all systems in place to begin
Add another 6 months to begin to see 50% of sites accomplishing year 1 thresholds
Sustainability
Huddles/Interdisciplinary Care Conferences
Productivity = encompassing Primary Care pace

20. References
Boyd, C., Leff, B., Weiss, C., Wolff, J., Hamblin, A. and Martin, L. (2010). Faces of medicaid: clarifying multimorbidity patterns to improve targeting and delivery of clinical services for medicaid populations. Center for Health Stratagies. Obtained online on 2/22/17 from
Thorpe, K., Jain, S. and Joski, P. (2017). Prevalence and spending associated with patients who have a behavioral health disorder and other conditions. Health Affairs, 36 (1),