1. Session # - C5
Track 3 – Population & Public Health
Connecting the Faces and Places of Integration: A Central Structure Working Regionally
CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
Mary Jean Mork, LCSW, Vice President for Integration MaineHealth/Maine Behavioral Healthcare
Cynthia Cartwright, MT RN MSEd, Program Manager Behavioral Health Integration, MaineHealth
Neil Korsen, MD, Medical Director
Behavioral Health Integration, MaineHealth
Stacey Ouellette, LCSW, Director
Behavioral Health Integration, MaineHealth/Maine Behavioral Healthcare

2. Or: How to build a beautiful kinetic sculpture for your system
Promoting the highest level of integration possible within a large healthcare system with a large number of integrated practice sites is a challenging goal. What works is to have a central structure that operates regionally, tailoring the work and the goals to regions and practices through creating and sustaining relationships and appreciating the uniqueness of every location. Through a series of video interviews with stakeholders, we will hear what actually works for the people in the practices and share lessons learned that can be adopted in other settings. In small groups, participants will work through a Guide to Creating a Central Structure while Working Regionally that can serve as a checklist for their ongoing integration efforts.

3. Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships during the past 12 months.

4. Learning Objectives
At the conclusion of this session, you will be able to:
List centralized structural elements that support a system- approach to integration
Identify successful intervention strategies for spreading integration
Incorporate new strategies into your ongoing work to develop integration

5. References
Raney LE (Ed). Integrated Care: Working at the Interface of Primary Care and Behavioral Health. American Psychological Association, Washington, DC
Robinson PJ, Reiter JT. Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer, NY, NY
Kathol RG, Patel K, Sacks L, Sargent S, Melek SP. The Role of Behavioral health Services in Accountable Care Organizations. Am J Manage Care. 2015; 21(2):e95- e98.
Tear down this wall: Rocky Mountain Health Plans embarks on a mission to bring together behavioral health and primary care
Enhancing Patient Outcomes and Health System Value through Integration of Behavioral Health into Primary Care. Institute for Clinical and Economic Review, Policy Brief, 2015.

6. Learning Assessment A learning assessment is required for CE credit.
A question and answer period will be conducted at the end of this presentation.

7. BHI in Maine

8. BHC Model
Behavioral health clinician (BHC), most often LCSW, works side-by-side with PCPs
Brief, problem-focused treatment approach
Mental Health Problems
Behavioral and Psychosocial Aspects of Physical Health Problems
Warm handoffs

9. Progress to date 7 Hospital Systems
About 40 FTE’s working in about 60 practices
Most LCSW; some LCPC or psychologist
Most 0.5 FTE FTE
Practice types
25 FM, 15 IM, 10 Peds
5 Ob/Gyn, 2 pain clinics, diabetes center, pediatric multi- specialty practice
Neurology, cardiology, oncology, bariatric center

10. Framework for this session:
Standardization
Customization
Fingerprinting
Innovation
Toussaint, John, MD. Management on the Mend. TedaCare Center for Healthcare Value. Appleton, WI. 2015

11. MaineHealth Dr. Van, Psychiatrist Kyle, Practice Manager
Mary, Practice Administrator
Monique, BHC
Carol, Practice Manager

12. Standardization – creating the frame

13. Standardization Contracts
Processes - operational, financial and clinical. documentation, billing, crisis management, policies
People – recruitment, hiring, orientation, training, supervision = FIT
Resources – supervision, training, policies, marketing
Central leadership connections among programs
Mary – benefits of standardization

14. Elements that support Standardization
Strong system leadership that supports standardization
Standard contracts
Set orientation for staff and practices
History and reputation of the program
Regional presence with national ties
“Adequate” clinical and administrative resources
Placement of the program within the continuum of behavioral and medical care

15. Customization – working with the parts

16. Customization
Regional approach – diverse geography, rural & urban, poverty & age
Hospital system identification
Separate leadership within each hospital system
Relationships – all work starts with relationships at all levels
Face-to-face connections – site visits
Responsiveness
Connections – seeking connections with key staff and leaders. Active outreach. Care coordination focus.
Framework that allows for variation
Spread to specialty medical practices including Ob/Gyn, and others identified by hospital region
Monique and Kyle

17. Elements that support customization
Administrative team meetings focused on care coordination, data and clinical
Point person for practices, regional leadership and BHI clinicians
Flexibility of expectations based on regional resources, culture and need
In-person presence of program staff
Responsiveness (high expectations)
Site visits to identify opportunities and regional needs

18. Fingerprinting – supporting uniqueness

19. Fingerprinting Relationships – how best to approach
“The (staff) of every….unit that adopts the new work of the model… must feel that their fingerprints are all over the work.” (Toussaint)
Relationships – how best to approach
Team building within practices
Recognition and support for uniqueness
Acknowledgement of culture
Support for staff and practice attributes
Carol - example

20. Elements that support Fingerprinting
Strong physician leadership
Fit between practice and the BHC
Strong, supportive Practice Manager/management
Participation in regional meetings
Supportive clinical leadership
Number of competing practice initiatives

21. Innovation – where do you want to go next?

22. Types of Innovation Psychiatry Consultation to primary care
Patient Centered Medical Home
Behavioral Health Homes & Health Homes
Specialized medical initiatives: Childhood obesity, Trauma screening, suboxone treatment models, Suicide prevention,
Link between pediatric and ob/gyn practices
Extending the program into specialty medical practices: oncology, neurology, bariatrics, palliative care, pain clinics, endocrinology…

23. How are you working centrally to support a regional structure?

24. Start where you are
Use what you have
Do what you can
Arthur Ashe

25. Contact us: Mary Jean Mork, LCSW morkm@mmc.org
Cynthia Cartwright, MT RN MSEd
Neil Korsen, MD
Stacey Ouellette, LCSW