1. Reverse Integration: A Collaboration for Wellness
Session # A7b, Track 3
Reverse Integration: A Collaboration for Wellness
Donald Thompson, PhD, Executive Director of Operations, Behavioral Health Division, NHS Human Services, Inc.
Kevin Moore, PsyD, Director of Integrative Medicine,
AIDS Care Group, Inc.
Please insert the assigned session number (track letter, period number), i.e., A2a
Please insert the TITLE of your presentation.
List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation.
You may acknowledge other authors who are not attending the Conference in subsequent slides.
CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. Faculty Disclosure
The presenters of this session have NOT had any relevant financial relationships during the past 12 months.
You must include ONE of the statements above for this session.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

3. Learning Objectives
At the conclusion of this session, the participant will be able to:
Identify action steps that facilitate coordination of care between behavioral health and primary care practices for individuals with serious and persistent mental illnesses and/or substance abuse disorders.
Identify chronic illness self-management strategies for this population.
Identify evidence based practices that facilitate improved health and wellness for this population.
Include the behavioral learning objectives you identified for this session
Collaborative Family Healthcare Association 12th Annual Conference

4. Bibliography / Reference—EBPs
Motivational Interviewing : Lundahl, B, Burke, B. (2009) The Effectiveness and Applicability of Motivational Interviewing: A Practice-Friendly Review. J Clin Psychol: Vol. 65 (11): 1232–1245.
Whole Health Action Management:
Medication Therapy Management: Burns, A. (2008) Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0). Journal of the American Pharmacists Association: Vol. 48, (3):  341–353.
InSHAPE:
Smoking Cessation:
Continuing education approval now requires that each presentation include five references within the last 5 years.
Please list at least FIVE (5) references for this presentation that are no older than 5 years.
Without these references, your session may NOT be approved for CE credit.
Collaborative Family Healthcare Association 12th Annual Conference

5. Learning Assessment A learning assessment is required for CE credit.
A question and answer period will be conducted at the end of this presentation.
Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

6. Setting and Population Characteristics for NHS Delaware County

7. NHS Delaware County Base Service Unit/Community Behavioral
Health Center since the early 1970’s
Serves the northern and eastern half of
Delaware County
Approximately 6,000+ children, adults, and
families participate in services annually

8. NHS Delaware County Behavioral Health Services provided:
Mental Health Outpatient and Intensive Outpatient Program
MH Blended Case Management
Office-based Administrative Case Management
Psychiatric Rehabilitation
Supportive Employment
Forensic Assertive Community Treatment Team

9. NHS Delaware County Behavioral Health Services Provided:
D&A Outpatient & Intensive Outpatient
D&A Intensive Case Management
Peer Support Services
Residential Programs
Long Term Structured Residence
Community Residential Rehabilitation Programs
Small Group Homes

10. Population Served Demographics: 61% -- White/Caucasian
38% -- Black/African-American
1% -- Asian
96% of services are reimbursed through
publicly funded sources - Medicaid, Medicare,
and County.
Most common MH diagnoses - schizophrenia,
bipolar disorder, major depressive disorders;
D&A diagnoses - alcohol, cocaine, opiates

11. Target Population Individuals participating in NHS Delaware
County behavioral health programs who have:
Serious and persistent mental illnesses and/or
substance abuse disorders,
Chronic co-occurring physical illnesses or conditions,
and
Highest total costs for physical and behavioral
healthcare (participation in Blended Case
Management as proxy for highest cost group).

12. Chronic Health Conditions:
Diabetes
Cardiovascular disease
Chronic obstructive pulmonary disease (COPD)
Asthma
Chronic bronchitis
Emphysema
Overweight (BMI >25)
Hepatitus C
Tobacco use

13. Health Home Plus Co-located Primary Care and Pharmacy
Primary Care Practice, Sharon Hill Medical, on- site utilizing primary care office suite at NHS Delaware County (800 Chester Pike, Sharon Hill, PA)
On-site pharmacy - Life Tree Pharmacy

14. Co-located Primary Care
Sharon Hill Medical
History of providing treatment/services for
individuals with chronic illness conditions,
History of serving individuals in poverty and
insured through publicly funded means - Medicaid,
Medicare, etc.
Invested in developing integrated primary and
behavioral healthcare.

15. On-site Pharmacy Services
Life Tree Pharmacy services available to all
participants
Coordination of medication therapy with
prescribers and other professional staff
Immediate medication prescriptions fills
Medication therapy adherence monitoring
Medication Therapy Management services

16. Staffing of Integrated Care Model
Health Home Team consists of:
Participating individuals
Psychiatrists
Primary care professional staff
Nurse Navigators (Registered Nurse on each Adult BCM team or RNs in Outpatient program)
Care Managers (Blended Case Managers)
Peer Wellness Coaches
InSHAPE Health Mentors (fitness trainers)

17. Staffing of Primary Care Sharon Hill Medical
Primary care staff on-site at NHS 5 days/week
Medical Director - family practice physician
Certified Registered Nurse Practitioner
Medical Assistant

18. Integrating Care

19. Integrating Care NHS/PCP leadership team meets every other week.
NHS supervisors and medical staff trained in
integrated care.
NHS case managers trained as care managers.
NHS nurse navigators on each Adult BCM
team.

20. Integrating Care Weekly care coordination meeting is best
practice providing whole-person integrative
care. All patients are discussed by entire
team a minimum of once a month. This
seemingly obvious activity is the single most
important activity to the success of the
project.
Direct psychiatrist and PCP consultation.

21. Evidence-Based Practices
Motivational Interviewing by case managers
and medical staff.
Whole Health Action Management by peer
wellness coaches.
Medication Therapy Management by
pharmacists.
InSHAPE program by fitness trainers.
Smoking cessation by nurse navigators.

22. Integrating Data MCO conducted analysis of hospitalization rates.
Care coordination through Health Information
Exchanges - NHS Delaware County is an early
member of HealthShare Exchange of
Southeastern Pennsylvania.
Shared access to medical and behavioral
health EHRs.

23. Role of MCO in Integration Effort
Magellan Behavioral Health
Supportive of effort throughout.
Agreed to expansion of nurse navigator staffing.
Worked with NHS to develop psychiatric consultation procedure code and reimbursement
rate.
Conducting the analysis of hospitalization rates as
an outcome indicator for the health home.

24. Outcomes

25. Program Monitoring and Evaluation
Improved Chronic Care Delivery for Individuals
with Mental Illnesses:
Percent of individuals diagnosed with schizophrenia or
bipolar disorder, who were dispensed any antipsychotic
medication and had a diabetes screening - 92%.
Bchmk = 76.9%*
Percent of individuals who had a diagnosis of hyper-
tension and whose blood pressure was adequately
controlled (<140/90) - 73%. Bchmk = 52.9%*
*2010 Medicaid Benchmarking Report on HEDIS indicators.

26. Program Monitoring and Evaluation
Improved number of Individuals with serious
mental illness who receive preventative care:
Percentage of individuals who received influenza immunization - 61%. (100% were offered influenza immunization). Benchmark = 60%*.
Percentage of individuals who smoked or used tobacco who were advised to quit - 100%. Benchmark = 81%*.
Percentage of individuals diagnosed with major depression, schizophrenia, schizoaffective, or bipolar disorder who had BMI documented - 100%.
Benchmark = 75%.
*2010 Medicaid Benchmarking Report on HEDIS indicators.

27. Program Monitoring and Evaluation
NHS Health Home outcome measures:
Fewer hospital admissions - both physical health and mental health*
Fewer hospital re-admissions*
Follow-up after hospitalization for mental illness (within 7 days)*
Reduced cost of care per member/month.
* Magellan is tracking these BH measures.

28. Number of Inpatient Psychiatric Admissions per 100 Members

29. Inpatient Psychiatric Costs PMPM (Magellan claims)

30. Total Spending PMPM by Diagnostic Category (EAC payment excluded)

31. Total Costs PMPM

32. Thank you! Contacts: Don Thompson, Ph.D.
Executive Director of Operations
NHS Human Services, Inc.
Kevin Moore, Psy.D.
Director of Integrative Medicine
AIDS Care Group

33. Session Evaluation
Please complete and return the evaluation form before leaving this session. Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference