1. Session # H7
Experiences Using the AHRQ Academy Playbook - a web-based guide to integrate behavioral health in primary or other ambulatory care settings
Nina Freed, MPH, Research Analyst, Westat
Neil Korsen, MD, MS, Medical Director, Behavioral Health Integration program, MaineHealth
Jonathan Muther, PhD, Director of Behavioral Health & Psychology Training, Salud Family Health Centers
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.
Collaborative Family Healthcare Association 12th Annual Conference

3. Learning Objectives At the conclusion of this session, the participant will be able to:
Know where to find a web-based guide for integrating behavioral health care into ambulatory care on the AHRQ website.
Utilize the self-assessment available through the Academy Playbook to learn where their organization stands with respect to all aspects of integration.
Describe how the AHRQ Academy Playbook could be used by a practice wanting to implement integrated primary care.
Collaborative Family Healthcare Association 12th Annual Conference

4. Bibliography / Reference
Kathol, Roger G., and Bruce L. Rollman. "Value-based financially sustainable behavioral health components in patient-centered medical homes." The Annals of Family Medicine 12.2 (2014):
Massachusetts Patient Centered Medical Home Initiative (2012). Behavioral Health Integration Tool Box:
Melek, S. P., D. T. Norris, and J. Paulus. "Economic impact of integrated medical behavioral healthcare: Implications for psychiatry." Arlington VA: American Psychiatric Association (2014).
Patient-Centered Primary Care Institute (2013). Primary Care Behavioral Health Toolkit:
Safety Net Medical Home Initiative. Ratzliff A. Organized, Evidence-Based Care Supplement: Behavioral Health Integration. Phillips KE, Holt BS, eds. Seattle, WA: Qualis Health, MacColl Center for Health Care Innovation at the Group Health Research Institute, and the University of Washington’s AIMS Center; 2014.
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.
Collaborative Family Healthcare Association 12th Annual Conference

6. The AHRQ Academy Integration Playbook A Guide to Integrating Behavioral Health Care in Primary & Other Ambulatory Care Settings
Nina Freed, MPH
Research Analyst, Westat
October 15, 2016

7. Today’s Presentation Playbook overview and demonstration
Resources in the Playbook
Experiences using the Playbook
Q & A

8. The Academy
The Academy for Integrating Behavioral Health and Primary Care
A national resource center for the integration of behavioral health and primary care
Established in 2010 with AHRQ funding
Taken shape with guidance from a national expert panel, the NIAC

10. Tools Overview Academy Portal Literature Collection
Clinical Outcome Measures
HIT Case Studies
Lexicon
Workforce competencies
IBHC Measures Atlas
Integration Playbook

11. Integration Playbook

12. Integration Playbook Purpose Intended audience Development
To provide guidance on “how to integrate”
Intended audience
Practices working to integrate behavioral health in primary or other ambulatory care settings
Development
Team has included members from the National Integration Academy Council, UC Denver, Westat, and Informatics Studio

13. Guiding Principles Acknowledge that integration isn’t “all or nothing”
Use the Academy’s Lexicon as the foundation
Make it flexible
Link users to resources on the Academy Web portal and external resources

14. Playbook Content Overview
Using the Playbook
Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

15. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

16. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

17. Self-Assessment Checklist

18. Playbook Content The “How To’s” Using the Playbook
Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community
The “How To’s”

19. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

20. Layout

21. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

22. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community
Prepare Infrastructure
Establish Protocols
Track and Monitor Patients

23. Playbook Content Establish Operational Systems Using the Playbook
Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community
Establish Operational Systems
Secure Financial Support
Collect & Use Data for QI
Educate Patients & Families
Obtain BH Expertise & Build Culture of Integration
Prepare Infrastructure
Establish Protocols
Track and Monitor Patients

24. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community
Establish Protocols to ID Patients
Tailor the Care Team
Develop a Shared Care Plan
Build Patient Understanding of Setbacks & How to Deal
Prepare Infrastructure
Establish Protocols
Track and Monitor Patients

25. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community
Prepare Infrastructure
Establish Protocols
Track and Monitor Patients
Track Patients & Monitor Outcomes

26. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

27. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

28. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

29. Playbook Content Using the Playbook Self-Assessment Checklist
Planning for Integration
Implementing the Plan
Observations from Exemplary Sites
What Not to Do
FAQs
Connect with the Community

30. Check it out!
The Playbook is live and available at:

32. The Playbook Team at Westat
Garrett Moran
(301)
Josh Noda
Natalie Teixeira
Nina Freed

33. Playbook Resources
Neil Korsen, MD, MS
October 15, 2016

34. Patient Information

35. BHI Rack Card

36. Medical Provider Training

37. Warm Hand-Offs Concern presented, concept introduced Request BHC
Warm hand-off to bhc
Brief, focused treatment
Providers debrief

38. Documentation Template

40. Experiences Using the Playbook Salud Family Health Centers
Jonathan Muther, PhD
Director of Behavioral Health & Psychology Training
Salud Family Health Centers
Clinical Integration Advisor, Farley Health Policy Center

41. Sequential or
Customizable

42. Find Your Direction

43. Self-Assessment

44. Results from our Self-Assessment
Salud Priorities:
Financial Sustainability
Track Patients and Monitor Outcomes
Develop Shared Care Plans
Health IT

45. Priority 1: Financial Support of BH

46. How do you do it? Payer Mix: Insurance Below Poverty line Medicaid
Medicare
Private
CHP+
Uninsured
Percentage
61%
52.5%
5.7%
13.0%
2.8%
26.0%
Collaborative Family Healthcare Association 12th Annual Conference

47. How do you do it?
Awareness of BH Carve-outs and Carve-ins:

48. How do you do it? Identify Payment Methodologies of your Payers:
Current: Fee-for-service
PMPM – Care Management, State Innovation Model
Future:
??? ACC 2.0
Medicaid Carve-out is rumored to be going away
APM’s

49. What Not to Do: Financial
Maximize the license of the BH clinician

50. Priority 2: Track and Monitor Outcomes

51. How Do You Do It? Monitor Patients

52. How Do You Do It? Monitor Patients

54. Lessons Learned Don’t bite off more than you can chew
It’s not always linear
Ongoing self-assessment
Share & learn from others

55. 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