1. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus

2. Lifting spirits. Holding hope. Bryan Hatcher, MDiv, LCSW Director of Center Development and Education bhatcher@wakehealth.edu

3. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Schedule Who is CareNet What is Integrated Care Break Models of Integrated Care Lunch What is CareNet Doing Break Plan Your Integrated Care Strategy

4. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Who Is CareNet?

5. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Who Is CareNet? Wake Forest Baptist Health Winston-Salem, NC Department and Subsidiary

6. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Who Is CareNet? Grew out of Department of Pastoral Care (40+ years) Expanded to statewide network of pastoral counseling centers 501c3 nonprofit (CareNet, Inc.) established in response to managed care Currently, 35 clinical sites, 65 clinicians (+ residents and interns) 2 years ago, Dept of Pastoral Care became Dept of Faith and Health (Gary Gunderson)

7. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Who Is CareNet? Mission -- To improve the health of mind, body, spirit and community through spiritually-integrated counseling and psychotherapy, education and research

8. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care? Definitions  Integrated Care – the systematic coordination of general and behavioral healthcare (SAMHSA)  Integrative Care – the use of knowledge from many disciplines, including complimentary and alternative treatments, by a health provider (Duke Integrative Medicine)

9. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care?

10. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care?

11. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care?

12. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care? Benefits of Integrated Care in the Medical Home 84% of the time, the 14 most common physical complaints have no identifiable organic etiology. 80% of people with a behavioral health disorder will visit primary care at least one time in a calendar year. 50% of all behavioral health disorders are treated in primary care. 48% of the appointments for all psychotropic agents are with a non-psychiatric primary care provider. 67% of people with a behavioral health disorder do not get behavioral health treatment. 30-50% of referrals from primary care to an outpatient behavioral health clinic do not make the first appointment. Two-thirds of primary care physicians (PCPs) (N=6,660) reported not being able to access outpatient behavioral health for their patients. Shortages of mental health care providers, health plan barriers, and lack of coverage or inadequate coverage were all cited by PCPs as important barriers to mental healthcare access. (http://www.advancingcaretogether.org/why-integrated-care.php)

13. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care? Financial Benefits of Integrated Care Medical use decreased 15.7% for those receiving behavioral health treatment, while medical health use increased 12.3% for controls who did not get behavioral health. Depression treatment in primary care for those with diabetes had $896 lower total healthcare cost over 24 months. Depression treatment in primary care had $3,300 lower total healthcare cost over 48 months. Behavioral Health disorders account for half as many disability days as all physical conditions. Annual medical expenses — chronic medical and behavioral health conditions combined — cost 46% more than those with only a chronic medical condition. Of the top five conditions driving overall health cost (work related productivity + medical + pharmacy cost), depression is number one. (http://www.advancingcaretogether.org/why-integrated-care.php)

14. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care? Key Results Pharmacy costs were reduced by 23.4 percent, general hospital costs were reduced by 6.9 percent, and included with other changes, resulted in reduced costs overall of 16 percent. Independent Living for clients increased by 33 percent Vocational Activity increased by 44 percent Legal Involvement decreased by 68 percent Psychiatric Hospitalization decreased by 52 percent Illegal Substance Use decreased by 52 percent CMHCs Services substantially decreased overall medical costs (http://www.advancingcaretogether.org/why-integrated-care.php)

15. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care? Triple Aim  Better Care  Better Outcomes  Lower Cost (Affordable Care Act)

16. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care? Patient (Person) Centered Care Data Driven Bundled Payment Systems Team Care Approach Prevention and Wellness

17. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care?

18. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care?

19. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is Integrated Care?

20. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Break

21. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care HEALTH HOMES  Federal health home guidance lays out service requirements stemming from the ACA and “well-established chronic care models.  ”1 The required services (also termed “provider standards” in the guidance) include:  Each patient must have a comprehensive care plan;  Services must be quality-driven, cost effective, culturally appropriate, person- and family-centered, and evidence- based;  Services must include prevention and health promotion, healthcare, mental health and substance use, and long- term care services, as well as linkages to community supports and resources;  Service delivery must involve continuing care strategies, including care management, care coordination, and transitional care from the hospital to the community;

22. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care HEALTH HOMES (continued)  Health home providers do not need to provide all the required services themselves, but must ensure the full array of services is available and coordinated; and  Providers must be able to use health information technology (HIT) to facilitate the health home’s work and establish quality improvement efforts to ensure that the work is effective at the individual and population level.

23. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care

24. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care

25. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care

26. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care

27. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care  EMR/EHR  Population Health Management Philosophy  Assessments  PHQ-4/PHQ-9 (samples following)  SBIRT (sample following)  Wellness/Prevention  Smoking Cessation  Nutrition  Brief Treatments  Motivational Interviewing  Cognitive Behavioral Treatment  Solution-Focused Treatment  Community Education  Mental Health First Aid  Population/Community Driven Classes

28. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care

29. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Models of Integrated Care PHQ-9 1.Little interest or pleasure in doing things 2.Feeling down, depressed, or hopeless 3.Trouble falling or staying asleep, or sleeping too much 4.Feeling tired or having little energy 5.Poor appetite or overeating 6.Feeling bad about yourself — or that you are a failure or have let yourself or your family down 7.Trouble concentrating on things, such as reading the newspaper or watching television 8.Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual 9.Thoughts that you would be better off dead or of hurting yourself in some way

30. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus Lunch

31. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is CareNet Doing? East Carolina University

32. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is CareNet Doing? Columbus Family Medical

33. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is CareNet Doing? External –Columbus Family Medicine –Brunswick Family Medicine –Pembroke Pediatrics Internal –Downtown Health Plaza Adult Internal Medicine CarePlus -- Weight Management -- Joslyn Diabetes -- Internal Medicine -- Pediatric Outpatient

34. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is CareNet Doing? Collaborative Care Co-location Integrative Care Many Names, One Concept

35. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is CareNet Doing? Training Program CareNet is developing a clinical residency in integrated behavioral health in primary care –Goals Orient behavioral health clinicians to the workflow and culture of primary medical care practice Provide evidence-base tools and techniques to intervene or refer as appropriate Provide an understanding of the role of behavioral health screening in managing patient populations (shift from counseling and therapy paradigm to public health paradigm Provide theoretical orientation and supervised clinical experience in an integrated setting Expose clinicians to operational side of integrated care through up to date information on sharing of behavioral health records through EHR/EMR and HIPAA/privacy regulations, business models and billable services Will also need training for physicians, nurses, pharmacists, and other professionals There are currently no integrated care training standards Could possibly follow the path of addictions counselors – no training, organization certifications, state certifications, state licensure.

36. Lifting spirits. Holding hope. Integrated Behavioral Health Get on the Medical Home Bus What is CareNet Doing? Plans for Integrated Care WFBMC outpatient primary care and specialty care clinics Communities where CareNet has established outpatient counseling centers -- 32 clinical sites around the state of North Carolina Federally Qualified Health Centers Rural Health Centers County Health Departments Community primary and specialty care clinics