1. Intake and Screening Intake - Front Desk – Reception generally not reimbursable Initial Screening/Assessment and/or /Existing Consumer Visit With A Clinician Is this a billable BH service? For what credential? Are you billing for it? What can you do to make this billable? Different clinician credentials Include billable services (i.e., collecting vitals for all patients on BH side)

3. Remember, it’s all about Behavior Change? Individuals & organizations change voluntarily when they... Become interested in or concerned about the need for change Become convinced that the change is in their best interests or will benefit them more than cost them Organize a plan of action that they are committed to implementing Take the actions that are necessary to make the change and sustain the change

4. Health Promotion Programs for Persons with Serious MI  Reducing obesity and improving fitness in adults with SMI is challenging but possible, and requires a multi- component, intensive, evidence-based approach  The best studies demonstrate modest results in reducing obesity but better results in improving fitness  What works better? Intensive manualized programs that combine coached physical activity and dietary change lasting at least 6 months (or more).  Clinically significant weight loss is likely to be achieved by some, but improved fitness by more….. both are important for heart health

5. Health : Overcoming or managing one’s disease(s) or symptoms, making informed healthily choices that support physical and emotional wellbeing. Home: a stable and safe place to live Purpose: meaningful daily activities, such as a job, school, volunteerism, and the independence, income and resources to participate in society Community: relationships and social networks that provide support, friendship, love and hope

6. Tackling Challenges to the Integrated Health Workforce

7. PBHCI Workforce  Expand the role of consumers and their families to participate in, direct, or accept responsibility for their own care  Expand the role and capacity of communities to identify local needs and promote health and wellness  Implement systematic federal, state, and local recruitment and retention strategies  Increase the relevance, effectiveness, and accessibility of training and education  Actively foster leadership development among all segments of the workforce  Enhance available infrastructure to support and coordinate workforce development efforts

8. Building the Integrated Health Workforce Producing and implementing integrated health education curriculum and resources for Psychiatrists Working in Primary Care Consumers serving as Peer Educators Case Managers as Health Navigators Addiction Professionals Working in Primary Care Primary Care Physicians Working in Behavioral Health Settings Care Management in Primary Care for current Behavioral Health Workforce Mental Health First Aiders in Rural Community Health Centers Social Worker Standard of Practice and Field Placement

9. CIHS and Financing Analyzing integrated health staffing and billing structures; Supporting state dialogues on efforts to address same day billing, identified billing codes; Sharing lessons learned from integration sites from across the country; Training and presentations for PCAs, individual TTA to health centers; and Fostering private foundation support for state and local integration efforts.

10. Billing and Coding Infrastructure Staffing – Sample of needed expertise Chief Financial Officer Payables and Receivables staff Claims Processers Knowledge of Payer Requirements Private Payers Medicaid Medicare Technology supports Accurate, good documentation of services

11. Maximizing Who Can Bill, for What, and By Whom – Interim Billing Worksheets Point in time review of each states Medicaid program on what may or may not be reimbursable in your state for integration using currently available codes Point in time review of Medicare reimbursement Link CPT, Diagnostic Code and Credential One of many tools – a place to start the conversation and billing locally and in a state Do not GUARANTEE you will be paid based on the worksheet Worksheets Available at: www.integration.samhsa.gov

12. Sustainability Checklist Administrative Sustainability Organizational Infrastructure Human Resources Health Information Technology Clinical Sustainability Patients/Consumers Medical Staff Behavioral Health Staff Financial Sustainability Billing and Reimbursement

13. Decision Points When Considering A Model Source: Rick Hankey, LifeStream Behavioral Health

14. Integration with SU Self-Management Recovery Principles in PC Trauma Informed Care Suicide Prevention Transitions of Care Children & Adolescents State Regulations

15. A Few Questions to Ponder  Will your partnership position your organization to be successful in the future?  How much control are you willing to give up?  Will your staff adapt to a new model of practice and actually support the integration?  Are you able to demonstrate that you are accountable for cost, quality and experience outcomes/value?  How will you ensure that your integration efforts are focused on empowering consumers to lead healthier lives?  Are we willing to give it the time it takes? Integration is a process, that takes intention and time to make it happen.

16. Energy and persistence conquer all things. ~Benjamin Franklin

17. The resources and information needed to successfully Integrate primary and behavioral health care Laura Galbreath, Director Online: integration.samhsa.gov Phone: 202-684-7457, ext 231 Email: laurag@thenationalcouncil.org laurag@thenationalcouncil.org Twitter: @laura3530