1. Care Integration A Case Study at WVCH By Ruth Rogers Bauman Chairperson, WVCH CEO, ATRIO Health Plans

2. Who is WVCH ATRIO Health Plans Capitol Dental Care Mid Valley Behavoral Network WVP Health Authority Northwest Human Services, Inc Polk County Salem Clinic, PC Salem Health/Salem Hospital Santiam Memorial Hospital Silverton Health West Valley Hospital Yakima Valley Farm Workers Clinic

3. What is Integration Is it integration of contracts? Is it integration of OHP contractors? Dental Physical Behavioral

4. What is Integration Is it integration of care? Primary Care Specialists Hospital Ancillary Outpatient Non traditional

5. Conventional Wisdom Conventional wisdom says: Mental Health needs to be integrated into primary care because so many high utilizers and chronically ill also have mental health issues You have to have patient centered homes Non traditional workers can help patients navigate the health system at a lower cost and with a closer bond Nurse Case Managers are essential to coordinating primary care, specialty care and transitions of care

6. The WVCH Experience Conventional Wisdom Mental Health needs to be integrated into primary care because so many high utilizers and chronically ill also have mental health issues Long history of WVP and BCN working closely together X Some clinics are beginning to add mental health resources as part of their PCPCH but warm hand offs are not the norm most of the time You have to have patient centered homes Large clinics and hospital systems are moving toward level 3, almost all PCP’s are level 1, and WVP is moving toward level 3 for the balance of the network Non traditional workers can help patients navigate the health system at a lower cost and with a closer bond Hired navigators last summer who had a huge impact on high utilizers of ED Nurse Case Managers are essential to coordinating primary care, specialty care and transitions of care WVP had 12 nurse case managers X we just needed more

7. WVCH Experience Survey Says! All we had to do was get more nurse case managers and more mental health workers and we would have it made Then we did a survey Salem Hospital reported 22 nurse case managers with 4 support staff and 10 MSW’s West Valley Hospital had 1 nurse case manager NW Senior and Disabilty Services reported 40 case managers, 2 program specialists and 2 screeners Salem Clinic reported 1 nurse case manager dedicated to transitions Salud had 1 nurse case manager Polk County Mental Health reported 6.5 case managers and 1 drug case manager WVP had 12 nurse case managers

8. WVCH Experience 110 FTE’s were involved in care coordination WVCH took a giant step forward by simply identifying resources already deployed We learned that even among case managers, we needed a way to coordinate the coordinators! Members of the clinical advisory committee gained a deeper understanding of what each organization was doing and a greater realization of where overlaps, gaps and missed opportunities lie

9. Key barriers Limited Communication Limited exchange of medical information Lack of secure systems to exchange information Lack of alignment of goals Lack of sharing of care plans Lack of understanding of care plans Limited physical contact between team members and with patients

10. Another Interesting Finding No one mentioned: Lack of financial incentive Lack of shared risk Lack of time More people needed

11. What’s Next Clinical Advisory Committee has a number of small projects that are closing the communication gaps Navigators are being deployed to specific populations at the front end of care Common care plans are being deployed for special needs population