1. UW H EALTH P RIMARY C ARE / B EHAVIORAL H EALTH I NTEGRATION U NITED W AY F ORUM September 22, 2014 1

2. UW Health Overview

3. UW Health Enterprise Facts and Figures UW Health Healthcare Entities –UW Hospital and Clinics (566 beds) –American Family Children’s Hospital (61 beds) –UW Medical Foundation (1 of 10 largest medical groups in nation) Facts and Figures –26,797 Inpatient Admissions –2,317,332 Outpatient Visits –43,806 Emergency Visits –1,200+ Physicians; 10,000+ Employees –Level 1 Adult and Pediatric Trauma Center –Comprehensive Cancer Center –48 Primary Care & Specialty Clinics –Outreach sites in 50+ communities

4. UW Health Primary Care 38 Primary Care Clinics* –Family Medicine = 21 –General Internal Medicine = 9 –Pediatrics = 8 194 Primary Care Physicians 266,000 medically homed patients –35,600 with behavioral health diagnoses Top diagnoses: depression, anxiety, alcohol *8 clinics with on-site Behavioral Health provider

5. 5 Family Medicine General Internal Medicine Pediatrics Dept of Psychiatry Locations Behavioral Health Provider Embedded in Clinic

6. Impetus for Primary Care / Behavioral Health Integration In pursuit of the Triple AIM –Improve health of populations –Improve experience of care –Reduce per capita cost Primary Care Redesign launched 2008 –Patient Centered Medical Home Recognition Behavioral Health Analysis 2013 –Demand exceeds capacity 46% of behavioral health care is managed by UW Health PCPs 85% of PCPs not satisfied with access to behavioral health services –Depression is #1 outpatient and inpatient diagnosis –Poor access and follow-up for behavioral health services –Poor continuity of care and communication between providers –Insurance barriers –Led to system-wide initiative to improve behavioral health services Institute for Healthcare Improvement

7. Primary Care / Behavioral Health Integration Model Development Depression Screening launched for age 65+ (July 2014) Interventions for patients who screen positive: –RN educational intervention –PCP prescribes medication –Psychiatry advice to PCP –Psychiatry consult Foundation for new PC / BH integration model 7 Total Depression Screening Rates for all Primary Care Clinics by Week

8. Team-based and patient-centered Co-location is not Collaborative Care. Team members learn to work differently. Collaboration Treat-to-target Treatments are actively changed until the clinical goals are achieved Evidenced-based care Stepped Care All patients tracked in a registry No one falls through the cracks Population-based approach Close follow-up 8 Primary Care / Behavioral Health Integration Model Development: Collaborative Care

9. 9 DRAFT UW Health Collaborative Care Model BH Complex Case Management Specialty/Org Resources PC Clinic Resources Adapted from University of Washington, 2013

10. September 2014 –Endorsed by Primary Care and Behavioral Health leadership October 2014 – January 2015 –Model design and build February – March 2015 –Test model in five Primary Care Clinic locations 10 Primary Care / Behavioral Health Integration Model Development

11. Strengths –Patient-centered –Evidence-based model –Proven cost-savings –Aligned with UW Health Primary Care Redesign and other organizational imperatives Challenges –Paradigm shift for key roles –Investment in time and resources –Adapting model to variation in UW Health Primary Care clinics 11 Primary Care / Behavioral Health Integration Model Strengths and Challenges

12. Thank You 12 Contact Information: Sue Ertl, RN, MSN Vice President, Clinical Joint Ventures 608.821.4806 Sue.Ertl@uwmf.wisc.edu