1. The Real-World State of Primary Care Integration: Findings in Arizona Colleen Clemency Cordes, Ph.D. Clinical Associate Professor Ronald R. O’Donnell, Ph.D. Program Director Nicholas A. Cummings Behavioral Health Program Arizona State University Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Session #I1-Data Blitz October 28, 2011 10:30 AM

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Need/Practice Gap & Supporting Resources Recent efforts have been made to understand the prevalence of integrated care practices in FQHCs Private physician groups provide a significant percentage of care in the United State o No effort has been made to date to understand integration practices

4. Objectives Review current research on the prevalence of integration in FQHCs Discuss purpose of the ASU physician survey Review early findings of the study Identify opportunities to expand the role and prevalence of the behavioral health provider in primary care settings beyond the FQHC or grant-funded practice

5. Expected Outcome By the end of today’s session, we hope that you will understand the importance of understanding integration practices in the private sector, as well as opportunities promoting integrated care

6. Background In 2010, the National Association of Community Health Centers (NACHC) surveyed FQHCs to determine the prevalence of mental health and substance abuse services provided o 38.9% of FQHCs participated 82% reported offering some sort of behavioral health services at at least one of their clinics 85.6% of services are provided in a co-located practice 86.4% of medical providers had access to behavioral health records

7. 75.9% reported join decision-making processes 83.7% rating communication between physicians and behavioral health providers as good or excellent 90% reported routine screening for depression o 65% use PHQ-2/9 o 17% BDI o 5% MDQ o 17% other 38.8% routinely screen for SA, 37.4% screen specific subpopulations o 44.5% use CAGE o 36.1% Other o 12% AUDIT o 4.1% Mini SSI o 3.1% ASSIST Ramifications for SBIRT

8. CHC Integration in AZ ADHS recently surveyed CHCs in AZ on level of integration Classified respondents into five levels of collaboration: o Very Low - Minimal Collaboration o Low – Basic Collaboration at a Distance o Moderate – Basic collaboration on-site Separate systems in the same facility o High – Close collaboration in a partly integrated system o Very high - Close collaboration in a fully integrated system

10. Physician Survey Overview Integrated care practices are still rare outside of systems such as HMOs, the VA, FQHCs, and CHCs (Walker & Collins, 2009) Goal of this project is to better understand the level of integration in the private sector through the state of Arizona Data collection ongoing

11. Research Questions What are the current practices within primary care practices with regards to routine screening, assessment, and direct treatment for behavioral health concerns? To what extent do physicians utilize local behavioral health agencies as referral targets for their patients? How do providers describe the quality of their relationships? What are the current practices in primary care clinics in providing their patients behavioral interventions for medical conditions? What are the current staffing patterns of onsite behavioral health providers, and what activities to these providers engage in? To what extent do practices identify the significance of behavioral health integration? What do they identify as barriers and benefits to integration?

12. Preliminary Findings Recently piloted survey with a small number of practice groups that are serving as training sites for DBH students Goal was to determine acceptability of the survey instrument prior to state-wide dissemination

13. Findings – Staffing Patterns

14. Findings – Screening Patterns

15. Findings – Referral to BHPs 4 = Often 3 = Sometimes 2 = Rarely 1 = Never

16. Discussion Lack of knowledge about how to bill for BHP services remains the primary barrier to integration Providers reported being least likely to refer to BHPs for some of their most highly prevalent patient concerns o Providers may benefit from education around the role of the BHP in promoting physical health Current survey screen was deemed acceptable length by participating practice o Wide-spread dissemination and data collection to begin by December 2011

17. Thank you! Questions?