Integrated Care

Objectives

• Describe the current models
• Match site to patient groups effectively
• Communicate with primary care effectively
• Integrate physical health needs into case reviews

Current Models

3 Models, 1 "Program"

• PCBH
• Collaborative Care
• SBIRT
• Bidirectional

Role Play Models

Screening Tools

Strengths & Weaknesses

• PCBH: Breadth, immediacy, acceptability
• CC: Clear outcomes, tracking
• SBIRT: Clear outcomes, tracking
• Bidirectional: Consistent environment

Continuum of Integrated Care Efforts

What You Will See In The Real World

• SMH services in a medical space
• Enhanced referral programs
• Homegrown registries; modified protocols
• Basic screening (mental health or medical issues) + referral

Rule of Thumb:

Matching Patients To Sites

How Do You Interact With Patients or Providers (MH/PC)?

Exemplars

• 32-year-old pregnant patient with depression
• 23-year-old male patient with schizophrenia and hypertension
• 72-year-old female patient with depression and mild signs of dementia

System Exemplars

• A patient with SPMI is showing up at ED with frequent chest pain
• A medical high utilizer patient is morbidly obese, diabetic and suffers from depression without improvement in outcomes at CMHC

Site Exemplars

• Patient discharged from ACT Team to FQHC
• Patient of CMHC in ED for abdominal pain
• Patient at small private primary care practice with poor communication with SMH providers

The Promise of Data

• Managed care can leverage data, macro and micro, in ways that individual practices cannot
• Integrated and coordinated care depends on various kinds of data from formal to informal data

Communicating With Primary Care

Put Yourself In Provider Shoes

• They don't just cater to ABH patients
• Don't have time for "meetings"
• If work is going to get done, it gets done today
• Need specific instruction not vague information
• Varying levels of comfort with MH care

Provider Shoes Cont...

• Primary care providers know little of the MH system, find it difficult to engage
• Very different EHRs and communication strategies than SMH

The phone call I want as a BHC

• Alert that a patient has been to the ED and could use a call and appt
• Alert that a patient has missed patient appt at SMH
• Connecting information between services a patient is receiving at a SMH site and primary care
• Discharge to medical home

Primary Care Etiquette

• Ask to speak to triage nurse for clinical issues
• Be prepared, brief, concise, specific, action-oriented
• Be helpful, don't dump work

Integrating Physical Health Needs

How Do You Do It Now?

Top Concerns

• Obesity
• Tobacco Abuse
• Diabetes
• Hypertension
• Cardiovascular Disease
• Hyperlipidemia

Cueing the system

• BH providers need cueing to address medical issues
• PC providers need cueing to address medical issues related to psychotropic medication treatment

What Gets In The Way: Priority of The Day

The Ideal

• Taking care of pressing priorities &
• Keeping track of and being mindful of correct time to integrate medical/ behavioral/ psychiatric tx

This Is Why We Need Integrated Care

• A site will use the tools at its disposal which are not necessarily the right tools for the job at the moment
• More tools, better decision making for the patient