A Behavioral Health Medical Home for Adults with Serious Mental Illness

Aileen Wehren, EdDVice President Systems Administration

Porter-Starke Services, Inc.Beth Wrobel, BSME

Chief Executive OfficerHealthLinc, Inc.

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session # G3aOctober 28, 2011

Faculty Disclosure

I/We have not had any relevant financial relationships during the past 12 months.

Need/Practice Gap & Supporting Resources

In addition to the wealth of research regarding the effectiveness of integrated care, there is recent research (Alakeson, Frank and Katz, May 2010) that

indicates that specialty behavioral health medical homes are a more effective method of meeting the unique health needs of individuals with

serious mental illness

Key factors for improving the health of individuals diagnosed with serious mental illness

Medical and behavioral health staff work as a team Form a health Care Home where the patient feels at “home” and where

other supportive services are avialable, usually the CMHC

Objectives Know how to achieve buy in from leadership and practitioners

in implementing a medical home for individuals with a serious mental illness

Understand the elements to successful integration of primary medical and behavioral health care for this group of individuals including identifying and overcoming barriers

Know how to define and to achieve measurable healthcare outcomes

Learn options to financially support behavioral health medical homes and integration of primary and behavioral healthcare

Expected Outcome Establishment of metrics that can be used to guide

development of the care design and to determine effectiveness of the model

Practical understanding of one design option

Our Design• FQHC located a health clinic at the CMHC• Staffed with a Healthcare Team: Nurse Practitioner, Nurse, Case

Manager/Skills Trainer• Started small with a hand selected group of consumers• Grew the clinic after operational issues were resolved• Medical appointments involve the entire Healthcare Team and the

consumer• Case Manager/Skills Trainer works with the consumer in-between

appointments on actions identified in the healthcare/treatment plan• Data Elements for evaluation: Exercise behavior, smoking behavior, PHQ9

scores, GAD scores, CAGE-AID scores, triglycerides, cholesterol levels, A1C levels, weight and BMI

Achieving and Maintaining Buy In• Must have the confidence and support of the leadership, the practitioners

and the individuals receiving the care. • Everyone needs to understand the why and how of integrated health care• Project design should include all staff that will have contact with the

individuals• Analyze finances to ensure that the project design can succeed financially• Build evaluation into the project from the very start, both clinical (health

and behavioral health) and financial • Have regular meetings of the staff from involved providers to ensure

effective management

Successful Integration of Care

• Behavioral health care is embedded in the primary healthcare clinic and framed in terms of overall health improvement and feeling better

• At medical appointments the individual, the primary healthcare staff and the behavioral health care staff are all present so that services are decided and agreed upon by all

• Healthcare/Treatment plans are jointly developed• Review of current status and what are specific

manageable steps to take until the next appointment

What Works• Coordinated care between primary and behavioral health; providers work

together toward common goals• Health behavior coaching and skills training including initially participating

with the individual to improve skills and motivation• Focus on helping people improve/stabilize chronic physical/mental health

conditions and to feel better about themselves• Teaching illness management including physical and behavioral health and

the intersection between them• Helping to improve diet and exercise patterns • Supporting consultation and joint treatment planning between primary

care and psychiatry

What Might be a Barrier

• Lack of engaged and supportive leadership and/or staff• Behavioral health carve outs within Medicaid programs• Finances: Not determining what services can be billed, by

which provider, at what rate, for what individuals (insurance status)

• Lack of staff training, initial and ongoing• Lack of defined roles and responsibilities for staff as well as

systems of communication• Lack of engagement of the individuals receiving the care • Psychiatric symptoms

Satisfaction with the Clinic

Success Stories• Expansion recent so have only limited clinical outcomes• Indiana Medicaid is interested in our results including financial impact• Since October 2010 John has increased his weight (good), decreased his

non-HDL cholesterol from 233 to 85, decreased LDL from 190 to 63 and decreased triglycerides from 215 to 158

• Dale had his weight increase but his non HDL cholesterol decreased and he now wants to pursue employment

• Scott’s weight is decreasing, his PHQ9 decreased fro 14 to 5, his GAD from 7 to 2 and he has obtained a membership at the YWCA and is exercising regularly on his own

• Robert has lost 28 pounds and 3 inches off of his waist in the past four months. According to the Project RN, Callie, he is watching what he is eating and “feels so much better”

Some Preliminary Results

Learning Assessment

Evaluation of a behavioral health medical home should include measurement of both physical and behavioral health

indicators.Yes/No

As long as the clinical team supports integrated service delivery the position and support of the leadership is irrelevant.

Yes/No

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!