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Behavioral Health Integration;Experiences of RIPCPC and RIBHN
2010 - 2013
A bit on history and backgroundDevelopment of current modelDemonstration of point-of-care database
referral systemProspects for the futureQuestions
History of RIPCPC
RIPCPC formed in 1994 as an Independent Practice Association (IPA) with a focus on quality improvement Originally formed to:
Challenge insurers that were lowering reimbursement Combat the trend of hospitals buying up community
based practicesRIPCPC is the largest IPA in Rhode Island
140 Primary Care Physicians (began with 40) Cover over 300,000 Rhode Island Lives 25% of Rhode Island’s Pediatricians are Members
RIPCPC’s Focus on the Patient Centered Medical Home
Principals of the PCMH Personal physician provides care Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Enhanced access for patients Focus on safety & quality improvement Payment appropriately recognizes the added
value provided to patients
Behavior Health’s Integration is Essential to Improving Outcomes!
Patient Centered Medical Home Model
PCMH effect:Care delivered by primary care
physicians in a Patient-Centered Medical Home is consistently associated with better outcomes: Reduced mortality Fewer hospital admissions Lower utilization Improved patient compliance Lower healthcare spending
Collaboration with Specialists/Providers
True patient care coordination can only happen with meaningful & efficient provider collaboration
We can improve outcomes and the effectiveness and efficiency of our care delivery systems by embracing this concept
Our effectiveness and efficiency as clinicians will soon be directly tied to our reimbursement
Behavioral Health Committee Focus
Mission Statement: To improve the health of our patients by facilitating
communication and coordination of care between Rhode Island Primary Care doctors and Behavioral Health Professionals in Rhode Island
We have assembled a team of primary care doctors along with our IT professionals and behavioral health professionals and we have created a forum with regular monthly meetings focused on: Improving access to Behavioral Health Providers Improving communication between Behavioral
Health Providers and PCP’sSupport the IPA by addressing behavioral
health’s role in the PCMH, helping satisfy our behavioral health contract components
Behavioral Health Committee Initiatives
Evaluate/Revise/Approve BCBSRI policies and procedures stated within the three-way contract between BCBSRI, RIPCPC & Behavioral Health Provider Both the Co-located & Collaborative Model
AgreementsCreation of a comprehensive list of
Behavioral Health Providers and facilities for our physicians membership Listing will be compiled and posted on our website
Refine pilot between the Behavioral Health Providers and PCP’s focused on securely exchanging standardized clinical
correspondence Patient Clinical Summaries / Referrals (from PCP) Behavioral Health Evaluations (from BHP)
Behavioral Health Committee Initiatives
Things to Come (in 2012): Database to access at point of care to allow for
smooth referral of patients to appropriate providers Collaborative agreements to allow for the majority of
our physicians to enter into arrangements that enhance access and improve communication
Network wide ability to use the secure, HIPPA-compliant communication system piloted in 2011.
Goals of Behavioral Health Integration
Improve 2-way communication between clinician and the referring PCPBetter access to BH for our patients Formation of quality metrics that can prove better outcomes with BHDelivery quality comprehensive coordinated care to our Patients!
Behavioral Health Integration
Through collaborative agreements spelling out expectations on both sides, a behavioral health pod within RIPCPC was formed:
Timely response to referral (same day for urgent referrals, 72 hours for routine) with willingness to accept patients
Thorough 2-way communication with detailed referral from PCP, and with regular progress notes for ongoing therapy
Emphasis on electronic communication
Point-of-Care Referral Database
A web portal, accessible at the point of careAllows PCP to appropriately tailor referral to
the needs of the individual patient with respect to geography, age, insurance, behavioral or mental health goals and need for comprehensive care.
Can refer to individuals, group practices or facilities
Preferred communication is electronic, but can be via web, fax or phone depending on providers preferences
What we accomplished..
Formalized an affiliate membership between the RIPCPC physicians and behavioral health providers
Established a RIPCPC Behavioral Health PodCreated a RIPCPC Behavioral Health provider
and facility portal This is a searchable database of BH providers that
RIPCPC member physicians can filter by: Specialty, insurance, city, hours of availability, insurances accepted & population treated
Utilize ‘Direct’ messaging to communicate with BH providers
Things to Come
A focus on the collaborative model approach Strengthen network and build lasting relationships Assist patients in making better choices and measure those
patient outcomes (healthier lifestyle = lowered health care costs)
Improve our communication and access with BH specialists for the benefit of our patients, this will help us better manage our patient population in an ACO/AQC/RISK environment Successful behavioral health integration is
vital to containing costs!