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March 17, 2017
Tosca Marquee
Bronx, NY
Town Hall
Town Hall Agenda – March 17, 2017
Breakfast and Registration
Welcome and Overview
PPS Updates
General Updates
Shift to Initiatives
Cash Position
Maternal and Child Health Spotlight
Behavioral Health Spotlight
• 100 Schools Project
• Integration of Primary Care and Behavioral Health
Network & Wrap-up
2
CCHL Training Series
Spring/ Summer 2017
3
Date Title
Wednesday March 22 Culturally-Informed Mental Health and Substance Abuse Prevention and Treatment Strategies for West African Immigrants
Friday April 21 LGBT Sensitivity Training and Providing Affirmative Healthcare
Friday May 19 Engaging Black and Latino Males in Substance Abuse Treatment
Friday June 9 Latinos and Wellness: Diverse Strategies for a Diverse People
Friday July 28 Black LGBT Health: An Intersectional Approach for Healthcare Providers
Registration and Questions: Vanessa Joubert 718 901-8071/[email protected]
Road to PCMH
• 461 providers in network (2014)
197
86
178
PCPs attributed to BHA (3/17)
Certified 2014 Level 3
Ineligible/ opt-out
Other (in process/ engaged/ left network)
82
86
305
PCPs attributed to BHA (10/16)
Certified 2014 Level 3
Ineligible/ opt-out
Engaged
Dennis Maquiling
Executive Director, Bronx Health Access PPS
PPS Updates
6
• Midpoint Assessment Status. • DY2 closing this month. • Continue to refocus efforts to meeting Pay for Performance
Measures. • Budgeting: projects + initiatives • Internal meetings as well as with partners • Closely monitoring performance vs baseline • MY2 – ended June 2016. Results released soon. 1st
Payment in DY3Q2 (Jul-Aug 2017). • MY3 – ends June 2017. Results released DY4Q1. 1st
Payment in DY4Q2 (Jul-Aug 2018). • HIE and Information Sharing
• Bronx RHIO • Data sharing
PPS Update
7
• Bronx Health Access to Provide Grants to Partner CBOs. • One-Year Grants Up to $75,000 Each. • Provide Social or Supportive Services or Interventions to Population
in Central and South Bronx to Improve Health Outcomes. • Must coordinate with PPS partner network, especially primary care,
and track patients.
• Allowed Costs Include Infrastructure and Salary. • Priority Given to Tier 1 CBOs. • Tier 2 CBOs Also Eligible for their Non-Medicaid-Reimbursable
Services. • Reapply Every Year
• RFP to be Released Early April – will be posted on web site. • Proposals due on May 19. • Awards Announced by June 30.
Send questions to: [email protected]
CBO Grant Program
Dr. Suneel Parikh
Medical Director, Bronx Health Access PPS
PPS Updates Shifting to Initiatives
Projects to Initiatives: Align with P4P
9
Domain 4 Population Health - Prevention
Domain 3 Clinical Improvement
Domain 2 System Transformation
Initiatives Initiatives Initiatives Initiatives Initiatives
Pay for Performance Metrics
Care Coordination/
Care Transitions
Primary Care +
Behavioral Health
Integration
Diabetes
Asthma Maternal and Child
Health
Access
Pharmacy
10
Target outreach and monitoring for DM, CVD and schizophrenia
Group Visits
Integrated Pest Management
Centering Pregnancy
Improve urgent, routine appt access
Preconception Outreach in target areas
Food/ nutrition support
Embedded Care Management
Expand mobile crisis units
Peer Support for BH discharges
“Frequent Flier” Interventions Same Day Access for BH providers
BHA Initiatives
DY3
Improved communications around medication management and adherence
Care Coordination/
Care Transitions
Primary Care +
Behavioral Health
Integration
Diabetes
Asthma Maternal and Child
Health
Access
Pharmacy
11
BHA Initiatives
DY3
Victor Demarco
BHA PPS, Finance Committee Chair
Bronx Lebanon, CFO
PPS Updates Cash Position
Name Change!
DSRIP Award Letter
13
Equity Programs (EIP and EPP
Budgeted Funding by Year
© Bronx Health Access 14
Net Project Valuation
Equity Infrastructure Program
Equity Performance
Program
Total
DY1 $11,515,003 $7,927,277 $5,284,852 $24,727,132
DY2 $12,271,038 $7,927,277 $5,284,852 $25,483,167
DY3 $19,838,663 $7,927,277 $5,284,852 $33,050,792
DY4 $17,556,017 $7,927,277 $5,284,852 $30,768,146
DY5 $11,515,003 $7,927,277 $5,284,852 $24,727,132
Total $72,695,724 $39,636,387 $26,424,258 $138,756,369
Funding Received to Date
© Bronx Health Access 15
Payment Net Project Valuation
Equity Infrastructure
Payment
Equity Performance
Payment
High Performance Fund (State)
May 2015 $6,906,715
January 2016 $2,099,309
June 2016 $7,883,005
August/ September 2016
$2,302,226
$2,005,116
November/ December 2016 $1,951,946 $688,319
January/ February 2017 $1,994,903 $2,938,860 $971,597
Total $11,308,212 $13,834,969 $3,627,179
$971,597
FUNDING SPENT OR COMMITTED
16
Funds Spent or Committed
17
Key: Black= Governance expenditure, Green: partner benefit *Offset by Capital Grant
Category Total expected through
March 1, 2017
Administration $6,901,073
Domain 2,3,4 workgroups $6,140,573
IT* $934,285
PCMH $739,821
Stakeholder $495,255
Workforce $5,163,242
Performance Payments $7,583,933
Total $27,958,182
Funding Overview as of March 1st
© Bronx Health Access 18
Received versus Spent Amount
Funds Received by PPS $29,741,957
Funds Spent or Committed by PPS $27,958,182
Funds remaining $1,783,775
Funding Overview as of March 1st
© Bronx Health Access 19
Unfunded Reserves Amount
Sustainability Fund $3,568,242
Contingency Fund $2,402,299
Other Fund _ $1,441,379
Total $7,411,920
Received versus Spent Amount
Funds Received by PPS $29,741,957
Funds Spent or Committed by PPS $27,958,182
Funds remaining $1,783,775
Note: PPS is due over $5M from DOH as of January 2017 in NPV payments
20
Improving Maternal Child Health in the Bronx
Glenys Thomas Perales, Program Director, Bronx Lebanon Health Center
Colette Sturgis, MICHC Program Director, Urban Health Plan
Bronx Health Access Town Hall
Tosca Marquee
March 17, 2017
Project Overview
Increase support programs for maternal and child health (including high risk pregnancies)
PPS Partners Archcare at Home (formerly known as Dominican Sisters)
Bronx Lebanon Hospital Center
Urban Health Plan Visiting Nurse Services of NYS
Target Population: all pregnant women and mothers of children age 2 and below
PPS Selected 2 Models
Implementation of a Nurse Family
Partnership Program
• Enhance VNSNY’s current NFP program
• Develop a referral system for early identification of women who are or may be at high risk
Implementation of a Community Health Worker Program
•Modeled after the Maternal and Infant Community Health Collaboratives (MICHC) program
•Employ 4-6 CHWs and a supervisor with knowledge of the community, community organizations and community leaders
© Bronx Health Access 23
Purpose
Improved maternal and child health
outcomes
Address the social
determinants of health
Early and comprehensive prenatal care
Linkages to community resources
MICHC Program
Goal: improve maternal and infant health outcomes for high-need, low income women and their families.
Key priority outcomes include reducing:
Preterm Births (<37 weeks gestation of pregnancy)
Low Birth Weight (<2,500 grams at birth)
Infant Mortality
Maternal Mortality
© Bronx Health Access 25
https://www.health.ny.gov/community/adults/women/maternal_and_infant_comm_health_collaboratives.htm
MICHC Program Strategies
Life course Model
Preconception: staying healthy before pregnancy, whether or not a pregnancy is planned
Prenatal: staying healthy during pregnancy
Postpartum: staying healthy just after birth
Interconception: staying healthy between pregnancies
© Bronx Health Access 26
Bronx SHINES
• Urban Health Plan MICHC Program
• Bronx SHINES works to improve maternal and infant health outcomes for high need women and to reduce, racial, ethnic and economic disparities in those outcomes
• Bronx SHINES uses CHWs as a strategy to identify, engage, support and refer the targeted population to myriad of services within our agency as well as
MICHC Program in the Bronx
© Bronx Health Access 28
• The CHWs reach out to those lost to care and in disadvantage situations (undocumented, uninsured, homeless, etc.) that without advocacy and support, would not follow up with prenatal or child care.
• Multi-disciplinary team involved in patient care
Physicians
Social workers
Nutritionists
CHWs
Clients/patients
Midwives
• Centering Pregnancy
Evidence-based model
Comprehensive Prenatal Care in 5 years
Increase in proportion of pregnant women who receive care in the first trimester
Increase in proportion of pregnant women who receive early and adequate prenatal care
Baby friendly hospitals
Preconception and
Inter-conception Care
Centering Pregnancy
Performance Goals
© Bronx Health Access 30
64%
73%
8%
67%
95%
6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PostpartumVisits
Timeliness ofPrenatal Care
Low BirthWeight
BHA PPS
BLHC
Interested in DSRIP MCH Program?
© Bronx Health Access 31
Kathy Alexis, Project Manager [email protected] Glenys Thomas Perales, Program Director [email protected] Colette Sturgis, Co-lead [email protected]
Behavioral Health Spotlight
100 Schools Project
34
Bronx Health Access Bronx Partners for Healthy
Communities Community Care of Brooklyn OneCity Health
What does the program do in the schools?
Trainings with staff and students to increase knowledge of behavioral health (mental illness and risky substance use)
Train staff to promote wellness and prevention and facilitate a school’s connection to and use of needed community treatment and services, including hospital systems
Coaching, training and supporting school staff to do universal and targeted assessment of behavioral health issues
Establishing and making community referrals and linkages for students in crisis or in need of treatment
Providing staff professional development, support, self care and resource sharing
35
Behavioral Health in Schools Project—Organization Chart
The Jewish Board
Psychologist/LCSW
Supervisors
Behavioral Health
Subcontractors
20 Schools (Each Cluster)
Office of School Health
NY Academy of Medicine
Behavioral Health Coach
(4 schools)
Behavioral Health Coach
(4 schools)
Behavioral Health Coach
(4 schools)
Behavioral Health Coach
(4 schools)
36
Behavioral Health Coach
(4 schools)
Project Model
The Behavioral Health Team is comprised of 3-5 School Behavioral Health Coaches with expertise in adolescent mental health and substance use who will work with their partner schools to determine the schools’ strengths, needs and priorities Coaches are required to be licensed clinicians, including LMSW, LCSW,
LMHC, LMFT, LCAT A support and coaching plan, based on identified and mutually-agreed
upon priorities and goals that are consistent with the project’s goals, will be developed, reviewed and revised, as needed
Coaching includes supporting school staff via various interventions to address barriers
and priorities for improvement technical assistance to understand when a student needs treatment Understanding when presenting issues can be well accommodated by
school staff or behavioral health providers in the school
37
Program Model
38
Mental Health Literacy
Substance Abuse
Prevention
Training and Technical Assistance
Community Partnerships and Linkages
Crisis Response
Behavioral Health in Schools Project
Pilot Phase – Bronx Schools
39
12
8 9
7
11
3
21
9
4 4
6
3
16
4 5
0
5
2
8
1
3
1 1 2
9
4
0 0 1 1
Meetings withschool staff
(includesstructured
interview of
school needs)
Unplannedconversations
with school staffabout project or
school needs
Coaching sessionwith school staff
Training forschool staff
Classroomobservations
Referrals andcase conferences
Pilot Phase Schools Services (Oct - Jan)
School 1 School 2 School 3 School 4 School 5
Bronx Schools – Successes/Lessons
40
Coaches have been welcomed into schools and are actively engaging with school staff on variety of activities Staff training on mental health literacy and reducing
stigma are ongoing in 7 of 10 schools Providing strategies and support to Parent
Coordinators on delivery of Behavioral Health workshops for families
Coaches have provided information on stress management techniques to staff to increase coping skills for themselves and students.
Working with schools on development of Crisis Intervention plans
Classroom observations done in phases in order to avoid teachers feeling “singled out”
41
Next Steps
Set-up initial meetings with Principals Work with web designer in development of
technology based support Customizing evidence based curriculum based on
school plans Development of toolkits for school staff Annual conference
Save the Date – May 4, 2017
https://jewishboard.org/100schoolsproject
42
Integrating Behavioral Health and Primary Care
Vicente Liz Defillo, MD, Bronx Lebanon Hospital Center
Deborah Pantin, VIP Services Terri Udolf, St. Christopher’s Inn
Bronx Health Access Town Hall
March 17, 2017
Purpose
Why is this project so important to our network & community?
• Based on NYS Office of Mental Health (OMH)
data, approximately 54.4% (9,215/16,942) of Bronx clients served by OMH-licensed and OMH-funded programs have one or more physical chronic health condition, indicating a need for coordinated behavioral & physical health care.
[Data obtained from 2014 Bronx Community Needs Assessment (CNA)]
What is the prevalence of BH issues in our community?
• As of 2014, 7.1% of all people in the Bronx report experiencing serious psychological distress, compared to 5.5% in NYC overall.
• Among Medicaid beneficiaries in the Bronx, 13.4% (111,000) have a depression CRG diagnosis, a rate nearly twenty percent higher than the city rate (11.3%)
© Bronx Health Access 45
Commonality of Comorbidity
Mental Health &
Substance Abuse
Diabetes 10-30%
Heart Disease
10-30%
Smoking, Obesity & Physical Inactivity
40-70%
Cancer
10-20%
Neurological Disorders
10-20%
Chronic Physical
Pain
25-50%
© Bronx Health Access 46
Project Overview
Integrated Primary
Care
Improved access
Patient centered
care
Improved effectiveness
© Bronx Health Access 47
Usual care = 20%-40% treatment response/ improvement Integrated care = 50%-70% treatment response/improvement.
Progress to Goal
The IMPACT collaborative care model is an effective, well researched, evidence based approach to depression care within primary care outpatient practices.
Patient Centered Team Care
Population Based Care
Measurement Based Treatment-to-Target
Accountable Care
Ongoing IMPACT training and support provided by The University of Washington AIMS Center, in collaboration with the NYS Office of Mental Health & the Institute for Family Health
St. Christopher’s Inn
Goals/ Objectives
• Ensure that people with behavioral health (mental and substance abuse) and medical needs are receiving high quality, coordinated care
• Ensure that behavioral health and primary care teams are working together and communicating about a patient’s needs
• De-stigmatizing –we provide a level of comfort for clients by informing them that behavioral health and physical health needs will be addressed in one place
– Reaching young people with mental health or substance abuse issues as early as possible is a major factor to setting the stage for success
© Bronx Health Access 49
Integrated Primary Care
• Collaboration among all treatment team members
• Everybody prescribed psychiatric medications is seen at least monthly for medication monitoring (more if necessary)
• We use EHR to ensure coordination of care – also provides ease of record access for after-care
• Family Program that allows inclusion of family members and significant others
• Medical Assurance Committee is integrated and provides a forum for all aspects of physical and behavioral health to be discussed with a focus on quality improvement
© Bronx Health Access 50
Integrated Primary Care at St. Christopher’s Inn
MH and PH assessments
are done during the admissions process by
RNs
Depending upon acuity, clients are
scheduled for psychiatric or
medical appointments
Referred to Psychiatric NPs and
Director of Psychiatry for
treatment
Medical doctor and psych providers
collaborate about
treatment and outcomes
© Bronx Health Access 51
Use collaborative care model where mental health and primary health providers are co-located within our Medical department
VIP Services
• Brief History of VIP (Vocational Instruction Project)
Behavioral Health
Substance Abuse ( Opioid, Residential and Outpatient Treatment)
Mental Health (Article 31 & Ryan White)
Primary Care Provider/FQHC
Housing/Shelter Provider
Vocational Services
Centralized Admissions
© Bronx Health Access 52
VIP/ BH and Primary Care Integration
Integration from CBO/FQHC perceptive
• Longstanding work with BH and Primary integration
– SAMHSA Grants
– Assessment of MH, Primary health
– AIDS Institute
– Mental Health Licenses
© Bronx Health Access 53
VIP/ BH and Primary Care Integration
Co-location of MH and Primary Care Clinic
• Assessment in primary care---PHQ 2/9
• SBIRT Tool
• Integrated Case Conferences
• Referral and Follow-up
Collaborative/IMPACT Model
• VIP is in the process of being trained
© Bronx Health Access 54
SBIRT
SBIRT can help to prevent the unhealthy consequences of alcohol and drug use such as poor health outcomes
Move SUD into Primary care settings enables healthcare/behavioral health
professionals to systematically screen and assist people who may not be seeking help for substance use problem
Screening Tools: AUDICT-C, DAST, CRAFFT
© Bronx Health Access 55
Overall Workforce Development
CASAC Training
LMSW/LCSW Bootcamp
Training (i.e Cultural Competency and Health Literacy)
SBIRT Training
© Bronx Health Access 56
5 Year vision
• Interoperability for Electronic Health Records/ Use of the same Electronic Health Record
• Integration will be the standard of care- we will no longer have a fragmented health care system
• Standardization across models of integration
• Psychological and Medical Education of providers will promote integration of care
© Bronx Health Access 57
Patient Engagement
– Engaged by care team member
• Screening
• Assessment and evaluation
• Supportive Counseling
– Documented referral to to BH provider
– Follow-up/ Feedback/ recommendations
© Bronx Health Access 58
Patients Screened in Primary Care
DY1Q4 (March 2016)
10,642
DY2Q2 (September 2016)
35,854
Kathy Alexis, Project Manager [email protected] Vicente Liz Defillo, MD- Co-lead [email protected] Deborah Pantin – Co-lead [email protected] Terri Udolf- Co-lead [email protected]
