Trilogy Behavioral HealthcareChicago, IL

The Evolution of Integrated Healthcare at a Behavioral Health Organization in an Urban

Community

Sara Gotheridge, MD Alice Geis, DNP, APN

Chief Medical Officer Director of Integrated Healthcare

Mary Colleran, MSW John Mayes, LCSW, CADC Chief Operations Officer President/CEO

Agenda

Who is Trilogy?

Defining the Need

The Integrated Healthcare Model

Program Outcomes

Challenges

Lessons Learned

Future Directions

Who is Trilogy? Trilogy’s mission is to assist people in their recovery from serious mental illness by helping them discover and reclaim their own capabilities

and life direction.

Who Trilogy Serves

950 clients currently

When coming to Trilogy:48% of clients have co-occurring substance use

issues75% of clients do not have a psychiatrist40% of clients do not have a primary care physician18% of clients are homeless

Average # of Primary Care encounters annually: 7Average # of Psychiatry encounters annually: 6Average # of Medications: 8

THE TRILOGY TEAM

The Need for Integrated Healthcare

Individuals with Serious Mental Illness (SMI) die on average 11-32 years earlier than individuals without SMI, almost always due to highly preventable or manageable medical co-morbidities

Stigma

Insufficient Access to Primary Care

Fragmented Health System

Complex psychosocial and biological conditions

The Integrated Healthcare Model

CULTURE

OUTCOMES

PEER STAFF

PRIMARY

HEALTH

TECHNOLOGY

WELLNESS

SERVICES

PARTNERSHIPS

CONSUMERS

LEADERSHIP

EDUCATION

BEHAVIORAL

HEALTH

SMOKING CESSATIONSUSTAINABILITY

NURSING

OCCUPATIONAL

THERAPY

WORKFORCE

Well-coordinated CareQuality CarePerson-CenteredShared MissionCreativityFlexibility

CULTURE

Behavioral

Health

Primary Care

Co-locationLayout of siteWorkforceCare coordination

WELLNESS

SERVICES

ExerciseNutritionIllness ManagementSelf-careEducation

PARTNERSHIPS

Heartland Health CentersRush University College of Nursing

Chicago House

SUSTAINABILITY

FQHC BillingUtilizing StudentsMaximizing reimbursement value

WORKFORCE

DEVELOPMENT

Academic Partnership

The Center for Integrated Healthcare Education

Peer Ambassadors

TECHNOLOGY

Electronic Medical Records

Sharing Information

What is a Peer Specialist?Paid staff person who is willing to self-

identify as a person with a serious behavioral health disorder with lived experiences.

Service Activities:Peer mentoring/coachingRecovery resource connectingFacilitating & Leading GroupsBuilding Community

PEER SPECIALISTS

Consumer Advisory CouncilWRAP (Wellness Recovery Action Plan)WHAM (Whole Health Action Management)Trauma-Informed Care

CONSUMERS

Wellness FairsFamily NightsWorld AIDS DaySuicide Prevention WeekBBQsLandlord Meet & Greet

COMMUNITY OUTREACH

Practice ApartmentOT Assessments:

Includes Hygiene, Cooking, Safety, Cleaning & Leisure Activities

Adaptive DevicesInvolvement in Care Team

OCCUPATIONAL

THERAPY

Smoke-Free Campus

Participation in the American Cancer Society “Great American Smokeout”

Ask about tobacco use at every visit

Staff & client groups

Staff trained in Ask, Advise, Refer

Panelists on SAMHSA Webinar: "Craving Change: Implementing Tobacco Free Policies in Behavioral Healthcare"

SMOKING CESSATION

LEADERSHIP

Frequent communication

Administrative & financial investment

Technological integration & data

management

Build trust between partners

Focus on mission

Buy-in

Development Memoranda of

Understanding

Clear policies, procedures and workflows

The Center for Integrated Healthcare Education:Pilot Course: “Integrated

Behavioral Health, Primary Care, and Wellness: An Interprofessional Approach.”

Mental Health First Aid & Youth Mental Health First Aid

Certified Alcohol and Drug Counselor Training

EDUCATION

MANAGING WITH

OUTCOMES

Data CollectionMonitoringEvaluationDashboards & Reporting

Co-Morbidities and Disparities

Biomarker or Disease

Our Clients Nationally, individuals with SMI

Overall Population

BMI (n=486) Obese: 50% 60% of patients with bipolar disorder, 70% of patients with schizophrenia, & 55% of patients with depression

Obese: 35.7%

Diabetes (n=776)

15.7% 15%-18% of individuals with schizophrenia

11.3%

Tobacco Use (n=748)

54% 75% 18.1%

Blood Pressure (n=529)

Hypertension: 22.5%

21.9% of adults identifying with any mental illness experienced high blood pressure

Age 18-39: 7.3% 40-59: 32.4%60+: 65%(Overall: 31.4%)

Integrated Healthcare Outcomes

Over 1,000 clients have participated in the Trilogy Heartland Integrated Healthcare program over the last four years.

Of clients who completed the NOMs (National Outcome Measures) assessments:

47% have an improved BMI (weight management)

44% have an improved HgBA1C (diabetes management)

58% have improved cholesterol

18% have improved blood pressure

36% have improved Breath CO level (smoking cessation)

National Outcome Measures Results

National Outcome Measures (n=440) Outcome ImprovedHealthy Overall 19%Functioning in Everyday Life 62%No Serious Psychological Distress 14%Use of Illegal Substances 8%Use of Tobacco Products 4%Binge Drinking 6%Had a Stable Place to Live 14%Attending school regularly and/or employed 13%Involvement with Criminal Justice System 2%Socially Connected 47%

Consumer Smoking Status

2012 2014

54%46%38%

62%

Challenges

Need to continually redesign workflows

Need for staff training

Stigma

Inadequate space

Establishing efficient documentation process

Integrating technology

Addressing Challenges

Leadership Learning Community

Development of new financial model

Increase administrative support

Expand role of consumers

Increase relevance, accessibility &

effectiveness of training

Include evaluation in program

planning

Lessons Learned Need for ongoing staff

training

Be flexible & patient

Focus on qualitative results as well as quantitative

Take time to recognize successes

Focus on wellness

Future Directions Sustainability

Enhancing performance measurement and reporting progress of the IHC

Identify high risk clients through reporting

Population Health Management

On-site Pharmacy Services

Marketing, and an emphasis on outcome materials

Northside Collaborative

Questions?