Richard C. Veith, MD
Richard D. & Bernice E. Tutt Professor in the Neurosciences
Psychiatry & Behavioral Sciences
Adjunct ...
DISCLOSURES
Employment: University of Washington
Richard D. and Bernice E. Tutt Professor in the Neurosciences
Chief of Ps...
PRESENTATION OVERVIEW
• Behavioral health workforce/access/treatment
challenges in US
• Mental health care delivery in era...
HOW DO WE MEET THESE CHALLENGES?
• Poor access to mental health specialty
care
o Insufficient numbers and maldistribution ...
US HEALTHCARE REFORM IS PROMOTING CHANGES
• Affordable Care Act – “Obama Care”
o Triple Aim - better health; better qualit...
WHO DEFINITION OF HEALTH
Health is a state of
complete physical,
mental and social
well-being and not
merely the absence o...
20 years of Research and Practice
in Integrated Mental Health Care
DIVISION OF INTEGRATED CARE AND PUBLIC HEALTH
7
UW CATCHMENT AREA -- WWAMIMI
8
PRINCIPLES OF EFFECTIVE COLLABORATIVE
BEHAVIORAL HEALTH CARE – J. UNÜTZER, 2011
Patient Centered Team Care
• Team members ...
COLLABORATIVE TEAM APPROACH
J. UNÜTZER, 2011
General
Medical
Practitioner
Patient
Behavioral
Health
Care Manager
Consultin...
DANIEL’S STORY
11
WE CAN DOUBLE THE EFFECTIVENESS OF CARE
0
10
20
30
40
50
60
70
1 2 3 4 5 6 7 8
Usual Care IMPACT
% with treatment response...
CARE MANAGEMENT TRACKING SYSTEM ©
CMTS
• Access from anywhere
• Population-based
• Supports effective care
• Keeps track o...
ACHIEVING THE TRIPLE AIM
Patient care
experience
Clinical outcomes
Health care costs
“I got my life back”
14
COLLABORATIVE CARE AT UW MEDICINE
3 HMC
(CHPW
MHIP)
2008 2010 2012 2013
1 UWNC
4 UWNC
1 UWMC
1 UWNC
1 HMC
BHIP
Launch
11 P...
WASHINGTON STATE
MENTAL HEALTH INTEGRATION PROGRAM
over 40,000 patients served
16
UWNC PRIMARY CARE PHYSICIAN
“You have no idea how helpful it is for a
provider to have a resource like you in
the clinic. ...
ASD: HOW DO WE ADDRESS THIS CHALLENGE?
18
CDC: Surveillance Summaries. March 28, 2014 / 63(SS02);1-21
PROGRESS
19
• Increased public awareness
• Improving health coverage
• Centers of excellence are advancing
knowledge and t...
CHALLENGES
20
• How to disseminate knowledge
o Traditional educational venues
• Who will be the caregiver workforce?
o Wha...
Thank You
21
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Veith Presentation

  1. 1. Richard C. Veith, MD Richard D. & Bernice E. Tutt Professor in the Neurosciences Psychiatry & Behavioral Sciences Adjunct Professor, Global Health University of Washington COLLABORATIVE CARE IN MENTAL HEALTH AND ASD 1
  2. 2. DISCLOSURES Employment: University of Washington Richard D. and Bernice E. Tutt Professor in the Neurosciences Chief of Psychiatric Services, UWMC Professor, UW Psychiatry and Behavioral Sciences Adjunct Professor, UW Global Health Grant funding (current and recent) HRSA Office for Advancement of Telehealth (Veith, RC - PI) Enhancing Rural Primary Care Access to Mental Health and Opioid Management Consultations in Washington Via Telehealth $1,000,000; 9/2012-8/2016 2 R01 NR007755-06 (Mitchell, P - PI) Psychosocial/Behavioral Intervention in Post-Stroke Depression (PSD) $1,671,368; 7/2010-7/2014 Industry Sponsored Activities - None since 1998 2
  3. 3. PRESENTATION OVERVIEW • Behavioral health workforce/access/treatment challenges in US • Mental health care delivery in era of healthcare reform • Collaborative care model – leveraging scarce resources • ASD Education and Care Delivery Challenges • ? integrated care model • ? telehealth 3
  4. 4. HOW DO WE MEET THESE CHALLENGES? • Poor access to mental health specialty care o Insufficient numbers and maldistribution of specialists o Those with greatest need have fewest resources o Poor medical care access for those with chronic mental illness • Poor utilization of evidence-based treatments • Inadequate training of primary care providers • Stigma 4
  5. 5. US HEALTHCARE REFORM IS PROMOTING CHANGES • Affordable Care Act – “Obama Care” o Triple Aim - better health; better quality; reduced costs • Focus on patient-centered ‘medical home’, integrated care, inclusion of mental health care • Shifts in reimbursement priorities o Emphasis on comprehensive care and outcomes • Innovative mental health delivery models developed at UW 5
  6. 6. WHO DEFINITION OF HEALTH Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (1948). 6
  7. 7. 20 years of Research and Practice in Integrated Mental Health Care DIVISION OF INTEGRATED CARE AND PUBLIC HEALTH 7
  8. 8. UW CATCHMENT AREA -- WWAMIMI 8
  9. 9. PRINCIPLES OF EFFECTIVE COLLABORATIVE BEHAVIORAL HEALTH CARE – J. UNÜTZER, 2011 Patient Centered Team Care • Team members collaborate effectively Population-Based Care • Patients are tracked in a registry: no one ‘falls through the cracks’ Measurement-Based Treatment to Target • Treatments are actively changed until the clinical goals are achieved Evidence-Based Care • Treatments used are ‘evidence-based’ Accountable Care • Providers are accountable and reimbursed for quality care and outcomes 9
  10. 10. COLLABORATIVE TEAM APPROACH J. UNÜTZER, 2011 General Medical Practitioner Patient Behavioral Health Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Core Program Optional Additional Clinic Resources Outside Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources New Roles 10
  11. 11. DANIEL’S STORY 11
  12. 12. WE CAN DOUBLE THE EFFECTIVENESS OF CARE 0 10 20 30 40 50 60 70 1 2 3 4 5 6 7 8 Usual Care IMPACT % with treatment response Participating Organizations Unützer et al., Psych Clin NA , 2004 12
  13. 13. CARE MANAGEMENT TRACKING SYSTEM © CMTS • Access from anywhere • Population-based • Supports effective care • Keeps track of caseloads • Facilitates consultation • Allows research on highly representative populations • Licensed by UW C4C to 21 users in 14 states • Has supported care of over 80,000 patients Caseload summaries help manage clinical productivity and quality improvement 13
  14. 14. ACHIEVING THE TRIPLE AIM Patient care experience Clinical outcomes Health care costs “I got my life back” 14
  15. 15. COLLABORATIVE CARE AT UW MEDICINE 3 HMC (CHPW MHIP) 2008 2010 2012 2013 1 UWNC 4 UWNC 1 UWMC 1 UWNC 1 HMC BHIP Launch 11 Participating Sites Harborview Medical Center (HMC) Adult Medicine, Family Medicine, Pioneer Square, Women’s Clinic UW Neighborhood Clinics (UWNC) Belltown, Federal Way, Kent/Des Moines, Northgate, Ravenna, Shoreline UW Medicine Center (UWMC) General Internal Medicine 2014 15
  16. 16. WASHINGTON STATE MENTAL HEALTH INTEGRATION PROGRAM over 40,000 patients served 16
  17. 17. UWNC PRIMARY CARE PHYSICIAN “You have no idea how helpful it is for a provider to have a resource like you in the clinic. I practiced for 16 years without it and I will never go back! You are such a great support for all of us.” Sept, 2013 17
  18. 18. ASD: HOW DO WE ADDRESS THIS CHALLENGE? 18 CDC: Surveillance Summaries. March 28, 2014 / 63(SS02);1-21
  19. 19. PROGRESS 19 • Increased public awareness • Improving health coverage • Centers of excellence are advancing knowledge and training future workforce • Expanding educational and vocational opportunities
  20. 20. CHALLENGES 20 • How to disseminate knowledge o Traditional educational venues • Who will be the caregiver workforce? o What skills, training do they need? • Would a ‘collaborative care’ model be effective o Do we have enough ‘experts’ o Who will serve as care coordinators o How will this be financed and sustained? • Can telehealth be employed for educational and consultation outreach? o Videoconference consultations o Project ECHO – learning communities, case-based, capacity building
  21. 21. Thank You 21

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