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Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
Health Care Reform:  Primary Care and Behavioral Health Integration
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Health Care Reform: Primary Care and Behavioral Health Integration

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  • Consistent with the President’s prevention and wellness initiatives, we feel this multi-layered response not only meets the emerging needs of States, communities, and individuals; but also prepares HHS in moving toward a National response and recovery system that truly mitigates the prolonged effects of disasters. In closing, we would like to thank you for your time and attention. We look forward to a discussion about what was presented here today and we are particularly interested in your ideas and feedback. Thank you.
  • Transcript

    • 1.  
    • 2. Health Care Reform Primary Care and Behavioral Health Integration John O’Brien Senior Advisor on Health Financing SAMHSA
    • 3. Affordable Care Act
      • Major Drivers
        • More people will have insurance coverage
        • Medicaid will play a bigger role in MH/SUD than ever before
        • Focus on primary care and coordination with specialty care
        • Major emphasis on home and community based services and less reliance on institutional care
        • Preventing diseases and promoting wellness is a huge theme
    • 4. Person Served by SSAs/SMHAs
      • 12 M visits annually to ERs by people with MH/SUD
      • Individuals with schizophrenia have one of the highest rates of smoking (58%–88%)
      • Cardiovascular mortality was 6.6 times higher among SMI clients than the general population
      • 70% of SMI had at least 1 chronic health conditions, 45% have 2, and almost 30% have 3 or more.
    • 5. Primary Care And Coordination
      • Individuals with SMI die on average at the age of 53 years old
      • Barriers include stigma, lack of cross-discipline training, and access to primary care services
      • Have elevated (and often undiagnosed) rates of:
        • hypertension,
        • diabetes,
        • obesity
        • cardiovascular disease
      • Community-based behavioral health providers are unlikely to have formalized partnerships with primary care providers
    • 6. Primary Care And Coordination
      • Readmissions
        • 20% of Medicare patients are readmitted within 30 days after a hospital discharge
        • Lack of coordination in “handoffs” from hospital is a particular problem
        • More than half of these readmitted patients have not seen their physician between discharge and readmission
    • 7. Affordable Care Act Opportunities
      • Grants for mental Illness with co-occurring primary care conditions (SAMHSA)
      • Health Homes (CMS and SAMHSA)
      • Prevention Trust Fund and Primary care and Behavioral Health Integration (SAMHSA)
      • Community health teams (CMS/Medicare)
    • 8. SAMHSA Grant Program
      • To improve the physical health status of people with serious mental illnesses (SMI) by supporting community-based efforts to coordinate and integrate primary health care with mental health services in community-based behavioral health care settings
    • 9. SAMHSA Grant Program
      • To better coordinate and integrate primary and behavioral health care resulting in:
        • improved access to primary care services
        • improved prevention, early identification and intervention to reduce the incidence of serious physical illnesses, including chronic disease
        • increased availability of integrated, holistic care for physical and behavioral disorders
        • better overall health status of clients
    • 10. SAMHSA Grant Program
      • FY 2010
      • $28 million to help 56 community behavioral health agencies
      • $5.3 million national resource center (co-funded by SAMHSA/HRSA/HHS)
    • 11.
      • Facilitate screening and referral for primary care prevention and treatment needs
      • Provide and/or ensure that primary care screening/assessment/ treatment and referral be provided in a community-based behavioral health agency
      • Develop a registry/tracking system for all primary care needs and outcomes
      • Offer prevention and wellness support services (>10% of grant funding)
      • Build processes for referral and follow-up for needed treatments that are not appropriately provided in a primary care setting
      PBHCI: Services Delivery
    • 12.
      • Baseline Descriptive Information
      • Personal/family history of: diabetes, hypertension, cardiovascular disease; substance use; tobacco use
      • Medication history/current medication list, with dosages
      • Social supports
      • Health Outcome Indicators (by individual)
      • Weight/Height/Body Mass Index Blood pressure
      • Blood glucose or HbAiC Lipid profile
      PBHCI: Data Collection and Performance Outcomes (<20% of grant funds)
    • 13.
      • Services Outcome Indicators
      • The number of mental health consumers receiving primary care services
      • The number of mental health consumers screened for:
        • hypertension;
        • obesity;
        • diabetes;
        • co-occurring substance use disorders; and
        • Tobacco product use
      PBHCI: Data Collection and Performance Outcomes (<20% of grant funds )
    • 14. Training and Technical Assistance Center
      • In partnership with HHS/Health Resources and Services Administration
      • Purpose
        • to serve as a national training and technical assistance center on the bidirectional integration of primary and behavioral health care and related workforce development
        • provide technical assistance to PBHCI grantees and entities funded through HRSA
    • 15. Training and Technical Assistance Center (TTA)
      • TTA will:
      • Increase the number of individuals trained in specific behavioral health related practices;
      • Increase the number of organizations using integrated health care service delivery approaches;
      • Increase the number of consumers credentialed to provide behavioral health related practices;
      • Increase the number of model curriculums developed for bidirectional primary and behavioral health integrated practice; and,
      • Increase the number of health providers trained in the concepts of wellness and behavioral health recovery.
    • 16. Health Homes
      • Section 2703
        • Enhanced integration of primary and specialty care for individuals with:
          • At least two chronic conditions
          • One chronic condition and be at risk for another, or
          • Serious and persistent mental illness
        • Chronic conditions include:
          • mental health condition,
          • substance use disorder,
          • asthma,
          • diabetes,
          • heart disease, and
          • being overweight, BMI < 25.
    • 17. Health Homes
      • Health homes (several new services):
        • Comprehensive Care Management
        • Care Coordination and Health Promotion
        • Patient and Family Support
        • Comprehensive Transitional Care
        • Referral to Community and Social Support Services
      • Timing
        • States can submit plans for effective dates as early as 1/2011
    • 18. More Information: http://www.samhsa.gov

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