Behavioral Health Specialist Meeting: Keeping You in the Loop


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Behavioral Health Specialist Meeting: Keeping You in the Loop

  1. 1. Behavioral Health Specialist Meeting: Keeping You in the Loop December 17, 2013 American Polish Cultural Center
  2. 2. Today’s Agenda  Introduce Medical Network One  Describe BCBSM PGIP  Explain how collaboration might look  Introduce the PCMH, PCMH-N and OSC  Open discussion 2
  4. 4. Who Are We?  Health solutions organization with a 30 year legacy  Primary care providers in five counties  Multi-specialty  Strong relationship with behavioral health  Addition of psychologist  Engaged in transformative activities including PCMH, PCMH-N and OSC 4
  5. 5. Timeline  2004 BCBS launched PGIP  Initially PGIP was only open to primary care physicians  2011 PGIP is opened to a number of specialties  2012 psychologists invited to join PGIP 5
  6. 6. Want to Join?  Individual physicians and psychologists need to join a participating Physician's Organization  Psychologists were eligible to join and participate in PGIP beginning in 2012  Physician Organizations could add psychologists in their Summer 2012 Self Reported Database 6
  7. 7. Collaborating with a New Partner  Create a mission statement by answering the question: What do we hope to accomplish by working collaboratively  Examine initiative and identify who will be responsible (MNO or Both)  Consider issues and develop an action plan  Record decisions to form a shared vision of initiative responsibilities 7
  8. 8. Steps to Successful Collaboration  Translate beliefs into a shared vision  Establish regular cycles  Attain an Advance Plan  Make time to Communicate and Evaluate  Repeat Regularly Stick to the Plan 8
  9. 9. HOW IT STARTED 9
  10. 10. Catalyzing Health System Transformation in Partnership with Communities 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 PGIP PCMH OSC Chronic Care Model Primary care transformation Organized Systems of Care • Transform care processes to effectively manage chronic conditions • Build registry and reporting capabilities to manage populations of patients • Achieve savings in specified areas • Reward physicians for improved performance and efficiency • Share savings • Build PCMH infrastructure • Strengthen doctor-patient relationship • Support PCPs and their team’s ability to effectively manage care • Coordinate care across the continuum for a defined patient population • Support establishment of systems of care that assume responsibility and accountability for managing a defined population of patients across all locations of care in a community • Establish linkages with community services Expand PGIP to include specialists involved in chronic care Implement PCMH and quality/use initiatives Continue to increase number of initiatives Continue to add new specialties to PGIP Extend providerdelivered care management with links to BCBSM for customer reporting statewide 10
  11. 11. 2007 Principles of the PCMH Personal physician Physician-directed team Whole person orientation Quality and safety Coordinated, integrated care Enhanced access Appropriate payment structure *March 2007 Statement Issued by: American Academy of Family Physicians (AAFP); American Academy of Pediatrics (AAP) American College of Physicians (ACP); American Osteopathic Association (AOA) 11
  12. 12. 10 Trained and Engaged Leadership Building Blocks of a High Performing PCMH 9 Template of the Future 5 Population Management 1 Shared Vision and Goals 2 Data-driven Improvement 8 Coordination of care 6 Continuity of care 7 Prompt access to care 3 Empanelment and panel size management 4 Team-based care
  13. 13. Key Element: Care Registry  This population-based application stores age appropriate surveillance, disease-condition specific individual and population-based information to support care management, outreach, quality improvement, and outcomes  This tool helps identify gaps in care, run reports, and perform a practice, clinician, physician organization, and payer level assessment Join the Conversation: 13
  14. 14. Key Element: Evidence Based Guidelines  EBGs are embedded in the care registry or EMR  PCP utilizes and refers to evidence-based guidelines  The United States Preventive Services Task Force (USPSTF) Guidelines, National Quality Forum (NQF) or other evidence-based guidelines helps identify care needs of the patient population not the payer population  HEDIS measures are selected by NCQA committee but based on EBGs Join the Conversation: 14
  15. 15. Key Element : eTools Enhance Practice Transformation  Focus on the patient-physician relationship; physician-led practice team; enhanced access to care; coordinated and integrated care; which is comprehensive, continuous care Join the Conversation: 15
  16. 16. Key Elements of New Care Models  Planned care and planned care visits  Shared medical visits  Team building activities including huddles  Self management training  Care management/coordination  Motivational Interviewing  Transitions in care Join the Conversation: 16
  17. 17. PCMH PCMH-N OSC 17
  18. 18. PCMH-Neighborhood 18
  19. 19. What’s a PCMH-N  Communication  Sharing of information  Agreement or Memo of Understanding  Connectivity  Community of Care Join the Conversation: 19
  20. 20. What’s a PCMH-N: OSC  Accountable to improve performance measures for a defined population  Legal governance structure  Formal network of providers  Ensure inclusion of the safety-net  Ensure networks are comprehensive and include acute, preventive, chronic disease, behavioral, developmental, oral health, and social services Join the Conversation: 20
  21. 21. What’s a PCMH-N: OSC  OSCs are accountable for patients enrolled or attributed to primary care providers within their network • They must improve care, improve health, contain costs • Engage patients in program design and quality improvement  Establish relationships and protocols across the OSC network • Promote technology adoption, including workflows and models for using telemedicine and mobile devices Join the Conversation: 21
  22. 22. What’s a PCMH-N: OSC  Enhance resources of all OSC network providers • Support practice-embedded Care Managers and define a shared patient-centered care plan Develop common data solutions across the network • • Provide training and education Join the Conversation: 22
  23. 23. MESUREMENT: HEDIS 23
  24. 24. What Is HEDIS  Originally titled the "HMO Employer Data and Information Set" (Version 1.0: 1991)  "Health Plan Employer Data and Information Set” (Version 2.0: 1993)  “Healthcare Effectiveness Data and Information Set” (Version 3.0: 1997)  HEDIS 2009 (year) Join the Conversation: 24
  25. 25. NCQA  A private, independent, non-profit health care, quality oversight organization committed to measurement, transparency, accountability and uniting diverse groups around a common goal: improving health care quality. Join the Conversation: 25
  26. 26. Why Create HEDIS  Designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks  Designed for employers to compare health plans Join the Conversation: 26
  27. 27. Overall Definition of HEDIS  HEDIS measures are related to many significant public health issues, such as cancer, heart disease, asthma and diabetes, preventative services Join the Conversation: 27
  28. 28. Measures  Currently, the HEDIS measurement set contains 70 measures across 8 measurement domains  Most of the measures in each domain have more than 1 rate associated with it (for example: there is a measure of comprehensive diabetes care that is comprised of 9 specific rates) Join the Conversation: 28
  29. 29. Measures and Domains of Care  76 (80) HEDIS measures divided into five domains of care • Access/Availability of Care • Experience of Care • Utilization and Relative Resource Use • Cost of Care • Health Plan Descriptive Information Join the Conversation: 29
  30. 30. Effectiveness of Care  Prevention and Screening  Respiratory Conditions  Cardiovascular Conditions  Diabetes  Musculoskeletal Condition Join the Conversation: 30
  31. 31. Effectiveness of Care  Behavioral Health  Medication Management  Measures Collected Through Medicare Health Outcomes Survey  Measures Collected Through the CAHPS Health Plan Survey Join the Conversation: 31
  32. 32. Pay For Performance  Payers rely on HEDIS measures to incentivize primary care physicians  BCBSM is utilizing HEDIS measures  Select target measures to incentivize Join the Conversation: 32
  33. 33. Communication and Marketing  NCQA collaborates annually with U.S. News & World Report to rank HMOs  “Best Health Plans" list is published in the magazine in October Join the Conversation: 33
  34. 34. Advantages  Rigorous selection process  Useful for "evaluating current performance and setting goals”  Associated with cost-effective practices or with better health outcomes  Measures focus largely on processes of care: reflect care that patients actually receive  HEDIS measures are widely known and accepted Join the Conversation: 34
  35. 35. Provider Role in HEDIS  Providers play a central role in promoting health  Providers facilitate HEDIS process by: • Providing appropriate care within designated timeframe • Accurately documenting all care in the medical record • Accurately coding all claim submissions Join the Conversation: 35
  36. 36. HEDIS Data Collection  HEDIS data is gathered by • Administrative (claims) data • Hybrid Method – claims data and chart reviews • Survey - CAHPS Join the Conversation: 36
  37. 37. What Are We Measuring Today  Blue Cross Blue Shield of Michigan is committed to improving the quality of mental health treatment delivered to patients: • Encouraging doctors and other health care professionals to follow treatment standards developed by the Michigan Quality Improvement Consortium and Blue Cross • Tracking certain aspects of care quality by using measures within the Healthcare Effectiveness Data and Information Set (HEDIS®) 37
  38. 38. Tracking Measures  Follow-up after hospitalization for mental illness (FUH7): Proportion of patients discharged from a mental health facility who are seen by a mental health care provider within seven days of discharge  Antidepressant medication management: Proportion of newly diagnosed depressed adults who receive an antidepressant: • For 12 weeks (acute phase) • For six additional months (continuation phase) 38
  39. 39. Tracking Measures  Follow-up care for children prescribed attention deficit hyperactivity disorder medication: Proportion of children prescribed medication for ADHD who receive: • At least one follow-up visit within 30 days of medication initiation • At least two additional visits within the next seven months 39
  40. 40. Tracking Measures  Initiation and engagement of alcohol and other drug dependence treatment: Proportion of patients diagnosed with alcohol and other drug dependencies who receive treatment within 14 days, followed by two additional services within 30 days 40
  41. 41. PGIP Endorses Two HEDIS Measures  The Blue Cross Physician Group Incentive Program (PGIP) has endorsed two of the HEDIS based behavioral health measures related to depression medication and follow-up for patients with ADHD in its tracking initiative (Evidence-Based Care Reports) 41
  42. 42. Mission 42
  43. 43. DISCUSSION 43