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Edge of Amazing: Breakout Session B - Integrating behavioral health into primary care

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Edge of Amazing: Breakout Session B - Integrating behavioral health into primary care

  1. 1. Behavi or al Heal t h I nt egr at i on Paul Schoenfeld, PhD; Director Behavioral Health The Everett Clinic
  2. 2. Dr . Paul Schoenf el d Di r ect or Behavi or al Heal t h, TEC
  3. 3. Today’ s goal s • Be aware of the continuum of behavioral health integration • Know why it matters • Apply learnings today
  4. 4. What does i nt egr at i on l ook l i ke? •Where are we today? 4©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  5. 5. TEC Jour ney
  6. 6. TEC Jour ney: Why We Began- 1993• Poor access to BH care • Lack of communication • Inconsistent quality of care • Long-term therapy – without demonstrated outcomes: One size fits all • Value-based contracts elevate need
  7. 7. TEC Jour ney: The Begi nni ng• 10,000 commercially covered lives in prepaid health care—5 clinician dept. – Reduced visits per thousand – Reduced hospital days and admits per thousand – High patient and provider satisfaction
  8. 8. TEC Jour ney: Today • Same-day urgent access • Co-location in pediatrics, family practice, and internal medicine • Integrated into comprehensive pain center • Intensive care management program • EMR Integration
  9. 9. Fast Fact s: 2017- 2018 • 500 new intakes per month • 40 Clinicians: 6 MD’s, 4 ARNP’s, 18 Master’s clinicians, 12 PhD’s • 2 Care Managers, 3 Medical Assistants • 43,319 visits in 2017 • 10,000 plus patients • 4.1 visits per counseling episode 9©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  10. 10. Measur i ng Out comes: Boei ng•Evaluate a medical home model – 740 high cost commercial patients with chronic health problems or high expenses •Results: – 20% reduction in per-capita medical cost of care – 56% reduction in absenteeism
  11. 11. Measur e Out comes: Boei ng Cost• Integrated care at TEC reduces number of visits per patient by 40% compared to outside providers
  12. 12. Payment Model Mat t er s
  13. 13. Tool s f or heal t hy l i vi ng • Adverse Childhood Experiences (ACE’S) • PHQ-9, with added questions • Distress thermometer 13©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  14. 14. Adver se Chi l dhood Exper i ences• Complete the questionnaire on your own. 14©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  15. 15. What was your scor e? • How many had 0 ACE? • How many had 1 ACE? • How many had 2 ACE? • How many had 3 ACE? 4? • How many had 5 or more? 15©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  16. 16. What does ACE’ s mean? • What was the story of the Adverse Childhood Experiences Study? • What does it tell us? • How can we use it in health care? • Why should we use it? 16©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  17. 17. How wi despr ead i s ACE’ s? • Prevalence –36% had no ACE’s –26% had 1 –16% had 2 –9.5% had 3 –12.5% had 4 or more 17©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  18. 18. I mpact • Over 12% of the population with 4 or more ACE’s can expect to have: –Lung disease increases 390% –Hepatitis 240% –Depression 460% –Suicide Attempt 1,200% increase 18©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  19. 19. I t get s wor se…. • The risk of developing mental, medical, or substance abuse disorders goes up in a linear relationship with the number of ACE’s! • It predicts human suffering. • It’s associated with poor self care and management of chronic illness 19©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  20. 20. Tal ki ng hel ps… • When patients simply shared their ACE stories with their providers, who listened, there was a 35% reduction in medical office visits • When they talked to a therapist, they were 50% less likely to come back to see their doctor 20©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  21. 21. Measur e depr essi on and di st r ess• PHQ-9 with added questions –Anxiety, Substance Abuse • 30-40% of referred patients have undiagnosed Substance abuse issues • Administered at every visit in BH • Treat to target 21©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  22. 22. Di st r ess Ther momet er • Used on cancer care • Correlates well with longer paper and pencil questionnaires • Easy to complete; useful in many settings 22©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  23. 23. Key Poi nt s • Identify risk factors (ACE) • Assess Depression and Distress • Measure outcomes: change • Communication with PCP’s • Good access 23©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.
  24. 24. What can you do i n your set t i ng? 24©2017 DaVita Inc. All rights reserved. Proprietary and confidential. For internal use only.

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