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. 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. 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
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. Measur e Out comes: Boei ng
Cost• Integrated care at TEC reduces number of
visits per patient by 40% compared to
outside providers
But there is another way. And if we intend to create a special place, we should pursue this way.
This way involves taking a different approach. This will take us down the path of broadly integrating the care of mind and body together in a wholly different way.
This way is different but not uncharted. In fact, our speaker today will share over 10 years of experience with BH integration. And our panel will bring together speakers from diverse backgrounds to discuss a variety of approaches to achieve integration.
Doesn’t mean it will be simple, as there are payment model barrier to recognize and to overcome. But we can do it, and if we want to have a special place, we will do it.
Started small; minimal investment
Focused on patients in prepaid healthcare
Emphasis on cost-effective groups and classes for high incidence conditions
Brief therapy approach
Continued focus on evidence based group programs for: Anxiety, Depression, PTSD, Personality disorders, chronic physical illness, Shared Medical Appointments
KEY POINT Learnings: These commercial patients had high incidence of BH diagnoses, and without BH integration, the underlying issues would not have surfaced for intervention. These were patients which led providers to cringe, long problem lists, ED visits, anxiety, history of trauma. When care was transferred from IMED to combination of FP and Therapist, the work evolved from formal diagnosis and treatment (typical medical model) to group visits, engagement, peer support and improvements were realized. The importance of surfacing and managing a history of high ace score was highlighted. ACE is a way of measuring lifetime risk based on a multiplicity of adverse childhood experiences. The Commercial high cost population in the Boeing project had a high incidence of early childhood adverse experiences
An ongoing relationship with BH does not imply 20 visits per patient each year. With effective interventions, most patients are treated in 4 visits or less.
In FFS environment, most payers including United have a separate arrangement for BH services, separate and distinct from the medical contract. In the WA market, these providers are typically contracted at very low rates. There is limited vetting and quality management. BH carve-out networks evolved as a means to assure some access, however access is often very limited. Even solo BH providers who are part of the Carve Out network commonly limit enrollment as the rates of pay are so low. There is typically no requirement or service agreement in place for information sharing standards, outcome measures or utilization guidelines. Even with an effective staff model, there is work to be done to create insurance payment models which reward appropriate effectiveness rather than volume.
In the capitated environment, specialty networks have dominated the BH scene. Again, similar service concerns exist especially concerning access. However, within the prepaid market, there are fewer barriers to establishing the integration processes and structures which support effective management such as case management, Shared Medical Appointments, warm handoffs and consultation without the patient being present.
