This document discusses integrated care and behavioral health. It provides examples of integrated care models in various states and settings. It also describes the experience of one behavioral health provider, Center for Cognitive and Behavioral Therapy, in establishing an integrated care partnership with Central Ohio Primary Care Physicians, a large primary care group practice. Key elements that supported a successful partnership included sharing office space, using an interoperable electronic health record, measuring outcomes related to cost and quality of care, and negotiating value-based payment contracts with health plans.

1. Independent Practice and IntegratedCare

2. PLC Legacy Sponsor
2017 CE Technology
2017 Pre-Conference Wifi
PLC Gold Sponsor
2017 Conference Wifi
Kevin D. Arnold, PhD, ABPP
Owner and President
Center for Cognitive and BehavioralTherapy &
The Assoc. of Practices for Evidenced Based CBT (APEB)
Columbus, OH
www.ccbtcolumbus.com
kda1757@gmail.com
Clinical Faculty, Ohio State University
Dept. of Psychiatry and Behavioral Health

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• Various Models inVarious States
• Varies by Setting (Hospital, Hospital Owned PCP,
Independent PCP)
• SAMSHA/HRSA Definitions
http://www.integration.samhsa.gov/integrated-
care-models
What is Integrated Care?

4. Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-
HRSA Center for Integrated Health Solutions. March 2013

5. Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-
HRSA Center for Integrated Health Solutions. March 2013

6. Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-
HRSA Center for Integrated Health Solutions. March 2013

7. Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-
HRSA Center for Integrated Health Solutions. March 2013

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• PCP Integrated BH models in Hospital Systems
• Most Systems Owned by Hospitals
• Employees of Hospital Systems
• Early Adoption ofValue-Based Integration
• Independent PCP Practices are Often Stand-Alones
Using Code Based Fee for Service
• Not Much Interest in Integration Re: Cost
Experience in Central Ohio

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• Aggressive Pursuit of Integration
• Approached Large Non-Hospital Based PCP Network (50+
Offices)
• Sought Integration
• Was Offered Co-Location
• Needed to Prove Clinical and BusinessValue
• Obtained Better EHR (Valant)—Meaningful Use Certified/Inter-
operable to Create Integration Potential for EHR
• Value Markers: Patient Experience,Timeliness of Referral
Process, Quality of Care, “Free” Integration (Warm Hand-Off
Available, On-going MutualValuation (including Patient
Messaging)
Experience For CCBT

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• Met initially with Director of Adult and of Pediatric
Medicine and the COO
• Met with the Medical Staff at the First Location
• Launched about 8 months after Initial Meeting
• Payment Currently CPT Code Based
• Add Location to FTID to Avoid Problems Later
• NegotiateCo-Location Agreement
• Set Up Additional Informed Consent Form
Central Ohio Primary Care

11. Central Ohio Primary Care Physicians
• Founded in July 1996 11 Offices/33 Physicians
• 2017 - 320 Physicians in 58 locations.
• FourCounties: Franklin, Delaware, Union, Fairfield
• 60% Internal Medicine (70 Dedicated Hospitalists)
• 20% Family Practice & 20% Pediatrics
• Subspecialties Endocrinology, Rheumatology, ID, PMR
• 325,000 + Active Patients in Metro Columbus
• 100% Physician Owned and Governed
• COPC is 27% of the Central Ohio Primary Care Market

12. COPC Network Coverage
COPC

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• Access to PMPM Payment Models
• Reduced PCPTime during Encounter
• Positioning for Future Private Payer PMPM Models
orValue Based Contracting
FutureValues

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• Did Literature Research on Health Care Costs and Cost
Reductions
• BuiltTriple Aims Capacity (Patient Experience Measure)
• Saw Payers as Partners
• PreparedWhite Papers
• ApproachedCarriers
• Negotiated FirstVBC in 2017
Value Based Contracting

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 “Not surprisingly, depression has been shown to increase medical costs in patients with
these problems by 50% to 70%, according to recent research published in the Archives of
General Psychiatry. In that study, when nurse care managers monitored patients
diagnosed with depression and either diabetes or heart disease, the patients had lower
mean outpatient costs of $594 per person and 114 more depression-free days compared
with patients who received usual care.”
(http://medicaleconomics.modernmedicine.com/medical-
economics/content/tags/affordable-care-act/integrating-primary-care-and-mental-health-
key-im?page=full)
 “Primary prevention efforts will be needed to address common risk factors for comorbid
conditions, such as adverse health behaviors and substance use, in their social and
environmental contexts. Secondary prevention should include screening for common
mental disorders in primary care settings and for common medical health conditions in
specialty medical settings.”
(http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf69438/subasse
ts/rwjf69438_1)
Basics of Behavioral HealthValue

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• In a Milliman Research Report (Melek and Norris, 2008), the authors
reported that patients with chronic medical conditions and depression were
2.1 more likely to eat healthy less than 1x per week, and 1.3 times more likely
to eat more than 6 high fat foods per week. (Melek, S. & Norris, D. (2008). Chronic
Conditions and Comorbid Psychological Disorders. Seattle: Milliman.]
• Primary PreventionThrough Early Intervention—Target Highly CoMorbid
Medical Dx atTime of Dx
• Secondary Prevention—Screenings (e.g., PHQ-9,Vanderbilts) atWellVisits,
Referral for Diagnostic Consult andTx Planning for EarlyTreatment,
Stabilization, and Sx Reduction/Elimination
• Tertiary Prevention—Screenings and Diagnostics with CoMorbid Sx
Presentation, Stabilization, Sx Management/Reduction/Elimination
• Use of CBT, EBTs that are a)Theoretically Modeled and b) Enjoy Strong
Empirical Support
Basics of Behavioral HealthValue (the
CCBT Way)

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• Metrics
• Not “BDI” outcomes
• Is Health Outcomes
• Prevention Behaviors
• Medical Compliance
• Reduced High-Cost Utilization
• Consults to PCPs re Med Management and Compliance
• Relates Directly to Reduced Costs of Co-Morbidity
• QOL of Patient
• Management of Health Care Services for Public Health
Improvement
Value Based Contracting

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• Prevention Models and Levels
• IHI andTriple Aims
• SAMSHA/HRSA
• Innovation (Stand Still is Fall Behind)
• Meaningful Use Certified EHR
• DefineValue-based Role in Health Care (Redefine
Independent Practice as Inter-dependent Practice)
Keys to Know

19. apapractice.org