Michigan Health and Wellness Initiatives:
Peer Services in Federally Qualified Health Centers
and Integrated Health Settings
Lynda Zeller, Deputy Director
Behavioral Health and Developmental Disabilities Administration
Pam Werner, Recovery Oriented Systems of Care
Behavioral Health and Developmental Disabilities Administration
Mary Beth Evans, CPSS
Mid-Michigan Community Health Services
Michigan Department of Community Health
(Public Health, Medicaid, Behavioral Health and Developmental Disabilities, Aging)
Strategic Priorities
 Promote and Protect Health, Wellness and
Safety
 Improve Outcomes for Children
 Transform the Healthcare System
 Strengthen Workforce and Economic
Development
Key Strategic Action Items:
“Transform Health System”
 Integrated Care for Dual Eligible
Demonstration (Medicaid/Medicare)
 Healthy Michigan Plan (Medicaid Expansion)
 State Innovation Model “Blueprint for Health
Integration” testing payment and delivery
Michigan Managed Care &
Specialty Services System
Physical Health and Behavioral
Health General Population
(Mild-Moderate BH)
Specialty Behavioral
Health & Developmental
Disabilities
Managed CareMedicaid
-Competitively Bid
-13 Medicaid Health Plans
-Multiple plans within regions
(Majority in managed -Includes Mild/Moderate BH
care plans=except NH- -Model consistent for over a
LTC)
decade
-CMH First Opportunity
through regional PIHP
-PIHP Sole Sourced in 10
Regions
-Shared Risk, A-87
-1915 (b)(c) concurrent
-CMH SMI, SUD, DD, SED
Services
Healthy Michigan Plan -Repeat items above
(Medicaid Expansion) -Added: Savings Acct, Personal
ABP-SPA & 1115
Incentives, Contributions
-Repeat items above
-Added: Broader addiction
& recovery services
Non Medicaid Funds
-SUD federal, state, local
(SUD Coordinating Agency
merging with PIHP)
-CMH state, local, federal
SMI, DD, SED
-Michigan Marketplace
(Exchange-EHB include BH)
Michigan’s Peer Trained Workforce
2005 - 2014
1400
1283
1150
1200
999
1000
859
800
729
595
600
405
400
235
200
91
0
2005-2006
2006-2007
2007-2008
2008-2009
2009-2010
2010-2011
2011-2012
2012-2013
2013-2014
MDCH 1915 (b)(c) Managed Care
Specialty Services Waiver
 Medicaid Provider Description for Peer
Specialist Covered Services
Developing health and wellness plans
Developing advance directives
Integration of physical and mental health care
Developing, implementing and providing health and
wellness classes to address preventable risk factors for
medical conditions
Transformation Transfer Initiative (TTI)
Project
 Employment of 3 CPSS as Healthcare Navigators and
Wellness Coaches
 Selection of two Federally Qualified Health Centers
(FQHC). One urban and one rural serving 1,552 and
423 individuals with behavioral health needs
respectively.
 Utilization rates for behavioral health needs at
Michigan FQHC sites
 2011: 26,382 served with mental health needs
1,953 for persons with Substance Use
Disorders
Number of Mental Health & Substance Abuse
Visits in Michigan FQHCs*
Alcohol Related Disorders
Other Substance Related Disorders(ex. tobacco use
disorders)
Tobacco Use Disorder
2963
2011
14355
2012
6649
24990
4202
52347
47606
Depression and Other Mood Disorders
132450
23548
Anxiety DisordersIncluding PTSD
73393
26041
Attention Deficit and Disruptive Behavior Disorders
39987
26058
Other Mental Disorders (Ex Drug or Alcohol
Dependence)
SBIRT
78261
150
159
*2012 was the first year Health Centers were required to report for all diagnoses, not just primary. Dramatic
increases more accurately reflect the population prevalence.
Number of Mental Health & Substance Abuse
Patients in Michigan FQHCs*
Alcohol Related Disorders
Other Substance Related Disorders (ex. tobacco use
disorders)
1553
5490
2011
2012
2528
6195
3454
Tobacco Use Disorder
31393
20448
Depression and Other Mood Disorders
46295
12181
Anxiety DisordersIncluding PTSD
28563
10072
14356
Attention Deficit and Disruptive Behavior Disorders
12739
Other Mental Disorders (Ex Drug or Alcohol
Dependence)
SBIRT
24104
103
114
*2012 was the first year Health Centers were required to report for all diagnoses, not just primary. Dramatic
increases more accurately reflect the population prevalence.
TTI Program Objectives
 Enhance knowledge and access to primary
care
 Increase self-management of chronic
conditions
 Enhance physical and behavioral health and
wellness
 Improve quality of life
 Enhance recovery
Peer Roles and Responsibilities
 Health Navigation
 Assistance with appointments, follow up with
specialty services and managing complex health
and service systems
 Identifying community resources, benefits, and
referral to outside agencies
 Linking to community based formal and informal
supports
Peer Roles and Responsibilities
 Health and Wellness Coaching
 Developing Wellness Recovery Action Plans
 Facilitating classes and support groups in smoking
cessation, Whole Health Action Management
(WHAM), diabetes, pain management, and
increasing physical activity.
 Providing individual support related to managing
two or more chronic conditions
TTI Individual Patient Outcomes Anecdotal
Evidence
 Teaching benefits of diabetes self-management
including walking and healthy eating – one individual
lost 18 pounds, reduced insulin and in Hemoglobin
A1c test dropped from 8.2 to 5.9
 Teaching navigation - supported an individual who
had a goal of employment how to navigate the public
bus system to go to Michigan Works, a job
placement/GED organization
TTI Individual Outcomes Anecdotal
Evidence
 Teaching better self-management of finances – supported one
individual who was homeless and on disability how to budget
to rent her own apartment – also supported the same
individual to locate and lease an affordable apartment
 Introducing the Wellness Recovery Action Plan (WRAP) for
recovery self-management – worked one-on-one with an
individual to create a WRAP plan identifying early warning
signs, triggers and how to build a wellness toolbox.
Continuing Education
 Smoking Cessation/Tobacco Recovery: University
of Colorado and CHOICES of New Jersey
 Wellness Recovery Action Planning
 Trauma Informed Peer Services and Supports
 Emotional CPR (e-CPR), National Empowerment
Center
 Leadership
 Whole Health Action Management
Peer Specialist and Recovery Coach
Innovations and Opportunities
 2010 Association of State and Territorial Health
Officials Vision Award for Peer-led Health and
Wellness Initiative
 Michigan Cancer Consortium 2012 Spirit of
Collaboration Award for Peer to Peer Tobacco
Recovery Program
 Stanford CDSMP research study
 Spotlight Agency for Health Care Research and
Quality Innovations Exchange
Vision and Mission
Our Guide on the Journey Toward Population Health
Our Vision is to improve the experience of
health care, improve the health of populations,
and reduce per capita costs of health care
Our Mission is to protect, preserve and promote
the health and safety of the people of Michigan
with particular attention to providing for the
needs of the vulnerable and under-served
populations
Georgia’s
Health Integration through
Peer Support
Georgia Department of Behavioral Health & Developmental Disabilities
Frank W. Berry, Commissioner
Wendy White Tiegreen, Director of Medicaid and Health System Innovation
and
Georgia Mental Health Consumer Network
Sherry Jenkins-Tucker, Executive Director
for the
National Association of State Mental Health Commissioners
July 2014
Georgia’s Foundation
Peer Support approved in Summer 1999
• First specific “Peer”-delivered Medicaid approved
service in nation
• Approximately 1000 Certified Peer Specialists
certified in GA
• Medicaid approved Peer Support Whole Health
and Wellness Medicaid-billable service to
Medicaid State Plan in 2012 (implemented
January 2013)
Georgia: New & Now
Peer Support Whole Health and Wellness
 Key Modification: Prevention
 Modified Medicaid Rehab Option State Plan to add:
“…support and coaching interventions to individuals to promote
recovery and healthy lifestyles and to reduce identifiable
behavioral health & and physical health risks and increase
healthy behaviors intended to prevent the onset of disease or
lessen the impact of existing chronic health conditions by
teaching more effective management techniques that focus on
the individual’s self-management and decision making about
healthy choices which ultimately extend the members’ lifespan.”
Georgia: New and Now
Specific Interventions Include:
•
•
•
•
•
Skills development for sharing basic health information;
Promoting awareness regarding health indicators;
Assisting the individual in understanding the idea of whole
health and the role of health screening;
Supporting behavior changes for health improvement;
Building skills on the use of wellness tools (e.g. relaxation
response, positive imaging, wellness toolboxes, daily action
plans, stress management, etc.) to support the individual’s
identified health goals;
Georgia: New and Now
Specific Interventions, continued:
• Working with the individual in his/her selection of incremental
•
•
•
•
•
health goals;
Teaching/modeling/demonstrating skills such as nutrition, physical
fitness, healthy lifestyle choices;
Promoting and offering healthy environments and skillsdevelopment to assist the individual in modifying his/her own living
environments for wellness;
Supporting the individual as they practice creating healthy habits;
Personal self-care, self-advocacy and health communication;
Assisting in the coaching related to disclosing history, discussing
prescribed medications, asking questions in health settings
Georgia: New and Now
TECHNICAL ELEMENTS



Requires Professional Supervision in accordance
with CMS-SMDL #07-011
Requires goal(s) on the official Treatment
(Recovery) Plan
Requires health-related training for the Certified
Peer Specialist (CPS)
Georgia: New and Now
 CPS Training: Whole Health Action Management (WHAM)
o Engaging in person-centered planning to identify strengths and
supports in 10 science-based whole health and resiliency factors;
o Supporting the person in writing a whole health goal based on personal
motivation and person-centered planning;
o Supporting the person in creating and logging a weekly action plan;
o Facilitating WHAM peer support groups which create new health
behaviors;
o Building the person’s Relaxation Response skills to manage stress;
o Building the person’s cognitive self-management skills to avoid
negative thinking.
http://www.thenationalcouncil.org/cs/press_releases/eight_weeks_to_whole_health_national_council_offers_wham_peer_trainings
Georgia: New and Now
TECHNICAL ELEMENTS
• Health-trained CPSs are the lead practitioners
• Partnered with an agency-designated Behavioral
Health Registered Nurse/s who provides technical
medical advice, referral, and support as requested
and as necessary
Georgia: New and Now
TECHNICAL ELEMENTS:
• HCPCS Billing Code:
• Health and Wellness Supports, H0025
• Rate for 15 minute unit:
• Ranges from $15.13 to $24.36 depending on CPS
education level and location of service
Georgia: New and Now
Health-Certified CPSs have the ability to function in a variety of settings
Emergency
Room
FQHC
RN providing medical
technical support
Health-Trained
Certified Peer Specialist
Community BH
Center
Georgia’s Foundation
Model Billing:
 Emergency Rooms: Negotiations with Medicaid
 FQHCs:
 Per Diem billing
 Options for consideration:
 CMHC Partnership
 Specialized Medicaid Enrollment for Peer Support
 Outcomes Orientation
Core
“Medical history, physical
examination, assessment of
health status and treatment of a
variety of conditions amendable
to medical management on an
ambulatory basis by a
physician”*
FQHCs
“Evaluation and Diagnostic
services”
“Services and supplies incident
to a physician services including
pharmaceuticals “
Medical
WHOLE
HEALTH
Behavioral
Health*
Optional
“Centers may offer additional
services that are beyond the
scope of FQHC core…”
• Psychiatric Diagnostic or
Evaluative Interview
Procedures
• Psychiatric Therapeutic
Procedures
• Office or Other
Outpatient Services
• New Patient
• Established Patient
*Substance Abuse Center Services are non-covered
Medical
FQHCs
Performance
Based
WHOLE Behavioral
Health
HEALTH Diagnosis/
Behavioral
Health
Rehabilitation
Treatment*
Points of Dialogue
 Dialogue:
 Mutual goals
 Role discernment
 Our role, their role, combined roles
 Behavioral Health Treatment and
Rehabilitation
 Complementary functions/strengths
 Medicaid penetration
Georgia’s Foundation
 Lived Experience Perspective
 Improved Lives
 Health Engagement
 Patient Activation
Georgia’s Foundation
Emerging Outcomes:
 Health and Recovery Peer (HARP) Program study (Druss,
et.al): “…significantly greater improvement in patient
activation than those in usual care.”
 Cobb/Douglas Community Service Board (SAMHSA PBHI grantee):
 Significant improvements in cardiometabolic risk factors were seen
(hypertension, smoking status (breath CO), and A1C).
 Individuals with high blood pressure: % in sample group normal
range increased from 33% to 41%
 8% in sample group (n=21) quit smoking
 Improvements were also seen in BMI, total and LDL cholesterol
(statistically insignificant).
Contact Information
Wendy White Tiegreen
wtiegree@dbhdd.ga.gov