Integrated Behavioral Health
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Bryan Hatcher, MDiv, LCSW
Director of Center Development and
Education
bhatcher@wakehealth.edu
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Integrated Behavioral Health
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Schedule
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Who is CareNet
What is Integrated Care
Break
Models of Integrated Care
Lunch
What is CareNet Doing
Break
Plan Your Integrated Care Strategy
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Integrated Behavioral Health
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Who Is CareNet?
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Integrated Behavioral Health
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Who Is CareNet?
Wake Forest Baptist Health
Winston-Salem, NC
Department and Subsidiary
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Integrated Behavioral Health
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Who Is CareNet?
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Grew out of Department of Pastoral Care (40+ years)
Expanded to statewide network of pastoral counseling centers
501c3 nonprofit (CareNet, Inc.) established in response to managed care
Currently, 35 clinical sites, 65 clinicians (+ residents and interns)
2 years ago, Dept of Pastoral Care became Dept of Faith and Health (Gary
Gunderson)
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Who Is CareNet?
• Mission -- To improve the health of mind, body, spirit and
community through spiritually-integrated counseling and
psychotherapy, education and research
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Integrated Behavioral Health
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What is Integrated Care?
• Definitions
 Integrated Care – the systematic coordination of general and behavioral
healthcare (SAMHSA)
 Integrative Care – the use of knowledge from many disciplines, including
complimentary and alternative treatments, by a health provider (Duke Integrative
Medicine)
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Integrated Behavioral Health
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What is Integrated Care?
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Integrated Behavioral Health
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What is Integrated Care?
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Integrated Behavioral Health
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What is Integrated Care?
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Integrated Behavioral Health
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What is Integrated Care?
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Benefits of Integrated Care in the Medical Home
84% of the time, the 14 most common physical complaints have no identifiable organic etiology.
80% of people with a behavioral health disorder will visit primary care at least one time in a calendar year.
50% of all behavioral health disorders are treated in primary care.
48% of the appointments for all psychotropic agents are with a non-psychiatric primary care provider.
67% of people with a behavioral health disorder do not get behavioral health treatment.
30-50% of referrals from primary care to an outpatient behavioral health clinic do not make the first appointment.
Two-thirds of primary care physicians (PCPs) (N=6,660) reported not being able to access outpatient behavioral
health for their patients. Shortages of mental health care providers, health plan barriers, and lack of coverage or
inadequate coverage were all cited by PCPs as important barriers to mental healthcare access.
(http://www.advancingcaretogether.org/why-integrated-care.php)
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What is Integrated Care?
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Financial Benefits of Integrated Care
Medical use decreased 15.7% for those receiving behavioral health treatment, while medical health use increased
12.3% for controls who did not get behavioral health.
Depression treatment in primary care for those with diabetes had $896 lower total healthcare cost over 24 months.
Depression treatment in primary care had $3,300 lower total healthcare cost over 48 months.
Behavioral Health disorders account for half as many disability days as all physical conditions.
Annual medical expenses — chronic medical and behavioral health conditions combined — cost 46% more than
those with only a chronic medical condition.
Of the top five conditions driving overall health cost (work related productivity + medical + pharmacy cost),
depression is number one.
(http://www.advancingcaretogether.org/why-integrated-care.php)
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What is Integrated Care?
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Key Results
Pharmacy costs were reduced by 23.4 percent, general hospital costs were reduced by 6.9 percent, and included
with other changes, resulted in reduced costs overall of 16 percent.
Independent Living for clients increased by 33 percent
Vocational Activity increased by 44 percent
Legal Involvement decreased by 68 percent
Psychiatric Hospitalization decreased by 52 percent
Illegal Substance Use decreased by 52 percent
CMHCs Services substantially decreased overall medical costs
(http://www.advancingcaretogether.org/why-integrated-care.php)
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What is Integrated Care?
• Triple Aim
 Better Care
 Better Outcomes
Lower Cost
(Affordable Care Act)
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What is Integrated Care?
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Patient (Person) Centered Care
Data Driven
Bundled Payment Systems
Team Care Approach
Prevention and Wellness
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What is Integrated Care?
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Integrated Behavioral Health
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What is Integrated Care?
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Integrated Behavioral Health
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What is Integrated Care?
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Integrated Behavioral Health
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Break
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Models of Integrated Care
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HEALTH HOMES
Federal health home guidance lays out service requirements stemming from the ACA and “well-established
chronic care models.
”1 The required services (also termed “provider standards” in the guidance) include:
Each patient must have a comprehensive care plan;
Services must be quality-driven, cost effective, culturally appropriate, person- and family-centered, and evidencebased;
Services must include prevention and health promotion, healthcare, mental health and substance use, and longterm care services, as well as linkages to community supports and resources;
Service delivery must involve continuing care strategies, including care management, care coordination, and
transitional care from the hospital to the community;
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Models of Integrated Care
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HEALTH HOMES (continued)
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Health home providers do not need to provide all the required services themselves, but must ensure the full array
of services is available and coordinated; and
Providers must be able to use health information technology (HIT) to facilitate the health home’s work and
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establish quality improvement efforts to ensure that the work is effective at the individual and population level
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Models of Integrated Care
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Integrated Behavioral Health
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Models of Integrated Care
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Integrated Behavioral Health
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Models of Integrated Care
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Integrated Behavioral Health
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Models of Integrated Care
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Integrated Behavioral Health
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Models of Integrated Care
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EMR/EHR
Population Health Management Philosophy
Assessments
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PHQ-4/PHQ-9 (samples following)
SBIRT (sample following)
Brief Treatments
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Motivational Interviewing
Cognitive Behavioral Treatment
Solution-Focused Treatment
Community Education
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Mental Health First Aid
Population/Community Driven Classes
Wellness/Prevention
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Smoking Cessation
Nutrition
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Models of Integrated Care
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Models of Integrated Care
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PHQ-9
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too
much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself — or that you are a
failure or have let yourself or your family down
Trouble concentrating on things, such as reading
the newspaper or watching television
Moving or speaking so slowly that other people
could have noticed? Or the opposite — being so
fidgety or restless that you have been moving
around a lot more than usual
Thoughts that you would be better off dead or of
hurting yourself in some way
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Lunch
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Integrated Behavioral Health
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What is CareNet Doing?
East Carolina University
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Integrated Behavioral Health
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What is CareNet Doing?
Columbus Family Medical
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What is CareNet Doing?
• External
• Internal
– Columbus Family Medicine
– Brunswick Family Medicine
– Pembroke Pediatrics
– Downtown Health Plaza
• Adult Internal Medicine
• CarePlus
-- Weight Management
-- Joslyn Diabetes
-- Internal Medicine
-- Pediatric Outpatient
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Integrated Behavioral Health
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What is CareNet Doing?
Many Names, One Concept
Collaborative Care
Co-location
Integrative Care
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What is CareNet Doing?
Training Program
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CareNet is developing a clinical residency in integrated behavioral health in primary care
– Goals
• Orient behavioral health clinicians to the workflow and culture of primary medical care practice
• Provide evidence-base tools and techniques to intervene or refer as appropriate
• Provide an understanding of the role of behavioral health screening in managing patient populations (shift from
counseling and therapy paradigm to public health paradigm
• Provide theoretical orientation and supervised clinical experience in an integrated setting
• Expose clinicians to operational side of integrated care through up to date information on sharing of behavioral
health records through EHR/EMR and HIPAA/privacy regulations, business models and billable services
Will also need training for physicians, nurses, pharmacists, and other professionals
There are currently no integrated care training standards
Could possibly follow the path of addictions counselors – no training, organization certifications, state certifications, state
licensure.
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What is CareNet Doing?
Plans for Integrated Care
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WFBMC outpatient primary care and specialty care clinics
Communities where CareNet has established outpatient counseling centers
-- 32 clinical sites around the state of North Carolina
Federally Qualified Health Centers
Rural Health Centers
County Health Departments
Community primary and specialty care clinics
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