Session #D5a
Friday, October 11, 2013 or Saturday, October 12, 2013
The Evolution of Integrated Care at Kaiser
Permanente Colorado: Challenges and Opportunities
Arne Beck, PhD
Director of Quality Improvement & Strategic Re
search, Kaiser Permanente Colorado
Joanne Whalen, PsyD
Behavioral Medicine Specialist, Kaiser Permanente Colorado
Jo Anne Doherty, MS, RN, APN
Director of Mental Health, Kaiser Permanente Colorado
Collaborative Family Healthcare Association 15th Annual Conference
October 10-12, 2013
Broomfield, Colorado U.S.A.
Faculty Disclosure
I/We have not had any relevant financial relationships
during the past 12 months.
Objectives
• Describe integrated care programs at KPCO.
• Understand issues related to implementing
integrated care at KPCO, including clinician roles,
work flows, and use of electronic medical records
data for population management and clinical trial
recruitment.
• Discuss the variety of integrated care models used in
KPCO for primary care and for specific populations.
Behavioral Medicine Specialist
(BMS) Program
• Business case for BMS
• Currently 11 BMS clinicians serving KPCO primary care
clinics
• BMS involvement with population based programs and
specialty care
BMS Program Evaluation
• Evaluating reach and impact of BMS program
through grant from the Colorado Health Foundation
– qualitative data from BMS via online diary entries and
patient feedback
– tracking of BMS data from EMR on visits, assessments, and
referrals over time from start of BMS introduction to clinic.
• Visit stats
• Primary care provider survey of value of BMS
services
How Has BMS Changed Clinical Practice?
Qualitative Feedback
• PCPs note that with BMS in their medical practice, they will
screen for depression and anxiety on "all their patients“…
Rationale is that with BMS in the clinic to address these
issues, they are not afraid to look for these.
• I can obtain an immediate consultation without waiting, so I
manage my patients better, and it’s a more efficient use of
Behavioral Health services and my time.
• I made very few referrals to BH before, so having the BMS
here has increased the number of patients seen for BH issues
and access to BH has increased.
• I can offload BH issues to the BMS, otherwise I’d be putting
these patients on prescriptions.
How Has BMS Changed Clinical Practice?
Qualitative Feedback
• It gives the BH department a face and a name, so it’s great for
parents when I need to refer their child to BH.
• We do the PHQ-9 screen on the phone, and can schedule
patients whom we know have anxiety or depression for
appointments when the BMS is available.
• It’s helped with outreach to patients both before and after
and increased the compliance rate of those referred to BH
who actually go. We have a better BH capture rate.
Patient Feedback
• "I want to thank you from the bottom of my heart for giving
me the opportunity to see the BMS. She has been such a
supportive, warm, caring person who distills the information I
give her and makes sense of how I can navigate my emotional
landscape. She has been a pillow for my worrisome and sad
mind. I always feel safe with her, and her kind attention to my
issues. She is equally a pillar of common sense and strength
during the Bereavement Group that I attend each month I will
be forever grateful to you, her and Kaiser for providing this
service of counseling for those of us who grieve the loss of a
spouse or dear family member."
Primary Care Provider Survey: BMS functions Adding The Most
Value to Clinical Practice
average rank
N
curbside consults (2.67)
2.67
21
help PCP with CD patients (2.50)
2.50
8
help PCP decide about medication options (2.44)
2.44
9
help clarify BH diagnosis (2.15)
2.15
27
see patients same day (2.13)
2.13
45
outreach difficult-to-reach patients (2.00)
2.00
6
help refer patients to BH or Medicaid providers (1.98)
1.98
54
manage patients with straightforward BH concerns (1.95)
1.95
41
manage complex patients (1.71)
1.71
45
manage patients in crisis (1.64)
1.64
75
Care of Physical, Mental, And Substance
Use Syndromes (COMPASS)
• CMMI-funded innovation involves integrated
care for patients with depression and poorly
controlled diabetes or heart disease.
• Care managers, behavioral health clinicians,
and primary care teams provide collaborative
care to improve patient outcomes and reduce
risk for hospital admission.
Early Lessons with COMPASS
• COMPASS fills gap for complex patients with chronic illness
and high psychosocial needs
• Use of EMR to identify and outreach patients and as virtual
integration tool
• Engagement with primary care and care
• management teams to promote COMPASS referrals
• Phone-based BH interventions
• Provider and patient feedback
Prevention And Treatment Of
Perinatal Depression
• Use of Edinburgh Postnatal Depression Scale (EPDS)
– EPDS screening process during pregnancy, 2 week well visit, and
6 week postpartum follow up services (BMS, homecare, referral
to BH).
– improving pediatrician comfort in dealing with positive screens.
• Staying well - mindfulness and pregnancy study
– mindfulness based cognitive therapy groups for pregnant
women at risk for depression relapse
– sooner identification, intervention and treatment of active
symptoms
– help reduce risk of post partum depression
Prevention And Treatment of
Perinatal Depression
• Pilot testing mindful mood balance (MMB) web program for pregnant
women at risk for relapse
Prevention and Treatment of
Perinatal Depression
• Active Involved Moms (AIM) for wellness
– telephonic behavioral activation (BA) for women who
screen positive for depression in pregnancy, provided by
trained nurse practitioners.
– randomized trial at 4 sites (Kaiser Colorado, Kaiser Georgia,
Group Health Cooperative in Seattle, and HealthPartners in
Minneapolis) comparing BA to usual care for perinatal
depression.
– outcomes being analyzed include changes in depression
symptoms and quality of life over 6 months after study
enrollment.
Other Integrated Care Programs at Kaiser
Colorado
• Depression care management
• Tele-psychiatry
• Pilot programs (operational or research)
– screening for risky substance use in primary care
(SBIRT)
– using electronic PHQ9 item 9 data to predict suicide
risk and developing interventions for these patients
– using EMR data to identify first episode psychosis for
early intervention
Issues Related To Implementing
Integrated Care At KPCO
•
•
•
•
Clinician roles
Referrals, making seamless care transitions
Scope of practice (is it therapy or coaching?)
Work flows, incorporating EMR as integration
tool
• Short vs. longer term patient management
• Importance of case conferences for complex
patients
Issues Related To Implementing
Integrated Care At KPCO
• use of electronic medical records data and
other technologies for population
management and clinical trial recruitment (Big
Data)
• How to coordinate multiple integrated care
efforts/programs across KPCO
– Providing right care when and where the patient
needs it
Learning Assessment
Audience Question & Answer
Session Evaluation
Please complete and return the
evaluation form to the classroom monitor
before leaving this session.
Thank you!