Integrating Behavioral & Physical Health:
Building “Whole Person” Health
Presented by:
Peter Currie, PH.D
Senior Director of Clinical Transformation & Integration
Inland Empire Health Plan
1
IEHP Membership
2009
2015
2016
400,000
1,100,000
1,300,000
(Projected)
2
Carve Out Of Behavioral Health:
Unintended Consequences
County
Behavioral
Health
Drug
Medi-Cal
Health
Plan
Regional
Center
CCS
3
Why IEHP Integrated BH:
 Physical Health and Behavioral Health (BH) care were
Separate and Disconnected
 Outpatient Mental Health Services Under Utilized &
Substance Abuse Treatment was Nil
 IEHP had no influence over the BH Network
 Coordination of Care – PCPs describe referring into the
“Black Hole”
High Cost of BH Administrative Services:
50% of BH dollars reached the MBHO’s Providers
(2009)
Context – 95% of Tax Payer Dollars
paid to IEHP reach IEHP Medical Providers
The BH Integration Plan
Fully Integrated BH Program – “In House”
Streamline the coordination of physical and mental
health benefits
Redirect MBHO Admin/Profit (50%)to fund Expanded
BH Services
Directly Contracted BH Network – Identify and
Support Best Practices
Eliminate Reliance on Vendors (MBHOs) for all BH
Expertise including NCQA Compliance
BH Integration within the Health Plan:
Results in the First Two Years





Increased access to BH services – Cost Neutral to Plan
Medical Cost-Offsets for high-risk/high-cost populations
Improve coordination of physical & behavioral healthcare
through Web: Access to Health Record for BH Providers &
BH Treatment Reports through IEHP Portal for PCPs
IEHP’s Directly Contracted BH network - Private Sector,
FQHCs, County Mental Health & CBOs
Met 100% of NCQA requirements for BH in 2012 & 2015
BH Integration within the Health Plan:
Foundation for Practice Transformation
Psychiatrist
County
Mental
Health
PCP
Intensive
Outpatient
Program
Therapist
1-800 Number
Member
7
Identifying the Complex Target
Population by Adding a BH Lens
Riverside County Specialty Mental Health
Mortality Study (Jan 2007- May 2010)
US Average
Life Expectancy
77.7 years
RCDMH
41.8 years
Unnatural/
Unexpected
38.8 years
Natural Causes
46.8 years
8
Lessons from Riverside County
Co-Location Pilot
•
Patients arrive to health care providers “fully integrated”
with physical and BH needs intertwined
• Health care providers in the IE operate mostly in silos which
limits their impact on overall health status
• Blaine Street County Mental Health and Rubidoux Public
Health Clinic bi-directional Co-location pilot Learning
 People seek care where they are welcomed and
comfortable
 Rather than refer out to the “black hole” bring the
missing/needed care to where the population is getting
care
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Chronic health condition + SMI condition =
high costs
California Fee for Service Medi-Cal Analysis - 2007
Medi-Cal FFS Enrollees
Medi-Cal FFS Costs
Medi-Cal FFS Cost/Enrollee
Medi-Cal FFS Medi-Cal FFS
No SMI
SMI
Metric
166,786 11% SMI % of Total
1,413,654
$3,790,393,322 $2,395,938,298 39% SMI % of Total
$14,365 5.4 SMI/Non-Ratio
$2,681
Diabetes
Ischemic Heart Disease
Cerebrovascular Disease
Chronic Respiratory Disease
Arthritis
Health Failure
3.2%
1.5%
0.8%
4.1%
1.4%
0.8%
11.0%
6.0%
3.0%
13.0%
7.0%
3.0%
3.5 SMI/Total-Ratio
3.9
3.9
3.2
5.0
3.9
Inpatient Episodes/1,000
ER Visits/1,000
Inpatient Acute Days/1,000
Primary CareVisits/1,000
Specialist Visits/1,000
77
239
434
85
639
293
1,167
2,094
492
6,058
3.8 SMI/Total-Ratio
4.9
4.8
5.8
9.5
Data from JEN Associates, Cambridge, MA
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Traditional Health Care is NOT the Primary
Determinate of Health Status
Health Care
10%
Lifestyle
51%
Schroeder, NEJM 357; 12
Environment
19%
Human
Biology
20%
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Social Determinants:
Drivers of Population Health and Patient Experience
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Pressure on Health Plans to
Integrate Physical & Behavioral Health
•
Download of BH Benefits into the Health Plans
 January 1, 2014 Medicaid Expansion of Mental Health
 April 1, 2014 Dual Eligible Pilot
 September 15, 2014 EPSDT Benefit for Autism
•
State Direction & Lessons from IEHP’s recent CMS Audit
 Expectation that Health Plans have a Care Plan for members
that includes BH provider Treatment Plans
 Expectation that BH providers participate in Interdisciplinary
Care Teams
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Strategy for Change
Develop an array of Health Homes that are tailored to support practice
transformation and:
“Integrated care”
Integrated care “results from a practice team of primary care and
behavioral health clinicians, working together with patients and families,
using a systematic and cost-effective approach to provide patient-centered
care for a defined population. This care may address mental health and
substance abuse conditions, health behaviors (including their contribution
to chronic medical illnesses), life stressors and crises, stress-related physical
symptoms, and ineffective patterns of health care utilization.”
(Safety Net Medical Home Initiative, 2014)
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IEHP Strategy: BH Integration as
Platform for Population Healthcare
Primary Care
SUD
Specialty Clinic
FQHC
Long Term
Care Facility
15
BHI-I and CIN/PTI Shared Areas of Improvement
Shared Areas of
Improvement:
Access to Care
Integration of Care
BHI-I Themes:
Coordinated Care Plan of
Action
Patient/Provider
Experience
Site Based Planning
Team Based Care
CIN/PTI Themes:
Electronic Health Record
Conversion
Patient Management
Care Coordination
Complex Care Management
Self-Management
Disease Management
Population Health
Whole health care
that is personcentered, cost
effective, and
results in improved
health and wellness
The Behavioral Health Integration Initiative (BHI-I) Approach
PROVIDE FUNDING FOR INFRASTRUCTURE DEVELOPMENT
SUPPORT PRACTICE TRANSFORMATION WITH
COACHING
JCC Coaching Team
IEHP invests
Practice Improvement
$20,000,000 over 2
years in 13 health care Areas
orgs
a) Improve patient
and provider team
a) Build individual
experience
health homes
tailored to their
b) Provide teamtarget population
based care and
treat-to-target
AND ALSO
b) Work collectively c) Coordinate care
to improve the
d) Manage
Inland Empire
population health
local health care
e) Promote selfsystem
management
SUPPORT CULTURE CHANGE
FROM VOLUME TO VALUE
WITH QI FRAMEWORK
BHI-I Aim:
Improve the
whole health
and wellness
of all
individuals in
the Inland
Empire by
creating an
array of
populationbased,
integrated
health homes
©2015 Jen Clancy Consulting Team. Copying and distribution permitted with citation to JCC Team
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2.
3.
4.
5.
BHI-I Coaching Principles
“Bottom-Up” Approach to Building Population-Specific Health Homes
Relationship Based and Accessible to Ensure Accountability
Promote Learning and Improvement
Use of Qualitative and Quantitative Data
Peer to Peer & Health System to Health System Relationship Building
Inland Empire’s Thirteen (13) BHI-I Pilot Health
Care Learning Organizations
1. Riverside University Health System
2. Riverside County Department of
Ambulatory Care
3. Riverside County Department of Behavioral
Health
4. Borrego Community Health
5. Desert Clinic Pain Institute
6. My Family Inc. Recovery Center
7. Arrowhead Regional Medical Center Family
Medicine Clinics
8. San Bernardino County Public Health
9. San Bernardino County Behavioral Health
10.Social Action Community Health System
Clinic
11.Orchid Court, Inc.
12.San Bernardino Adult Day Healthcare
Center
13.Telecare Corporation
Key BHI-I Goals
1.
2.
3.
4.
5.
6.
7.
8.
9.
Improve access to primary care and behavioral health providers for
adults and pediatric patients, and meet NCQA practice standards.
Health and wellness is tracked (using appropriate clinical measurement
tools and data) to continuously increase the effectiveness of the
treatment team to improve the health status of the target population.
Increase whole health screening & systematic follow ups to positive
screens
Increase the percentage of individuals with self-selected “Total Health
and Wellness Goals” that are shared between key providers
Improve medication reconciliation
Improve patients & provider team’s experience of care
Reduce avoidable emergency room utilization
Reduce inappropriate hospital admissions
Reduce 30 day hospital readmissions rate
©2015 Jen Clancy Consulting Team. Copying and distribution permitted with citation to JCC Team)
Behavioral Health Integration:
Platform for Population Healthcare
Build & Support Health Home Array with “BH Inside”
Supporting Provider Partners who are already integrating
care to build out & refine what they have already begun
Linking best integration practices to achieve shared care
plans that live and breath and reflect the whole person
 Support New Trans Disciplinary Treatment Models for
Complex Populations:
E.g. Combining Pain Management, Mental Health
and Substance Abuse (SUD) to create a new
Pain/Narcotic Misuse Treatment Center
Why Behavioral Health Homes ?
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All Healthcare is Local
Historical Designs
Managed Care
Organizations (MCOs)
for Health Care of TANF
Fee for Service Health
Care Services for Aged,
Blind, Disabled
Emerging Designs
Managed Care
Organizations (MCOs)
for all Health Care
Clinical Integration
Activities
Mental Health Carve-Out
Fee for Service
Drug & Alcohol
Behavioral Health
Carve-Out
Emerging Designs
Fully Integrated Systems
of Care that Align Service
Delivery, Management
Structures and Financing
for Medical Care and
Behavioral Health
Services in Support of
Full Clinical Integration
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Achieving the Triple Aim
by Integrating the Social and Behavioral
Determinants of Health into Health Care
Payment and Delivery Systems
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