August 23, 2016 | Tags: Blog | Tags: Behavioral Health Integration , Portland , CareOregon , Measurement
In 2015, CareOregon and its provider partners set out to both build and sustain capacity of integrated behavioral health services in primary care in the Portland Metro region. Already a leader in the primary care medical home movement, investing in integrated behavioral health services easily fit into the existing portfolio of innovations being funded by CareOregon to address the total health of our members beyond traditional primary care.
Lessons learned from 2015
There is both adventure and humility when embarking into new territory and CareOregon and providers experienced both with the integration endeavor. With financial and technical assistance resources, we supported many clinics to “get on the integration bus” but also learned a great deal from the provider community about how to articulate and advance integration in primary care.
One easy lesson is the importance of developing common definitions and language around integration. Ten people will nod their heads about the importance of integrated behavioral health services, but each of the 10 will have a different definition of what that means. As stewards of the Medicaid dollar, we are required to be accountable for investments, but how can we measure integration if we are not sure we’re talking about the same thing?
Another lesson learned is the difficulty of quantifying the impact integration has on patients. For the 2015 investment, clinics chose from existing CCO metrics like SBIRT or Depression screening in addition to things like “provider satisfaction” or changes to workflows that now included the new behavioral health provider. We knew that getting access to these staff would improve the experience of members. And, it would potentially increase the access to primary care clinicians who could now “share the care” and distribute some of their workload to teammate focused on behavioral health. We set out to improve access as a goal but our feedback measurements were not defined effectively enough to quantify how access to these services was changing. Instead, we got back data that often told a better story about a clinic’s ability to track data in general rather than demonstrating access to behavioral health services.
Improvements for 2016
During the last year, collective understanding of integrated behavioral health advanced significantly for CareOregon and statewide. Thanks, in part, to the expertise in the Integrated Behavioral Health Alliance of Oregon (IBHAO) group from CCOOregon, integrated care was promoted for consideration with a more defined role in the Patient-Centered Primary Care Home (PCPCH) program. Using the new consensus, we created a payment model for 2016 that promotes these clinical standards for integration within primary care practices. With the continued goal of measuring access to these services, together we became more specific in 2016 for the information clinics track and report.
Rather than let clinics choose from a variety of options for all metrics, clinics were simply asked
- How many of our members come in each month and also connect with the integrated behavioral health services?
- How available are clinicians to deliver the service same-day, at the point of care when the need is identified?
- Identify and report on one sub-population in their clinic that might benefit from behavioral health services.
Collectively, we worked to support a set of shared metrics across payers so that clinics might be able to count and report all of these things along with the many other healthcare metrics (Cross your fingers!)
Considerations for other communities
For communities seeking to establish behavioral health integration metrics for primary care, as much as possible:
- Define the activity you are trying to promote and support based on the needs of the population you are serving.
- When creating metrics for new work, be diligent in defining the numerators and denominators with the knowledge that many EMRs are not built to track some of the things you might want to know.
- Don’t underestimate the amount of questions you are going to get regarding billing and sustainability of behavioral health services in primary care.
- When confusion and ambiguity reign, don’t forget to have fun while completing your continuous quality improvement loops!
Andrew Huff, LPC is a Behavioral Health Innovation Specialist for the CareOregon Metro region, is a Licensed Professional Counselor (LPC) who works as part of a diverse practice coaching team dedicated to advancing primary care medical home services for CareOregon members. For the last year and half he has been participating in various aspects of integrating behavioral health services into primary care including payment, one-on-one clinic coaching and also leading community collaboratives focused on behavioral health integration. Prior to CareOregon, Andrew worked at Multnomah County’s Mental Health and Addiction Services Division. Andrew performed several functions during his tenure there, beginning by doing outreach for the mental health insurance to hospital psychiatric units to help people get back on their feet and connect to services following their hospitalization. Andrew also acted as a central resource to community partners in helping them to navigate services for their adult clients. Prior to his work for insurance, Andrew worked in the criminal justice system for the mental health court program. He started his career in community mental health working with chronically homeless, severely mentally ill adults in several residential settings in both Washington and Multnomah Counties.