Behavioral Health Integration; Experiences of RIPCPC and RIBHN 2010 - 2013

1. Behavioral Health Integration;Experiences of RIPCPC and RIBHN2010 - 2013 • A bit on history and background • Development of current model • Demonstration of point-of-care database referral system • Prospects for the future • Questions

2. History of RIPCPC • RIPCPC formed in 1994 as an Independent Practice Association (IPA) with a focus on quality improvement • Originally formed to: • Challenge insurers that were lowering reimbursement • Combat the trend of hospitals buying up community based practices • RIPCPC is the largest IPA in Rhode Island • 140 Primary Care Physicians (began with 40) • Cover over 300,000 Rhode Island Lives • 25% of Rhode Island’s Pediatricians are Members

3. RIPCPC’s Focus on the Patient Centered Medical Home • Principals of the PCMH • Personal physician provides care • Physician directed medical practice • Whole person orientation • Care is coordinated and/or integrated • Enhanced access for patients • Focus on safety & quality improvement • Payment appropriately recognizes the added value provided to patients • Behavior Health’s Integration is Essential to Improving Outcomes!

4. Patient Centered Medical Home Model • PCMH effect: • Care delivered by primary care physicians in a Patient-Centered Medical Home is consistently associated with better outcomes: • Reduced mortality • Fewer hospital admissions • Lower utilization • Improved patient compliance • Lower healthcare spending

5. Collaboration with Specialists/Providers • True patient care coordination can only happen with meaningful & efficient provider collaboration • We can improve outcomes and the effectiveness and efficiency of our care delivery systems by embracing this concept • Our effectiveness and efficiency as clinicians will soon be directly tied to our reimbursement

6. Behavioral Health Committee Focus • Mission Statement: • To improve the health of our patients by facilitating communication and coordination of care between Rhode Island Primary Care doctors and Behavioral Health Professionals in Rhode Island • We have assembled a team of primary care doctors along with our IT professionals and behavioral health professionals and we have created a forum with regular monthly meetings focused on: • Improving access to Behavioral Health Providers • Improving communication between Behavioral Health Providers and PCP’s • Support the IPA by addressing behavioral health’s role in the PCMH, helping satisfy our behavioral health contract components

7. Behavioral Health Committee Initiatives • Evaluate/Revise/Approve BCBSRI policies and procedures stated within the three-way contract between BCBSRI, RIPCPC & Behavioral Health Provider • Both the Co-located & Collaborative Model Agreements • Creation of a comprehensive list of Behavioral Health Providers and facilities for our physicians membership • Listing will be compiled and posted on our website • Refine pilot between the Behavioral Health Providers and PCP’s focused on securely exchanging standardized clinical correspondence • Patient Clinical Summaries / Referrals (from PCP) • Behavioral Health Evaluations (from BHP)

8. Behavioral Health Committee Initiatives • Things to Come (in 2012): • Database to access at point of care to allow for smooth referral of patients to appropriate providers • Collaborative agreements to allow for the majority of our physicians to enter into arrangements that enhance access and improve communication • Network wide ability to use the secure, HIPPA-compliant communication system piloted in 2011.

9. Goals of Behavioral Health Integration • Improve 2-way communication between clinician and the referring PCP • Better access to BH for our patients • Formation of quality metrics that can prove better outcomes with BH • Delivery quality comprehensive coordinated care to our Patients!

10. Behavioral Health Integration • Through collaborative agreements spelling out expectations on both sides, a behavioral health pod within RIPCPC was formed: • Timely response to referral (same day for urgent referrals, 72 hours for routine) with willingness to accept patients • Thorough 2-way communication with detailed referral from PCP, and with regular progress notes for ongoing therapy • Emphasis on electronic communication

11. Point-of-Care Referral Database • A web portal, accessible at the point of care • Allows PCP to appropriately tailor referral to the needs of the individual patient with respect to geography, age, insurance, behavioral or mental health goals and need for comprehensive care. • Can refer to individuals, group practices or facilities • Preferred communication is electronic, but can be via web, fax or phone depending on providers preferences

12. What we accomplished.. • Formalized an affiliate membership between the RIPCPC physicians and behavioral health providers • Established a RIPCPC Behavioral Health Pod • Created a RIPCPC Behavioral Health provider and facility portal • This is a searchable database of BH providers that RIPCPC member physicians can filter by: • Specialty, insurance, city, hours of availability, insurances accepted & population treated • Utilize ‘Direct’ messaging to communicate with BH providers

13. Things to Come • A focus on the collaborative model approach • Strengthen network and build lasting relationships • Assist patients in making better choices and measure those patient outcomes (healthier lifestyle = lowered health care costs) • Improve our communication and access with BH specialists for the benefit of our patients, this will help us better manage our patient population in an ACO/AQC/RISK environment • Successful behavioral health integration is vital to containing costs!