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Incentives and Innovations

Incentives and Innovations. Robert Mayer, Senior Advisor, HIT SAMHSA. The Intersection of Behavioral Health and Primary Care. “Health” is a comprehensive term Co-occurring disorders complicate recovery Diabetes rate (Total = 4%, SMI* = 11%)

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Incentives and Innovations

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  1. Incentives and Innovations Robert Mayer, Senior Advisor, HIT SAMHSA

  2. The Intersection ofBehavioral Health and Primary Care • “Health” is a comprehensive term • Co-occurring disorders complicate recovery • Diabetes rate (Total = 4%, SMI* = 11%) • Chronic respiratory disease (Total = 5%, SMI = 13%) • Disproportionate use of medical services • ER visits / 1,000 (Total = 337, SMI = 1,167) • Primary care visits / 1,000 (Total = 128, SMI = 492) • Specialist visits / 1,000 (Total = 1,211, SMI = 6,058) (*SMI = those with Serious Mental Illness) Statistics from JEN Associates, for Medi-Cal FFS, 2007

  3. SAMHSA Tasks: Improve the integration and coordination between behavioral health and primary care Remove barriers to effective information sharing and preserve patient privacy Ensure we are providing effective care Engage patients in their own care

  4. Primary and Behavioral Health Care Integration (PBHCI) Grants • Existing grant with integration focus • Supports technical assistance center • Supplemental one year awards • Funding for EHRs • To existing grantees (up to 56 nationwide) • Funding for health information exchange • To State Designated Entities (3-5 nationwide) • Funding for expanded technical assistance • To existing technical assistance center (NCCBH)

  5. Primary and Behavioral Health Care Integration Grants • Existing grantees • Must install or upgrade EHR to meet meaningful use stage 1 requirements • Must use health information exchange • Must demonstrate • Improved patient health • Use of electronic prescribing • Electronic receipt of lab results • Exchange of a continuity of care document • Participation in regional extension center

  6. Primary and Behavioral Health Care Integration Grants • Technical assistance center grants • Sub-grants for State Designated Entities • Adapt systems to exchange continuity of care record between Primary Care and Behavioral Health providers • Share tools with other health information exchanges • Enhanced technical assistance • Assist in EHR adoption and health information exchange • Assist with workflow redesign, system selection, and policy development

  7. Effective Information Sharing Authorization Authorization must come from patient Authorization must be given by informed patients Authorization must travel with the information Authorization must be reaffirmed Information Information must be available at point of care Information must be secure Information access must be tracked

  8. Effective Information Sharing • Special challenges for behavioral health • 42 CFR Part 2 • Covered entities • SAMHSA FAQs http://www.samhsa.gov/healthprivacy/docs/EHR-FAQs.pdf • Qualified Service Organization (QSO) Agreement • State laws

  9. Effective Care • SAMHSA role (with partner agencies) in meaningful use stage 2 • Quality measures • Alcohol and substance use appraisal for specific patients • Assessment for depression remission at 6 and 12 months • Follow up for children with ADHD • Alcohol screening and follow up plan • Depression screening and follow up plan • Suicide risk assessment • Use of standard screening questions for substance abuse • Use of standard screening questions for trauma • Inclusion of behavioral providers and long term care providers in HIE • Home health consultations (partner with CMS)

  10. Engaging Patients • Innovation supported through Expanded Capacity Grants • Web-based services • Smart device apps • Personal Health Records • Messaging systems • Home-based health monitoring systems • HHS internal work group • Patient outreach and education on privacy

  11. Questions? Contact: Robert Mayer SAMHSA 240-276-2906 robert.mayer@samhsa.hhs.gov

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