Behavioral Health – Primary Care Integration Partnerships: Measure Outcomes

February 26, 2011March 5, 2011 ch3 Comments

MEASURING OUTCOMES

The value of shared outcomes
It should be no surprise to either behavioral health nor primary care partner that measuring outcomes is important. Each organization has a number of metrics that are tracked routinely. Measuring outcomes of the integrated partnership are just as important. These outcomes should be jointly agreed upon early in the project. Periodic re-evaluation of the outcomes is beneficial to assuring that they remain relevant to each partner. Be prepared to modify as needed.

Identifying outcomes to be measured and faithfully tracking them provides the necessary data for the organizations’ decision makers. The data serves to demonstrate the effectiveness to others as well as for use in securing additional funding in the future. Outcome measures need not be expensive or overly complicated. The important thing is to be consistent.

Measuring the benefits of the partnership
The integrated behavioral – health primary care partnership is far greater than the sum of its parts. The synergistic effect of the partnership results in enhancing the lives of the individuals served to a degree that cannot be matched by either organization alone. Treating the hypertension of a person who also suffers from schizophrenia has a far greater impact that in treating either of the comorbid disorders separately. Measuring the outcomes clearly demonstrates the value of the partnership and the significant impact on the life of the individuals served. While most healthcare professionals are driven by the day to day intrinsic value of helping, successes identified in objective reports serve as further motivation to dedicated members of the team.

There is a clear benefit in having fewer services that must be duplicated when the behavioral health and the primary care is provided separately. When exams and diagnostic tests are done by one provider, there is considerable cost savings. Tracking these savings will demonstrate the added value of the partnership.

Quality of life and client satisfaction surveys are effective ways of determining the value that is provided through the collaborative approach to treatment.

It is not enough to feel that you are doing a good job when it comes to demonstrating success. Through measuring the value of services provided in an integrated behavioral health – primary care partnership, the value of the partnership can be indicated in undisputable terms.

This is the last in the series of steps for a successful behavioral health – primary care partnership. These eight steps have been adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD, Behavioral Health Management May/June1998. Vol. 18 . No. 3:

behavioral health integration

Behavioral Health – Primary Care Integration Partnerships: The Value of Shared Solutions

January 11, 2011January 20, 2011 ch2 Comments

The next step in the process of developing a successful behavioral health – primary care integrated partnership, is developing shared solutions for the partnership. This is adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD, Behavioral Health Management May/June 1998. Vol. 18 . No. 3.

DEVELOPING SHARED SOLUTIONS

When behavioral health and primary care organizations collaborate to provide integrated services, it is very important to develop shared solutions for success in the endeavor. For a partnership to meet the needs of all partners, the decision-making must be shared. The decision makers must be open to new ideas and problem solving.

One of the most difficult tasks in a partnership is bringing two disparate organizations together, asking them to compromise for the good of the relationship. All stakeholders traditionally are in favor of creating a shared solution…..as long as they aren’t the ones who are asked to make the change. This step requires taking the time to explore the areas in which the partners can make adjustments versus the areas that require strict adherence to the regulations of the organization.

This step in the partnership requires time to come to an agreement. Negotiations may take some time, but are worth the investment. Everyone must have skin in the game. During the process of negotiating, the ideal end result will develop from compromise among all partners. Patience and understanding are vital at this point and will ultimately result in a shared solution if the partnership is viable. Shared solutions maximize organizational efficiency and capacity. It helps to avoid the “blame game”.

Healthy partnerships result from both give and take on the part of all partners. Compromise is important for the success of the partnership. Partners have much more invested in the successful outcome when there is agreement on the ultimate mission.

behavioral health integration

Reducing Health Disparities Among People with Serious Mental Illness

August 15, 2010October 17, 2012 ch3 Comments

“Psychiatrists need to pay attention to weight, lipid levels, blood pressure, and exercise in our patients with serious mental illness,” declares psychiatrist Dale Svendsen, M.D., medical director at the Ohio Department of Mental Health and co-author of the NASMHPD report. “The psychiatrist of the future is going to have to be more of a general physician than in the past, and our training programs are going to need to adapt.” In Those With Serious Mental Illness Suffer From Lack of Integrated Care, in Psychiatric News January 5, 2007, Vou. 42, No. 1, Pg. 5 Mark Moran summarizes the National Association of State Mental Health Program Directors (NASMHPD) report “Morbidity and Mortality in People With Serious Mental Illness.” Emphasizing the recommendation that people with serious mental illness “be designated as a distinct health-disparities population under the federal government’s initiative to reduce disparities in health outcomes.” Perhaps psychiatrists need to pick the stethoscope back up again…. and actually touch their patients.

Moran goes on to look at compelling data: In a study of people (25 to 44 years old) with serious mental illness in Massachusetts over a six year period, the cardiovascular rate was nearly seven times that of the general population. In another study in Ohio, state psychiatric hospital discharges were tracked over a six year period. People who had been hospitalized there died at three times the expected rate, primarily due to cardiovascular disease. The average loss of life was a startling 32 years. The NASMHPD report drew clear connections between antipsychotic medications in the development of metabolic syndrome in people with serious mental illness, particularly when multiple medications are prescribed. Their recommendations include integration of behavioral health and physical health, promotion of the recovery model, supporting wellness, and the implementation of care-coordination models.

In the nearly four years since this was published, there has been a marked increased in focus on the serious health disparities of this vulnerable population. The question remains whether there has been an improvement in overall health among this group. While ongoing studies must be conducted to adequately address this question, I am encouraged by the concentration on the issue. The National Council for Community Behavioral Healthcare, the Mental Health Corporation of America, Association of Healthcare Research and Quality, the Carter Center, the Collaborative Family Healthcare Association, National Institute of Mental Health, Substance Abuse and Mental Health Services Admistration, National Association of State Mental Health Program Directors, Institute for Clinical Systems Improvement, Collaborative Care Research Network, Health Resources and Services Administration, and a variety of other national and state associations have initiatives directed toward integration efforts. These efforts include new programs, partnerships, grants, learning collaboratives, and research. APS Healthcare of Georgia’s Disease Management division is working on an initiative with various community behavioral health organizations to create a ‘Virtual’ Medical Home. This novel approach is led by Dr. Bob Climko, Senior Medical Director. Health indicators in people with serious mental illness are monitored through telephonic health coaching and Medicaid claims data made available to providers.

It is hopeful that this increased focus will result in a significant increase in longevity for people with serious mental illness. In the words of UN Secretary General Ban Ki-moon, “Let us recognize that there can be no health without mental health.” It would appear that the reverse is true as well: There can be no mental health without health.