America’s Essential Hospitals recently hosted this webinar on collaborative care for depression in the primary care setting.
Led by Jessica Black, MPH, MSW, Program Manager, Collaborative Care and Kathleen Tatem, MPH, Data Analyst, both of OneCity Health, attendees learned how NYC Health + Hospitals developed collaborative care tools to drive operational workflows and quality improvement across multiple sites. As a result, the depression improvement rate at NYC Health + Hospitals increased from 17.7 percent to 58.2 percent.
The full webinar is available to view here:
This past June, NYC Health + Hospitals was awarded the 2017 Gage Award for Innovation and Excellence from America’s Essential Hospitals for implementing collaborative care for depression in the primary care setting. Read more about the award and program here.
Their approach, however, is not one-size fits all, as larger urban hospitals and small rural hospitals face different situations. To help illustrate how global budgeting – an annual expectation for revenue for all inpatient and hospital outpatient care in advance – might be applied in an urban area, the authors focus on some of our transformation activities underway at NYC Health + Hospitals through OneCity Health and the Delivery System Reform Incentive Payment (DSRIP) program.
Our major initiatives, which include primary care improvement, collaborating with community partners, identifying high-need patients and integrating behavioral health and primary care, are examples of how to establish a vision to improve health outcomes and lower costs. Moreover, they demonstrate how to operate when revenue is independent of inpatient volume, which would occur under an all-payer hospital budget.
Whether kids are adjusting to a new grade or a whole a new school, the first few weeks back in school have the potential to be both physically and mentally challenging. However, initiatives from both OneCity Health and NYC Health + Hospitals can help alleviate the stress, keep kids healthy and in school, and ensure they are able to excel.
100 Schools Project Promotes Mental Health
Through the 100 Schools Project – which, we’re proud to share, was recently featured in the New York Times! – Mental Health Coaches are now in place at 43 schools across Manhattan, Brooklyn, Queens and the Bronx. While they don’t work directly with students, these Coaches are training staff to identify the early signs of mental illness and substance abuse, and to promote wellness and prevention in the classroom.
For example, to help students feel more comfortable utilizing community resources, Coaches are training school staff in methods to reduce the stigma around mental health. Teachers are also learning motivational interviewing, which is a counseling technique to better engage students with positive behavior change.
Students aren’t the only focus though. School staff and teachers are also learning self-care practices to reduce classroom turnover and promote professional development.
Launched in September 2016 with a ten-school pilot, OneCity Health and three other New York City-based Performing Provider Systems (PPS) —Community Care of Brooklyn, Bronx Health Access, and Bronx Partners for Healthy Communities—oversee the 100 Schools Project while the Jewish Board of Family and Children’s Services (The Jewish Board) coordinates the initiative and leads the trainings. Participating schools are also learning how to connect students who have emotional, behavioral, or substance-use challenges with top-tier local mental health providers while enabling the students to remain in school.
The project will continue to expand throughout the remainder of 2017, as the Jewish Board has identified the next 58 schools for project implementation.
Visit the Exam Room Prior to the Classroom
From vision and hearings tests to advice on proper eating, a clean bill of health can help kids stay and strive in the classroom. To help, NYC Health + Hospitals offers pediatric and adolescent health services at little or no cost. Click the borough name below for a flyer detailing the locations where families can receive immunizations, physicals and other back-to-school check-ups.
The New York State Department of Health has launched Semester Two of VBP University, which is an online, educational resource created to raise awareness, knowledge and expertise in the move to value-based payment (VBP).
Topic areas in Semester Two include governance, stakeholder engagement, business strategy, finance, and data. The curriculum for Semester Two includes videos on each of the topics as well as detailed guidance documents targeted towards Primary Care Physicians, Behavioral Health Providers, and Community Based Organizations.
Semester Two also includes VBP arrangement fact sheets to serve as a continuation of the arrangements curriculum in Semester One. The fact sheets provide an overview of each of the NYS VBP arrangements, including the types of care included in the arrangement, the method used to define the attributed population for the arrangement, calculation of associated costs under the arrangement, and the quality measures recommended for use in the arrangement.
Throughout August, OneCity Health hosted a series of webinars on the Co-Location of Primary Care and Behavioral Health Services for our ten pilot sites currently planning for co-location. Led by consultants from Grassi & Co., our vendor currently working with our pilot sites, the webinar recordings were posted on this page following each session.
In addition to the webinars posted below, in June we hosted a webinar titled, “Navigating the Regulatory Options for Co-location of Primary Care and Behavioral Health,” which is available to view here.
Webinar Recordings Implementation of Co-Location of Primary Care and Behavioral Health Services
This webinar covered the key components of implementing co-location of primary care and behavioral health, including needs assessment, regulatory requirements, identification of resources needed (e.g. space, staffing, health information technology systems, etc.), care coordination, as well as monitoring implementation.
Measures and Quality Improvement for the Co-Location of Primary Care and Behavioral Health Services
This webinar covered clinical and operational measures recommended for co-location of primary care and behavioral health services and an overview of strategies for quality improvement.
Billing Considerations for Co-Location of Primary Care and Behavioral Health Services
This webinar reviewed information needed for billing and compliance for co-location of primary care and behavioral health services. The information presented is also helpful to information technology stakeholders who need to support billing, revenue cycle and compliance. Please note this information only addressed billing considerations for sites that have chosen the licensure threshold, DSRIP waiver or Integrated Outpatient Services (IOS) license as the regulatory option for co-location at their site.
Screening Tools for Co-location of Primary Care and Behavioral Health Services
This topic was addressed in two separate webinars:
Screening Approaches for Co-location of Primary Care Services in a Behavioral Health Setting
This webinar provided an overview of the use of screening approaches for physical health (e.g. chronic disease, pain, etc.) in the behavioral health setting. It included a discussion of the importance of provider involvement in achieving success of co-location. Click here to view the slides.
Screening Tools for Co-location of Behavioral Health Services in a Primary Care Setting
This webinar provided an overview of the use of screening tools for depression, anxiety as well as alcohol and substance abuse in the primary care setting. It included a discussion of the importance of provider involvement in achieving success of co-location. Click here to view the slides.
Both webinars are available to view in one recording. The presentation begins with a focus on behavioral health screening, and then the discussion on physical health screenings commences at the 31:10 mark. Watch the recording here:
While “moonshot” efforts may be typically used for curing diseases like cancer, transforming care for high-need patients – improving the outcomes of people with multiple, and often interconnected, medical, social and behavioral health needs – would be just as lofty, and no less impactful. But, as Dr. Dave Chokshi, Chief Population Health Officer, OneCity Health, writes in an article published this week by JAMA, the time might be right for a similar bipartisan push towards this health care goal.
Recognize the whole-person needs of complex patients
Build and nurture relationships between patients and care teams
Enhance the usual clinical services provided in primary care, particularly with resources to address behavioral health and social needs
Renew the focus on caregiving
About 12 million adult patients have three or more chronic conditions as well as functional limitations, such as difficulties with self-care, and could benefit from these improvements. Read the full article to learn more about these strategies, and why now may be the right time for bipartisan policy efforts to improve the care we deliver to high-need patients.
The following announcement, from the New York Association of Psychiatric Rehabilitation Services (NYAPRS) and their partners at the Mental Health Empowerment Project (MHEP) and the Alcoholism and Substance Abuse Providers of NYS (ASAPNYS), may be of interest to OneCity Health partners implementing behavioral health initiatives. Please reach out to NYAPRS for more information.
NYAPRS and their partners at MHEP and the ASAPNYS have launched a statewide initiative aimed at educating and encouraging eligible Medicaid members to enroll in Health and Recovery Plans and Health Homes, and to make use of newly available Home and Community Based Services.
Through this program, peer educators are available to come to program and community settings and engage in informal and interactive discussions about the new choices enrollees with more extensive behavioral health conditions can make to raise the bar for what they seek in their lives and from their services.
The project is funded by the Office of Mental Health and has been developed with guidance from OMH, the Office of Alcoholism and Substance Abuse Services, the Department of Health and the NYC Department of Health and Mental Hygiene.
Meetings can occur at local mental health, substance abuse, and medical treatment and rehabilitation agencies and programs, social centers, houses of worship, libraries, shelters and variety of other community settings. Please view this flyer for more details.
The New York State Office of Alcoholism and Substance Abuse Services (OASAS) is offering technical assistance resources and trainings to help our partners implement the Screening, Brief Intervention and Referral to Treatment (SBIRT) program.
Below please find complete details about SBIRT and how to access these resources. Our primary care partners that are Integrating Primary Care with Behavioral Health can report on their participation in any of these trainings through metric PM024 in their Phase 2 Comprehensive Schedule B.
SBIRT Technical Assistance Opportunity
What is SBIRT (Screening, Brief Intervention and Referral to Treatment)?
SBIRT is an evidence-based approach to identifying patients who use alcohol and other drugs at risky levels with the goal of reducing and preventing related health consequences, disease, accidents and injuries. Risky substance use is a health issue and often goes undetected. For more information on SBIRT please visit https://www.oasas.ny.gov/AdMed/sbirt/index.cfm and watch the following video:
What resources are available for SBIRT implementation?
NYS OASAS has a time-limited technical assistance opportunity for hands-on, intensive consultation, guidance, and training to emergency departments, primary care practices, and other health delivery practitioners implementing SBIRT across New York State. Technical assistance supports various stages of implementation and includes:
Advice and guidance on all aspects of readiness and practice implementation using OASAS resources and based on best practices;
education and training on SBIRT;
on-site implementation support, as needed.
NYS OASAS aims to advise individual sites in becoming fully operational and sustainable by:
Identifying barriers to implementation;
identifying strategies to overcome barriers;
assessing current workflows and assisting in reconfiguration;
creating and reviewing process maps;
and developing individualized project management tools such as project timelines & work plans.
Under the Patient Protection and Affordable Care Act (ACA), 32 states expanded Medicaid and millions of individuals gained coverage through health insurance exchanges. Provisions in the Affordable Care Act also supported delivery system reform with a strong focus on proactive, community-based care. For safety net providers such as NYC Health + Hospitals —those that by mission or mandate see all patients, regardless of their ability to pay—these two policy objectives are closely linked. As we describe in an article published yesterday in NEJM Catalyst: progress on delivery system reform is maximized when it stands on the shoulders of coverage expansion.
In their article “Coverage Expansion and Delivery System Reform in the Safety Net: Two Sides of the Same Coin,” the authors* describe how maintaining—and optimally, growing—our insured population is crucial in order to take care of those who are still uninsured, but it also is important for our system’s transformation efforts. For example, they discuss how expanding access to high-quality primary care, with integrated behavioral health services, is a linchpin of delivery system improvement. But hiring more primary care clinicians, launching collaborative care programs, and establishing linkages between hospitals and community health centers all require capital investment which stem from coverage expansions.
However, due to recent political developments, this initial progress is still vulnerable. Further progress will depend on keeping the ACA’s health insurance expansion in place.
* Jeremy P. Ziring, AB, Data Analyst; Kathleen S. Tatem, MPH, Data Analyst; Remle Newton-Dame, MPH, Director of Healthcare Analytics; Jesse Singer, DO, MPH, Assistant Vice President, Care Models and Analytics; and Dave Chokshi, MD, MSc, Chief Population Health Officer, all of OneCity Health
NYC Health + Hospitals has been awarded the 2017 Gage Award for Innovation and Excellence from America’s Essential Hospitals for implementing collaborative care for depression in the primary care setting, a OneCity Health initiative. The Gage Award is the preeminent national recognition for outstanding work at safety-net health systems around the country, and the award earned by NYC Health + Hospitals is its highest in the “Improving Quality” category.
Through its collaborative care program for depression, NYC Health + Hospitals, our largest partner, has significantly increased psychiatric consultations and treatment for depression in primary care, more than tripling the rate of depression improvement among patients enrolled in the program. In 2015, the public health system screened about 225,000 adult primary care patients for depression—more than 90 percent of patients who visited a NYC Health + Hospitals site. Nearly 15,000 of those patients—6.7 percent—screened positive. The program’s key clinical outcome metric focused on the depression improvement rate, which increased from 17.7 percent in the second quarter of 2015 to 57.6 percent in the first quarter of 2016.
“Across NYC Health + Hospitals, we’ve sought to meet patients where they are by coordinating care for medical and behavioral health conditions in a single setting,” said Dr. Dave Chokshi, Chief Population Health Officer, OneCity Health, a subsidiary of NYC Health + Hospitals focused on population health, care management, and implementation of the State’s Delivery System Reform Incentive Payment program.
“We’re honored to receive this award, which recognizes the dedicated work of our frontline staff to identify and manage patients with depression in primary care,” said Dr. Jesse Singer, Assistant Vice President of Care Models and Analytics, OneCity Health.
Depression affects 13 percent of Americans and 20 percent of Medicaid recipients in their lifetimes. However, when mental health specialists are not co-located in the primary care setting, only 10 percent of patients follow-up on a referral to a provider.
The collaborative care program for depression was launched under the New York State Hospital Medical Home Demonstration Project in 2014. NYC Health + Hospitals implemented a two-step process to better identify and treat patients with depression. First, the system began universal depression screening for adults in medical and primary care clinics. Second, patients who screened positive for depression were enrolled in the collaborative care program to receive treatment right in the primary care setting. The system’s goal is to ensure that at least 50 percent of patients enrolled demonstrate clinically significant improvement in depression symptoms.
“To ensure patients are receiving excellent care, we provide training and coaching to staff on the ground in depression screening and evidence-based treatment interventions,” said Jessica Black, MPH, MSW, Collaborative Care Program Manager, OneCity Health, who accepted the award on behalf of the health system at a ceremony in Chicago. “We also generate data to support patient outreach and treatment workflows. A newsletter and monthly webinars serve as vehicles to share best practices, such as the warm handoff amongst collaborative care teams.”
“The collaborative care program has had a significant impact,” said Dr. Michelle Izmirly, Consultant Psychiatrist, NYC Health + Hospitals/Lincoln. “Our new workflows ensure we begin to speak with patients who are depressed, but who have never talked to anyone about it before, thinking their condition was normal or not treatable. Our nurses and social workers ensure follow-up occurs, breaking down barriers that once prevented this type of care.”
To learn more about the collaborative care program, please view the following video:
The following information from the Health Resources & Services Administration is an opportunity for OneCity Health partners to consider submitting a grant application to expand the behavioral health workforce. All questions and requests should be directed towards the Health Resources & Services Administration, as instructed below.
The BHWET Program aims to develop and expand the behavioral health workforce serving populations across the lifespan, including rural and medically underserved areas. The BHWET Program places special emphasis on establishing or expanding meaningful, longitudinal internships or field placement programs in behavioral health that include interprofessional training for students/interns, faculty, and field supervisors to provide quality behavioral health services.
Grant recipients will help close the gap in access to behavioral health care services by establishing partnerships with a broad range of organizations and community partners to ensure a wide recruitment of students, opportunities for field placements, career development, and provide job placement services.
The deadline to submit an application is June 12, 2017.