Webinar Available to View: Collaborative Care for Depression

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.

Commonwealth Fund Report Highlights NYC Health + Hospital Transformation Activities

In a recent report, “An Emerging Approach to Payment Reform: All-Payer Global Budgets for Large Safety-Net Hospital Systems,” the Commonwealth Fund defines all-payer global budgets and details three primary steps to implementing them in large safety-net hospitals: a vision for transformation, an operational strategy, and an environment conducive to success.

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.

Click here to read the full report.

Webinar Series: Co-Location of Primary Care and Behavioral Health Services

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.

Click here to view the slides, or watch the recording below:

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.

Click here to view the slides, or watch the recording below:

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.

Click here to view the slides, or watch the recording below.

In addition to the webinar, click here to download an accompanying handout – Revenue Cycle Changes Checklist

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:

New York State SBIRT Resources Available to OneCity Health Partners

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;
  • gauging readiness;
  • and developing individualized project management tools such as project timelines & work plans.

To request OASAS SBIRT technical assistance and/or training, email SBIRTNY@oasas.ny.gov

New in NEJM Catalyst: OneCity Health Article on the link Between Coverage Expansion and Delivery System Reform

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.

Click here to read the full article.

* 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

OneCity Health Program Awarded Top National Quality Honor for Targeting Depression

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.

A poster on OneCity Health’s collaborative care program was displayed at a session at America’s Essential Hospitals VITAL2017 Conference. Integrating behavioral health and primary care is an important OneCity Health initiative, and the collaborative care program demonstrates the positive impact on patients’ health

“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.”

Congratulations to the OneCity Health Collaborative Care Team for earning a 2017 Gage Award for Innovation and Excellence from America’s Essential Hospitals

“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:

Webinar Available to View: Regulatory Options for Co-location of Primary Care and Behavioral Health

Our recent webinar “Navigating the Regulatory Options for Co-location of Primary Care and Behavioral Health” is now available to view below.

Consultants from Grassi & Co., which are currently working with 10 pilot sites in the OneCity Health network to plan for co-location, led the webinar and covered the various regulatory options for co-locating primary care and behavioral health. Options include waivers, integrated license, extension license or co-location with a partner organization. They discussed the advantages and disadvantages for each regulatory option, and shared their experiences and lessons from the pilot project.

We recommend Article 31 and/or Article 28 clinics interested in co-locating primary care and behavioral health review the webinar, and email our support desk with any questions (ochsupportdesk@nychhc.org) with the subject line “PCBH Integration Question”.

To further assist Article 31 and/or Article 28 clinics with integration, please download and review the following materials:

  • Needs Assessment Materials: A needs assessment will enable an organization to better understand the potential unmet demand for co-located services, and to estimate the percentage of patients with those needs who would be likely to engage the service – Click here

  • Regulatory Option Decision Tree for Article 28 Clinics to Co-locate Mental Health (MH) Services – Click here

  • Regulatory Option Decision Tree for Article 28 and/or 31 Clinics to Co-locate Substance Use Disorder (SUD) Services – Click here

  • Regulatory Option Decision Tree for Article 31 Clinics to Co-locate Primary Care (PC) Services – Click here

  • DSRIP 3.a.i Waiver Application Steps – Click here

  • Steps for applying for an Integrated Outpatient Services (IOS) License – Click here

  • Telehealth Guidance to Support the Integration of Primary Care and Behavioral Health – Click here

  • PC-BH Co-location IT Assessment Template – Click here

  • DOH Resources for PC-BH Integration – Click here

  • Co-location Implementation Plan Template – Click here

  • Co-location Financial Model Template – A28 Host – Click Here

  • Co-location Financial Model Template – A31 or A32 Host – Click here

Please note, the posted materials and information provide guidance on implementation planning for co-location, but are not intended to replace a health care organization’s independent legal, regulatory, and financial analysis as part of its internal planning activities. In addition, please note that the legal, regulatory, and financial environment is subject to change over time.

Click here to review the webinar slides, or watch it here:

Partner Webinar: Recapping and Enhancing Partner Engagement

Thank you to our partners who attended today’s OneCity Health Partner Webinar: Recapping and Enhancing Partner Engagement

For our partners who were unable to view the webinar, the slides are available to view here.

The recording of the webinar will be embedded here as soon as it is available.

Our partners should keep in mind next steps:

  • As soon as possible, but by May 31, 2017: If our partners have not yet completed DSRIP compliance training, please do so immediately. Background on DSRIP compliance, instructions on how to easily meet this requirement and the attestation form to submit are available on our website
  • As soon as possible: Our partners should invoice for all Phase I metrics that they submitted and are approved
  • By May 15, 2017: Partners need to sign their Comprehensive Schedule B and complete the attestation on the Portal, otherwise they will forfeit participation in Phase II contracting
  • Week of May 15: Keep an eye out for our new Project Participation Opportunity (PPO)
  • May 24, 2017: Register for our webinar on the Co-location of Primary Care and Behavioral Health. Details are in our Events Calendar
  • By June 9, 2017: For our partners implementing Project 11, please complete metrics PM031, PM032 and PE03
  • June 13, 2017: Attend our next monthly OneCity Health Partner Webinar. The webinar will be held from 2 – 3:30 p.m. Details are in our Events Calendar
  • By June 30, 2017: Complete metrics PM007 (Phase II Partner Network & Gap Assessment Survey) and PM016 (NPI Survey) in the OneCity Health Partner Portal. We recommend our partners get started on the Network & Gap Assessment Survey when it becomes available in the Portal next week, leaving time in June to complete the NPI survey
  • If our partners have questions about completing metrics or submitting reports, please contact our support desk

We look forward to continuing to engage with our partners on future webinars.

Partner Webinar: Concluding Phase I, Initiating Phase II

Thank you to our partners who attended today’s OneCity Health Partner Webinar: Concluding Phase I, Initiating Phase II.

For our partners who were unable to view the webinar, the slides are available to view here. In addition to discussing the final Phase I deadlines, we recognized our progress across a number of initiatives. Thank you to all our partners for their efforts to date!

Please also view the webinar here:

As we discussed on the webinar, our partners can view an updated sample Phase II Comprehensive Schedule B here. Our partners should keep in mind next steps:

  • This week: We have begun to distribute Phase II Comprehensive Schedules B. Our partners should inform us if they haven’t received one by March 31. Instructions to sign via DocuSign are here
  • March 20, 2017 was the DSRIP compliance deadline: If our partners haven’t done so yet, they need to satisfy their DSRIP training and compliance requirements. Complete and submit the Attestation form to Kevin Rogan, and contact him with any questions. His contact information is on our website along with instructions to complete compliance training
  • Beginning March 21: NYC Health + Hospitals is hosting panel discussions across the city to address health care rights for immigrants. Visit our Events Calendar for details
  • March 28 and March 29, 2017: New York State behavioral health value-based payment feedback sessions. Details are on our website Events Calendar
  • March 29, 2017: Our partner, SUNY Downstate Medical Center, is hosting a forum on HIV and pre-exposure prophylaxis (PrEP). Click here for details
  • Due March 31, 2017: We’ve been recommending to our primary care partners that they submit an application for the Mental Health Service Corps to support behavioral health integration. The deadline was extended to March 31. Click here for details
  • Due March 31, 2017: Three Phase I Data & Tracking (DT) metrics, and Participation (P) metrics 1 and 3
  • March 31, 2017: Phase I ends. Our partners need to remember to invoice!
  • April 1, 2017: Phase II begins
  • Beginning April 1, 2017: Our partners can now submit their Workforce Impact Survey to the OneCity Health support desk. Deadline is April 20. We posted a Q&A from our Office Hours session to our website; please view it here
  • On April 11, 2017: Attend our next monthly OneCity Health Partner Webinar. The webinar will be held from 2 – 3:30 p.m. Click here for details
  • April 26, 2017: Five Phase I Patient Engagement (PE) metrics are due to OneCity Health
  • April 30, 2017: Four Phase I recurring Operations & Outcomes (OO) metrics are due to OneCity Health
  • If our partners have questions about completing metrics or submitting reports, please contact our support desk

Finally, as we discussed on the webinar, we will continue to update partners on the development of the closed loop referral platform and our program to connect partners to the Regional Health Information Organization (RHIO).

We look forward to continuing to engage with our partners on future webinars.

Agenda for Wednesday’s PAC Meeting

We look forward to seeing our partners at Wednesday’s City-Wide Project Advisory Committee (PAC) meeting at the Brooklyn Public Library.

Here is the agenda for the 3 p.m. meeting:

  • Welcome
  • Networking
  • Follow up from November 2, 2016 PAC Meeting
  • Updates:
    • Status of Project Implementation
    • OneCity Health’s Midpoint Assessment
    • Phase II Contracting
    • Social Service Integration
  • We Need Your Input:
    • Facilitation of Referrals: What are the types of questions that facilitate effective referrals?
    • Performance Management: Request for partners interested in being part of a work group to improve PPS approach to performance monitoring
    • GSI Development: Request for partners to nominate staff for participation in GSI user acceptance testing
    • Understanding the Needs of Primary Care Partners: What technical assistance and support services do these partners need?
  • Upcoming Events and Deadlines

For complete details on the location and travel instructions, please visit our Events Calendar.

As a reminder, PAC meetings are important opportunities for partners to share their experiences with project implementation, provide input into our planning, design and evaluation activities, and get to know fellow OneCity Health partners.

Partner Webinar: Looking Ahead to Phase II

Thank you to our partners who attended today’s OneCity Health Partner Webinar: Looking Ahead to Phase II.

For our partners who were unable to view the webinar, the slides are available to view here.

Please also view the webinar here:

As we discussed on the webinar, our partners can view a sample Phase II Comprehensive Schedule B here, and view the final process metrics and outcome measures here. In addition to reviewing these materials, our partners should keep in mind next steps:

  • Due Tomorrow, February 15, 2017: We’ve been recommending to our primary care partners that they submit an application for the Mental Health Service Corps to support behavioral health integration. The deadline to do so is tomorrow. Click here for details.
  • On March 8, 2017: Attend our next City-Wide Project Advisory Committee (PAC) meeting at the Brooklyn Public Library
  • On March 9, 2017: Call in to “Office Hours” if our partners have questions about the Workforce Impact Survey. The template will be sent out next week
  • On March 14, 2017: Attend our next monthly OneCity Health Partner Webinar. We will share final details regarding Phase II contracts. The webinar will be held from 2 – 3:30 p.m.
  • Due March 20, 2017: Our partners should satisfy their DSRIP training and compliance requirements. Complete and submit the Attestation form to Kevin Rogan, and contact him with questions
  • If colleagues that have been trained in GSI or have accounts on the OneCity Health Partner Portal have left a partner’s organization, our partners should alert our support desk right away so their accounts are deactivated
  • If our partners have questions about completing metrics or submitting reports, please contact our support desk

We look forward to continuing to engage with our partners on future webinars.