IBHP Grantee ConvocationSacramento, CA
September 12, 2008
Frank deGruy
Integrated Combining dissimilar things into a coherent
whole that has meaning and value
Behavioral Health Mental disorders Substance use problems Health behavior change
Mental Health Services Research NIMH AHRQ RWJ MacArthur
Substance Use and Criminality Quality Improvement Clinical Decisionmaking and EBM PBRNs
Basic Design Issues Efficacy to effectiveness
Heterogeneous study samples Usual Care control groups Multilevel interventions Multilevel and mixed methods evaluations
Stepped Care Multistep interventions
QI “Research” PBRN methods
Economic analyses Direct and Indirect Costs Cost Offset Cost Effectiveness Cost Benefit
Chronic Disease Management Registry Self management Care manager Care protocol Objective outcome measurement
Prevalence and nature of the problems Depression & impairment, then the others Comorbidity Adequacy of treatment Health behavior change
Nature of primary care practices Patients are reluctant to fragment care Practices are overwhelmed: competing
demands Systemic nature of practice Easier to change than to sustain
Nature of the partners Strange environment, different assumptions Different work styles Not used well Teamwork: new layer of overhead
Nature of supporting systems Commodification of clinicians and practices Carveouts More difficult to change Different priorities, incentives (incentives!)
What is it? Probable defining context Behavioral/mental health integration at
risk for marginalization Mandate for MH resources to serve
multiple purposes Learn DM, Asthma, CAD literature Comorbidity
System Issues Carveouts Reimbursement rules & productivity
incentives Benefits design
How to deal with carveouts Who pays for care managers? Specialty
consultants? Who “owns” them? Where do they live?
Pilot Mentality Running assessment Midcourse corrections Emphasis on teamwork Vertical Integration