Finding the heart in health reform: What is your role?

A conversation with colleagues held at the Maryland Addiction Directors’ 2014 Annual Conference, Annapolis, Maryland

Johanna Ferman, M.D.Principal withIntegrus Health Group &Moran & Associates

It is suggested that you view these sides in two modes for different purposes:

In “edit mode” to read the accompanying notes and have a better sense of the discussion

In “play mode” to be able to view the ”Word Salad” Video shown at the beginning, developed to capture the experience of working in the field during this period. When in play mode, click the video icon twice and it will open up.

Word Salad Video

Video developed by Kevin PardoSunnyvale, California

Click onto ‘Word Salad when in ‘PLAY’ Mode to view video

This was developed to share the experience of most of us during this periodof rapid change with a bombardment of new concepts and demands

A Conversation in four parts:

I. By way of introductionII. The vision and wisdom in health reformIII. Pillars of Support and SustenanceIV. A Change Process

Pay for Performance (P4P) Infrastructure:

HR, Quality Improvement, IT, Space, and Training

IMPACT ON PRACTICE AND SYSTEM LEVELS(Models of Care Delivery)

Specialty care,Including BH withParity Community and

resources including employment, housing &‘connectivity’

Hospitals, Nursing homes, Rehab

Triple AIM: Cross Silo 3 Dimensional MeasuresQUALTY OUTCOMES, COST AND EXPERIENCE OF CARE

Whole-person centered Care

Part II

6

Cycle ofUntreated behavioral illness,

Disability& Poverty

Out of home

placementSocial Emotional

Developmental Delays

UntreatedAddiction & mental

Illness (Behavioral illness)

Disruption of familyas “developmental”

EnvironmentRepeated Trauma

Soc/Emotional Difficulties

Depression,

Aggression

Early Pregnancy

CMH

Learning Disabilities

School failure – Drop out

Gang Activity

Use of alcohol/drugs to

medicate underlying problems

“In utero” exposure to alcohol and drugs –

multiple sequelae

Part II

7

Mental HealthAddictions Primary Care

Chronic, complex conditions and costs

Acute and crisis ‘system’ overloadTransinstitutional shifts into homelessness and justice systemDemoralization

Reimbursement for volume and procedures Infrastructure: HR, IT, telecomm, space planning, training, quality assurance

Silos: Creation of the ‘revolving door’ Part II

Pillars of Support and SustenancePillars of Support and Sustenance

WHOLE-PERSONCENTERED CARE

PAY-FOR-PERFORMANCE (P4P)

TRIPLE AIM – CROSS-SILO 3 DIMENSIONAL MEASURES

INTEGRATED DESIGN, FLOW & INFO USE with IT TO SUPPORT

INFRASTRUCTURE HUMAN RESOURCES

QUALITYIMPROVEMENT TELECOM

SPACEWITH RAPID CYCLE FEEDBACK

TRAINING

Part III

BEHAVIORAL HEALTH 2nd floor

PRIMARY CARE

1st Floor

Integrated Primary Care team (IPC)

Referrals

IMPROVED HEALTH AND BEHAVIORAL

HEALTH OUTCOMES

Joint conferencing -- evolution of sub

specialty workforce

Health guide outreach

Ancillary Services

Consumer& Family Advisory

Panel

Johanna Ferman, M.D.Director Behavioral Health AmCareContra Costa County DHS

Integrating Primary Care into Behavioral Health: VISUAL MAPPING

FQHC and MHFunding streamsand same dayservices

Part III

INITIAL VISIT W/INTEGRATED TEAM

Annual H & P (Gather data/prior records/ancillary testing)

Second Visit for highest risk health concerns•Partnership Planning-consumer and support system and IPC Team

Urgent Care

Group-Education

Stabilization, reversalof acute or chronic

illness

Referral

Problem list with brief Plan Ancillary testing (labs, EKG, etc.) Conference (multi-disciplinary; reconciliation and integration of data)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

TRUSTFormation of relationship as health partners

Return visits PRN

Eventual movement to Health Center for follow-up

Initiation of data base through existing IT

Johanna Ferman, M.D.Director Behavioral Health AmCareContra Costa County DHS

Flow Chart for Integration into BHPart III

Capturing Critical InformationWhen IT is Siloed

PCMH

SUD NPO

Pharmacy

Functions crossing IT apps• Quality• Practice Transformation• Strict HIPAA compliance • Management incl follow-up• Reimbursement

SeeingMANY

Seeing ONE

Part III

• Information on human relationship AND as well as procedures • Central to recovery and chronic care work

• Careful attention to what information is collected

• Must be conceptualized -- part of design

• A function that an informed and concerned management brings to the table, NOT of the IT system itself

Information on human relationship: A ‘disappearing species’ of data unless protected

Part III

• TRIPLE AIM’s 3 dimensional Performance Measures – quality, cost and experience of care – can be readily accessed and used at all levels

• Interoperability to achieve ‘data fluidity’

• Articulate aspects of care that depend on human relationships

• Access ONE individual health record Access and trend MANY individual records/populations

• Readily available information supports ‘teachable moments’

• Supports entire team in taking ownership

• Readily provides feedback on evidence-based guidelines from people in a dynamic rapidly evolving field

Features of Desirable IT SupportPart III

Part IV

A Change ProcessPart IV

Role of leadership

• valuing & making room for ‘creative time’• moving towards pay-for-performance (P4P)• identifying organization and staff strengths and weaknesses

and building internal expertise• targeting greatest area of need• removing obstacles, support for champions• wise investment in information technology due to planning on

design, flow and info use

Part IV

Role of Champions

• Deep knowledge of evolving field: standard bearers and developers• Passion for innovation – working ‘out of the box’• Desire to build team/s & create skill base for new practice/s • Interdisciplinary

Role of other staff and community partners• Maintenance of effort – keeping the ship moving forward• Continued learning within existing system• Cooperation with change efforts being piloted• Second generation adapters

Brief Summary

Part I: By way of introduction In the midst of barrage, remembering who we are Identifying strengths within the sector to move forward

Part II: Whole Person Care as the central driver, the heart, of health reform

Part III:Pillars of Support and Sustenancespecial reference to design and the use of information

Part IV: A Change Process

Open discussion

Contact information:

Please feel free to contact me on-line orwith a call should you desireclarification on this material or haveany further questions or comments.

Johanna Ferman, M.D.Integrushealth.com (under ‘contact us) orjfermanMD@gmail.com

Cell: 510 789-7270