RWJF LPHI Kick-Off Meeting- July 29-30.2008 (New Orleans) 1 Greater New Orleans Collaborative to...

RWJF LPHI Kick-Off Meeting- July 29-30.2008 (New Orleans)

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Greater New Orleans Greater New Orleans Collaborative to Improve Collaborative to Improve

Behavioral Healthcare Access Behavioral Healthcare Access (C-IBHA)(C-IBHA)

with support from the Robert Wood Johnson with support from the Robert Wood Johnson FoundationFoundation

Harold Alan Pincus, MDHarold Alan Pincus, MDVice Chairman, Department of PsychiatryVice Chairman, Department of Psychiatry

Columbia UniversityColumbia UniversityDirector of Quality and Outcomes ResearchDirector of Quality and Outcomes Research

New York-Presbyterian HospitalNew York-Presbyterian HospitalSenior ScientistSenior Scientist

RAND CorporationRAND Corporation


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Overall Plan (1)Overall Plan (1)

• Introduction- Harold PincusIntroduction- Harold Pincus• Clinical/Provider- Steven ColeClinical/Provider- Steven Cole• Practice- Amy KilbournePractice- Amy Kilbourne• Improvement Process- Karen Scott Improvement Process- Karen Scott

CollinsCollins• Patient Self-Management- Jeanie Patient Self-Management- Jeanie

Knox-HoutsingerKnox-Houtsinger


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Overall Plan (2)Overall Plan (2)

• PlenariesPlenaries

• BreakoutsBreakouts

• In-BetweenIn-Between

• AfterAfter


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Why Behavioral Health and Why Behavioral Health and General Health Care?General Health Care?

• DepressionDepression

• Preventive / chronic illness care Preventive / chronic illness care for people with Severe Mental for people with Severe Mental IllnessIllness

• Disaster responseDisaster response


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Why Depression?Why Depression?

• PrevalentPrevalent

• Significant personal, social and economic Significant personal, social and economic impactimpact

• Strong clinical science baseStrong clinical science base

• Strong evidence on care improvement Strong evidence on care improvement interventions interventions

• Depression as a chronic diseaseDepression as a chronic disease• Large gap between evidence and actionLarge gap between evidence and action


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2020 World Health Organization 2020 World Health Organization Burden of Disease (DALYs)Burden of Disease (DALYs)

1.1. Ischaemic heart diseaseIschaemic heart disease2.2. Unipolar major depressionUnipolar major depression3.3. Road traffic injuriesRoad traffic injuries4.4. Cerebrovascular diseaseCerebrovascular disease5.5. Chronic obstructive pulmonary diseaseChronic obstructive pulmonary disease6.6. Lower respiratory infectionsLower respiratory infections7.7. TuberculosisTuberculosis8.8. WarWar9.9. Diarrhoeal diseasesDiarrhoeal diseases10.10. HIVHIV

DALY = Disability-adjusted life yearDALY = Disability-adjusted life year Source: WHO, Evidence, Information and Policy, 2000Source: WHO, Evidence, Information and Policy, 2000


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Leading Causes of Years of Life Leading Causes of Years of Life Lived with Disability (YLD) in 15- to Lived with Disability (YLD) in 15- to

44-Year-Olds44-Year-Olds (WHO, Mental Health: New Understanding, New Hope, 2001)(WHO, Mental Health: New Understanding, New Hope, 2001)

% total% total

11 Unipolar depressive disordersUnipolar depressive disorders 16.416.4

22 Alcohol use disordersAlcohol use disorders 5.55.5

33 SchizophreniaSchizophrenia 4.94.9

44 Iron-deficiency anemiaIron-deficiency anemia 4.94.9

55 Bipolar affective disorderBipolar affective disorder 4.74.7


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Why Depression?Why Depression?

• PrevalentPrevalent

• Significant personal, social and economic Significant personal, social and economic impactimpact

• Strong clinical science baseStrong clinical science base

• Strong evidence on care improvement Strong evidence on care improvement interventions interventions

• Depression as a chronic diseaseDepression as a chronic disease• Large gap between evidence and actionLarge gap between evidence and action


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The State of Health Care Quality The State of Health Care Quality 20062006, NCQA, NCQA

There are, however, disturbing There are, however, disturbing exceptions to this pattern of [overall exceptions to this pattern of [overall health care quality] improvement. The health care quality] improvement. The quality of care for Americans with mental quality of care for Americans with mental health problems remains as poor today health problems remains as poor today as it was several years ago. Patients on as it was several years ago. Patients on antidepressant medication are about as antidepressant medication are about as likely to receive appropriate care today likely to receive appropriate care today as they were in 1999.as they were in 1999.

www.ncqa.orgwww.ncqa.org


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Antidepressant Medication Antidepressant Medication Management: The Case for Management: The Case for

ImprovementImprovement


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Antidepressant Medication Antidepressant Medication Management: The Case for Management: The Case for

ImprovementImprovement (cont’d.)(cont’d.)


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Antidepressant Medication Management: Antidepressant Medication Management: The Case for ImprovementThe Case for Improvement (cont’d.)(cont’d.)


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Prevalence of Major Depression Prevalence of Major Depression in Patients with Physical Illnessesin Patients with Physical Illnesses

0% 10% 20% 30% 40% 50%

General General populationpopulationMyocardial infarctionMyocardial infarction

DiabetesDiabetes

HypertensionHypertension

EpilepsyEpilepsy

StrokeStroke

CancerCancer

HIV/AIDSHIV/AIDS

TuberculosisTuberculosis

WHO, 2003.

Up to 10%

Up to 22%

Up to 27%

Up to 29%

Up to 30%

Up to 31%

Up to 33%

Up to 44%

Up to 46%


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Comorbidities Among Comorbidities Among Depressed PatientsDepressed Patients

ComorbidityComorbidity % of Depressed Patients % of Depressed Patients with Comorbiditywith Comorbidity

ArthritisArthritis 48.1%48.1%

Heartburn / Acid RefluxHeartburn / Acid Reflux 42.1%42.1%

HypertensionHypertension 34.7%34.7%

High CholesterolHigh Cholesterol 29.7%29.7%

MigrainesMigraines 23.5%23.5%

Bowel ProblemsBowel Problems 20.1%20.1%

AsthmaAsthma 15.2%15.2%

DiabetesDiabetes 14.9%14.9%

Skin ProblemsSkin Problems 13.7%13.7%

Menstrual ProblemsMenstrual Problems 9.3%9.3%

Source: http://www.medstat.com/healthcare/depression4.asp


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General Medical Comorbidity General Medical Comorbidity in in severe mental illnesssevere mental illness

• Diabetes: 20%Diabetes: 20%• Cardiovascular disease: HBP 34%, Cardiovascular disease: HBP 34%,

Heart 15.6%Heart 15.6%• Weight gain and obesity (2x)Weight gain and obesity (2x)• Smoking (2x)Smoking (2x)• Other: breast cancer (9.5x), HIV (8x), Other: breast cancer (9.5x), HIV (8x),

Hepatitis B (5x) and C (10x)Hepatitis B (5x) and C (10x)• Reduced life spanReduced life span


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Mental-Health Challenge Emerges As Victims Face Multiple Traumas

BATON ROUGE, La. –

“…Post-traumatic stress disorder, depression and anxiety are common after major disasters, mental-health experts say, because disasters frighten people and disrupt their lives. But Hurricane Katrina poses special challenges…”

“…The hurricane’s upheaval also has exacerbated the symptoms of some people who suffer from developmental disabilities and mental illnesses such as schizophrenia…”


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Why Not? (Barriers)Why Not? (Barriers)• HistoricalHistorical• ConceptualConceptual• Patients / ConsumersPatients / Consumers• ProvidersProviders• Practices / Delivery SystemsPractices / Delivery Systems• Plans – Managed Care Organizations (MCO)/ Plans – Managed Care Organizations (MCO)/

Managed Behavioral Health Organizations Managed Behavioral Health Organizations (MBHO)(MBHO)

• Purchasers – Public / PrivatePurchasers – Public / Private• Population / CommunityPopulation / Community


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What’s Unique about Behavioral What’s Unique about Behavioral Health?Health?

• Mind-body dualismMind-body dualism

• StigmaStigma

• Role of the stateRole of the state

• Legal / regulatory distinctions (e.g., privacy, Legal / regulatory distinctions (e.g., privacy, competency)competency)

• Multiple complex systems intrinsically Multiple complex systems intrinsically involved (e.g., social services, criminal involved (e.g., social services, criminal justice, education, consumer-directed, etc.)justice, education, consumer-directed, etc.)

• Different diagnostic systemsDifferent diagnostic systems


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What’s Unique about Behavioral What’s Unique about Behavioral Health?Health?

(continued)(continued)

• Separate delivery systemsSeparate delivery systems• More heterogeneous work force / greater More heterogeneous work force / greater

solo practicesolo practice• Few proceduresFew procedures• Separate financing systems / different market Separate financing systems / different market

structurestructure• Less developed quality improvement / Less developed quality improvement /

performance measuresperformance measures• Less linkage to IT innovationsLess linkage to IT innovations


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Conceptual Issues:Conceptual Issues:Primary Care vs. Mental Health SpecialtiesPrimary Care vs. Mental Health Specialties

• Different perspectivesDifferent perspectives– Definitions / clinical measures (i.e., no lab tests)Definitions / clinical measures (i.e., no lab tests)– Majority of literature comes from specialty (and often Majority of literature comes from specialty (and often

tertiary) care settingstertiary) care settings– Diagnostic systems such as DSM-IV often seen as too Diagnostic systems such as DSM-IV often seen as too

complex and specialty-focusedcomplex and specialty-focused– But DSM PC unsuccessful?But DSM PC unsuccessful?

• Linkages between and among various Linkages between and among various systems (SUD, social services, schools, systems (SUD, social services, schools, consumer, directed, etc.)consumer, directed, etc.)


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Provider BarriersProvider Barriers

• TimeTime

• InterestInterest

• Tools: DSM-PC, PHQ-9Tools: DSM-PC, PHQ-9

• TrainingTraining


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• Organization does not enhance patient-Organization does not enhance patient-provider interactions & promote successful provider interactions & promote successful outcomesoutcomes

• WhoWho is responsible for care? is responsible for care?– Limited communication and teamwork between Limited communication and teamwork between

primary care and mental health specialtiesprimary care and mental health specialties

• HowHow should care be provided? should care be provided?– Consultative? Collaborative? Integrated?Consultative? Collaborative? Integrated?

• WhenWhen should care be provided? should care be provided?– Lack of longitudinal focusLack of longitudinal focus

Practices / Delivery System Practices / Delivery System IssuesIssues


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Policy (Public and Private)Policy (Public and Private)

• Depression not on radarDepression not on radar

• Stigma, bias, misinformationStigma, bias, misinformation

• Fragmentation encouragedFragmentation encouraged

• Quality not a factorQuality not a factor

• Change is coming fastChange is coming fast


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Who? Responsibility for CareWho? Responsibility for Care

PCP

BHS


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Referral

Consultative Care

Collaborative Care

Integrated Team

Independent

Autonomous (PCP)

Autonomous (MHS)

How?How?


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When?When?

Risk Factor Risk Factor Identification/Identification/

PreventionPrevention

Diagnosis/Diagnosis/

AssessmentAssessment

Short-termShort-term

ManagementManagement

Continuing Continuing CareCare


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How? StrategiesHow? Strategies

• Chronic (Planned) Care ModelChronic (Planned) Care Model• The Robert Wood Johnson The Robert Wood Johnson

Foundation’s national program on Foundation’s national program on Depression in Primary Care: Linking Depression in Primary Care: Linking Clinical Systems and StrategiesClinical Systems and Strategies

• Models of linkage/integrationModels of linkage/integration• Institute of Medicine / Crossing the Institute of Medicine / Crossing the

Quality ChasmQuality Chasm


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Evidence-Based Chronic (Planned) Care Evidence-Based Chronic (Planned) Care Approaches for Treating Depression Approaches for Treating Depression

Are EffectiveAre Effective

Prepared, ProactivePractice Team

Informed, Empowered Patient and Family

Productive InteractionsPatient-Centered Coordinated

Timely and Evidence- Efficient Based and Safe

Improved Outcomes

DeliverySystemDesign

Decision Support

ClinicalInformation

Systems

Self-Management

Support

Health SystemCommunity

Health Care OrganizationResources and Policies


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Chronic Disease Clinical Chronic Disease Clinical ModelsModels

• Hypertension Hypertension • Congestive heart failure (CHF) / Coronary Congestive heart failure (CHF) / Coronary

artery disease (CAD)artery disease (CAD)• StrokeStroke• COPD (Chronic Obstructive Pulmonary COPD (Chronic Obstructive Pulmonary

Disease)Disease)• DM (Disease Management)DM (Disease Management)• AsthmaAsthma• Multiple comorbiditiesMultiple comorbidities• Transitional care managementTransitional care management


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Depression Clinical ModelsDepression Clinical Models• Chronic (planned) care model – WagnerChronic (planned) care model – Wagner• Collaborative care – KatonCollaborative care – Katon• Partners in Care (AHRQ) – WellsPartners in Care (AHRQ) – Wells• PROSPECT – Alexopoulous, Katz, ReynoldsPROSPECT – Alexopoulous, Katz, Reynolds• Telephone care management – Simon, HunkelerTelephone care management – Simon, Hunkeler• IMPACT (Hartford) – UnutzerIMPACT (Hartford) – Unutzer• RESPECT (MacArthur) – DietrichRESPECT (MacArthur) – Dietrich• Quality Improvement for Depression (NIMH) – Rost, Quality Improvement for Depression (NIMH) – Rost,

Ford, RubensteinFord, Rubenstein• Child models – Campo, Asarnow, GLAD-PCChild models – Campo, Asarnow, GLAD-PC• Other models for anxiety/PTSDOther models for anxiety/PTSD


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A national program supported by The Robert Wood Johnson Foundation

www.depressioninprimarycare.org

The Robert Wood Johnson FoundationConstance Pechura, PhD, Senior Program Officer

Clinical Model TeamBruce L. Rollman, MD, MPHBea Herbeck Belnap, PhD Amy M. Kilbourne, PhDHerbert C. Schulberg, PhD

Economic TeamRichard Frank, PhDHaiden Huskamp, PhDTom McGuire, PhDColleen Barry, MPP

Evaluation TeamDaniel E. Ford, MD, MPHLisa A. Cooper, MD, MPHGail L. Daumit, MD, MHSMichael J. Kaminsky, MD, MBADarrel Gaskin, PhDLaura L. Morlock, PhDAlan Langlieb, MD

National Advisory CommitteeFrank deGruy, MD, Chair

National Program OfficeHarold Pincus, MD, DirectorJeanie Knox Houtsinger, BA, Deputy DirectorGail Wrobleski, Administrative SpecialistSusanne Salem-Schatz, ScD, Quality Improvement Consultant John Bachman, PhD, Communications ConsultantDonna Keyser, PhD, Communications Consultant


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““6 P” Conceptual Framework6 P” Conceptual FrameworkPatient /Consumer

Practice /Delivery Systems

Purchasers (Public / Private)

• Enhance self-management / participation• Link with community resources• Evaluate preferences and change behaviors

• Improve knowledge / skills• Provide decision support• Link to specialty expertise and change behaviors

• Establish chronic care model and reorganize practice• Link with improved information systems• Adapt to varying organizational contexts

• Enhance monitoring capacity for quality / outliers• Develop provider / system incentives• Link with improved information systems

• Educate regarding importance / impact of depression • Develop plan incentives / monitoring capacity• Use quality / value measures in purchasing decisions

Populations and Policies

• Engage community stakeholders; adapt models to local needs• Develop community capacities• Increase demand for quality care enhance policy advocacy

Providers

Plans


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Incentives DemonstrationIncentives Demonstration

• Partnerships of health plans (Health Management Organizations [HMO] and Managed Behavioral Health [MBHOs]) and practice groups (and purchasers)

• 8 sites• Commercial, Medicaid• Implementation of:

– Clinical Model– Economic Model


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Clinical Model: Major ComponentsClinical Model: Major ComponentsLeadershipLeadership Accountability Accountability

Vision Vision

ResourcesResources

Practice designPractice design Patient registryPatient registry

ProtocolsProtocols

Care managerCare manager

Clinical Clinical information information systemssystems

Red flagsRed flags

Feedback to provider on clinical progressFeedback to provider on clinical progress

Support care managerSupport care manager

Decision supportDecision support GuidelinesGuidelines

Provider trainingProvider training

Expert / specialist consultationExpert / specialist consultation

Referral pathwaysReferral pathways

Self management Self management supportsupport

Patient preferences, cultural competencyPatient preferences, cultural competency

Information on depression, medications, skillsInformation on depression, medications, skills

Community Community resourcesresources

Information on and for consumer groups and other servicesInformation on and for consumer groups and other services

Access to non-provider sources of careAccess to non-provider sources of care


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LeadershipLeadership

A Clinical Framework for Depression Treatment in Primary CareA Clinical Framework for Depression Treatment in Primary Care; ; Psychiatric Annals 32:9; September 2002Psychiatric Annals 32:9; September 2002

Component Key Principles Description

Leadership There must be a leadership team composed of organizational partners with overall program accountability for implementation across partnering organizations

A team of primary care, mental health, and senior administrative personnel that:

• Garners resources (personnel, space, financial)

• Incorporates and coordinates stakeholder interests

• Promotes adherence to treatment guidelines and protocols

• Sets target goals for key process measures and outcomes

• Encourages efforts at continuous quality improvement


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Delivery System DesignDelivery System Design



Delivery System Design

The delivery system is available to implement all aspects of decision support. It consists of:•Access to guidelines and protocols•A depression patient registry•A care manager responsible for implementing coordinated care in conjunction with primary care providers and, when necessary, mental health specialists•A systematized approach to obtaining access to mental health specialists for referral, consultation, and feedback

1) Care manager, either on or off site, implements protocols for:

• Systematically identification of patients at elevated risk for depression

• Screening of patients at elevated risk for major depression using a structured assessment tool

• Stratification of treatment intensity by episode severity and patient preference

• Monitoring and promotion of adherence to guideline-based treatment(s) for depression

• Routing follow-up at intervals specific to a patient’s phase of depression treatment (acute, continuation, or maintenance)

2) Structure is in place to ensure facilitated access to mental health specialists


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Clinical Information SystemClinical Information System



Clinical Information System

The clinical information system consists of tools to facilitate the roles of the primary care providers and care managers

Note: The clinical information system does not necessarily need to be interactive with other computer systems

• Enables the primary care physician and care manager to establish a registry to identify, manage, and track depressed patients

• Tracks key process and program measures (e.g. percent of patients who received a structured assessment for depression, percent of patients continuing pharmacotherapy after 3 months, percent of patients who achieved a 50% decrease in depression scores)


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Decision SupportDecision Support



Decision Support Evidence-based depression treatment guidelines and care protocols are available to improve recognition and treatment of depression

1) There are evidence-based treatment guidelines and care protocols for:

• Systematically identifying patients at elevated risk for depression

• Case identification using a structured assessment tool

• Stratification of treatment intensity by severity

• Treatment by provider and care manager• Mental health specialist referral2) Staff are trained in using decision

support tools3) Materials receive periodic review and

updating4) Mental health specialists are readily

available for decision support and patient referral


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Self-Management SupportSelf-Management Support



Self-Management Support

Materials, tools, and processes are available to promote patient activation and self-care for depression

Self-management support consists of:•Shared decision making between patient and provider(s), taking into account patient preferences for treatment and family involvement•Culturally appropriate patient information available in a variety of formats (e.g. print, audio, and videotape)•Self-study materials including such self-care techniques as goal setting and problem solving, as well as promotion of adherence to pharmacotherapy•CM follow-up on a patient’s progress with advice and acquisition of skills described in self-study materials


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Community ResourcesCommunity ResourcesComponent Key Principles Description

Community Resources

Patient information and education about depression are available from organizations that are independent of providers and health plan

Patients and families are informed of nonprogram information and other resources designed to assist in their understanding of depression and the various treatments available from such entities as:•Local/national organizations•Clergy, employee assistance programs, and support groups


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Functions of Care ManagersFunctions of Care ManagersPatient-Focused Support •Develop and maintain rapport

•Psychosocial treatment (e.g. interpersonal therapy or problem-solving therapy)

Follow-up •Facilitate and remind patient about telephone or personal visits

•Facilitate communication and linkages with mental health specialist and primary care provider

•Intervene in crisis

Education •Communicate, customize, and maintain self-action plan for patient

A Clinical Framework for Depression Treatment in Primary CareA Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002; Psychiatric Annals 32:9; September 2002


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Functions of Care Managers Functions of Care Managers (cont’d)(cont’d)

Clinical •Provide psychosocial therapy or counseling (e.g. interpersonal therapy or problem-solving therapy)•Monitor depressive symptoms, comorbidities, adherence

Follow-up •Monitor pharmaceutical treatment

•Encourage adherence to medications and education on their side effects

A Clinical Framework for Depression Treatment in Primary CareA Clinical Framework for Depression Treatment in Primary Care; Psychiatric Annals 32:9; September 2002; Psychiatric Annals 32:9; September 2002


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Phases of Depression Phases of Depression TreatmentTreatment

Kupfer DJ. J Clin Psychiatry. 52(5s):28-34,1991.

Treatment Phases

RelapseRecurrence

Recovery

Acute Continuation Maintenance

Syndrome

Symptoms

Remission

Response

No Depression


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Systems/ Economic ModelSystems/ Economic Model

• Reinforce clinical modelReinforce clinical model• Realign financial and non-financial incentivesRealign financial and non-financial incentives• Alter contractual / organizational arrangementsAlter contractual / organizational arrangements• Pay for:Pay for:

– PCP depression carePCP depression care– MHS consultationMHS consultation– Care managementCare management– Distinguished performanceDistinguished performance

• Unique issues in local contextUnique issues in local context


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Models of Linkage / Models of Linkage / IntegrationIntegration

Embedded PCP in BHSEmbedded PCP in BHS Co-location of BHS in PCPCo-location of BHS in PCP

BP

UnifiedUnified Coordination / Collaboration Coordination / Collaboration

B

PB

B PP


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Components of LinkageComponents of Linkage

• Formal agreements Formal agreements

• ReferralReferral

• ConsultationConsultation

• Information flowInformation flow


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PCASG StrategiesPCASG Strategies

• Medical HomeMedical Home

• FlexibilityFlexibility

• Quality IncentivesQuality Incentives


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““Crossing the Quality Chasm”Crossing the Quality Chasm”


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Studies Documenting the “Quality Studies Documenting the “Quality Gap”Gap”

• Literature reviews conducted by RANDLiterature reviews conducted by RAND– Over 70 studies documenting quality shortcomings Over 70 studies documenting quality shortcomings

• Large gaps between the care people should receive Large gaps between the care people should receive and the care they do receiveand the care they do receive– true for preventive, acute and chronictrue for preventive, acute and chronic– across all health care settingsacross all health care settings– all age groups and geographic areasall age groups and geographic areas

• Only 50% chance of getting appropriate careOnly 50% chance of getting appropriate care

(Schuster et al, MMFQ,1998; updated 2000; McGlynn et al, NEJM 2003)(Schuster et al, MMFQ,1998; updated 2000; McGlynn et al, NEJM 2003)


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To Err Is Human: To Err Is Human: Building A Safer Health SystemBuilding A Safer Health System

• First ReportFirst Report

• Committee on Committee on • Quality of Health Quality of Health

CareCare• in Americain America

• To order: www.nap.eduTo order: www.nap.edu


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Crossing the Quality ChasmCrossing the Quality Chasm

• Second ReportSecond Report

• Committee onCommittee on• Quality of Health Care Quality of Health Care

• in Americain America

• To order: www.nap.eduTo order: www.nap.edu


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Committee’s ConclusionCommittee’s Conclusion

The American health care delivery The American health care delivery system is in need of fundamental system is in need of fundamental change. The current care systems change. The current care systems cannot do the job. Trying harder will cannot do the job. Trying harder will not work. Changing systems of care not work. Changing systems of care will. will.


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Six Aims For ImprovementSix Aims For Improvement

•SafeSafe

•EffectiveEffective

•Patient-Patient-centeredcentered

•TimelyTimely

•EfficientEfficient

•EquitableEquitable


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What People Should Expect from What People Should Expect from the Health Care System (10 rules)the Health Care System (10 rules)

• Continuous healing relationshipsContinuous healing relationships• SafetySafety• Cooperation Cooperation • ScienceScience• IndividualizationIndividualization• ControlControl• InformationInformation• AnticipationAnticipation• TransparencyTransparency• ValueValue


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Evidence-Based Chronic (Planned) Care Evidence-Based Chronic (Planned) Care Approaches for Treating Depression Approaches for Treating Depression

Are EffectiveAre Effective

Prepared, ProactivePractice Team

Informed, Empowered Patient and Family

Productive InteractionsPatient-Centered Coordinated

Timely and Evidence- Efficient Based and Safe

Improved Outcomes

DeliverySystemDesign

Decision Support

ClinicalInformation

Systems

Self-Management

Support

Health SystemCommunity

Health Care OrganizationResources and Policies


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Six Problems in the Quality of Six Problems in the Quality of M/SU Health CareM/SU Health Care

• Problem 1: Obstacles to patient-centered careProblem 1: Obstacles to patient-centered care• Problem 2: Weak measurement and Problem 2: Weak measurement and

improvement infrastructureimprovement infrastructure• Problem 3: Poor linkages across MH/SU/GHProblem 3: Poor linkages across MH/SU/GH• Problem 4: Lack of involvement in National Problem 4: Lack of involvement in National

Health Information Infrastructure (NHII)Health Information Infrastructure (NHII)• Problem 5: Insufficient workforce capacity for QIProblem 5: Insufficient workforce capacity for QI• Problem 6: Differently structured marketplaceProblem 6: Differently structured marketplace


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Overarching Recommendation 1Overarching Recommendation 1

The aims, rules, and strategies for The aims, rules, and strategies for redesign set forth in redesign set forth in Crossing the Crossing the Quality ChasmQuality Chasm should be applied should be applied throughout M/SU health care on a day-throughout M/SU health care on a day-to-day operational basis but tailored to to-day operational basis but tailored to reflect the characteristics that reflect the characteristics that distinguish care for these problems and distinguish care for these problems and illnesses from general health care. illnesses from general health care.


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Preparing for the FuturePreparing for the Future

Standardize Practice ElementsStandardize Practice Elements– Clinical assessmentClinical assessment– InterventionsInterventions– IT infrastructureIT infrastructure

Develop GuidelinesDevelop Guidelines– Mental healthMental health– Substance useSubstance use– General healthGeneral health

Measure PerformanceMeasure Performance– For each “6P” levelFor each “6P” level– Across silosAcross silos

Improve PerformanceImprove Performance– LearnLearn– RewardReward

Strengthen Evidence BaseStrengthen Evidence Base– Document stakeholder valueDocument stakeholder value– Evaluate effective strategiesEvaluate effective strategies– Translate from bench to bedside Translate from bench to bedside

to community to community

Consumer ParticipationConsumer Participation

Leadership Leadership (PCP/MH/SUD) (PCP/MH/SUD)

SupportSupport

Clinical Clinical (PCP/MH/SUD) (PCP/MH/SUD) PerspectivesPerspectives

Integrative ProcessesIntegrative Processes


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Overarching Recommendation 2Overarching Recommendation 2

Health care for general, mental, Health care for general, mental, and substance-use problems and and substance-use problems and illnesses must be delivered with an illnesses must be delivered with an understanding of the inherent understanding of the inherent interactions between the mind / interactions between the mind / brain and the rest of the bodybrain and the rest of the body..


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Don’t Split Mind and BodyDon’t Split Mind and Body

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RWJF LPHI Kick-Off Meeting- July 29-30.2008 (New Orleans) 1 Greater New Orleans Collaborative to...

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