AND THE USH Andrew Pomerantz MD National Mental Health Director Integrated Care VACO Associate Professor of Psychiatry Dartmouth Medical School A Brief History of Psychiatric Care Hippocrates The four humors ID: 617276
Download Presentation The PPT/PDF document "INTEGRATED PRIMARY CARE: BACK TO THE FUT..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
INTEGRATED PRIMARY CARE: BACK TO THE FUTURE(AND THE USH)
Andrew
Pomerantz, MD
National Mental Health Director, Integrated Care
VACO
Associate Professor of Psychiatry
Dartmouth Medical SchoolSlide2
A Brief History of Psychiatric CareHippocrates – The four humors: Blood, Phlegm, Black Bile, Yellow Bile.
First description of depression.
400 B.C.: Romans remove civil rights of the mentally ill.
150 (or so) A.D.: “On Melancholia,” (Galen).
Depression caused by excess black bile
Many causes (Vapors, Wine, Age)
19
th
/20
th
Century America: InstitutionalizationSlide3
History of Psychiatric Care (cont’d)1960s: Deinstitutionalization begins1970s: Community Mental Health for SPMI1980s/90s: Community Mental Health for all
2000:
Moving back to integrated careSlide4
Models of MH Care in PCReferralConsultation/LiaisonCo-locationCollaborative CareIntegrated CareSlide5
Depression in Primary Care1970s: Biological underpinnings of MDD1980s: PCPs criticized for underrecognition1990s: PCPs criticized for undertreatment
2000s: PCPs criticized for overtreatmentSlide6
Ongoing study of MDD in PCPROSPECTIMPACTPRISM-ERESPECT
STAR-D
To date, all consistently demonstrate improved outcomes with care managementSlide7
The Problems“Voltage Drop” when moving from Research to Systems of CareAccess to Mental Health Care can be difficult
Limited # of Diagnoses in Evidence Base
Increasing demands on PCP timeSlide8
Organizational Ethics“…The intentional use of values to guide the decisions of a system.”“From Clinical Ethics to Organizational Ethics: The Second Stage of the Evolution of Bioethics.” Potter, Robert Lyman, in “Bioethics Forum.” Summer, 1996Slide9
6 Dimensions of IntegrationSpatialTemporalCommunication & Information SystemsAvailability of Psychiatric Expertise
Financial
StigmaSlide10
INTEGRATED CARE IN VATHE BLENDED MODELCO-LOCATED COLLABORATIVE CAREVERTICAL INTEGRATIONHORIZONTAL INTEGRATION
CARE MANAGEMENT
BEHAVIORAL HEALTH LABORATORY
TIDESSlide11
A DECADE OF CALLS FOR INTEGRATED CARESurgeon General reportInstitute of Medicine Quality Chasm ReportsPresident’s New Freedom CommissionVA Strategic PlanSlide12
Uniform Services HandbookSeptember, 2008Driven by VA strategic PlanOutlines basic “package” of MH benefits in all VA Medical Centers and ClinicsAll Medical Centers MUST have:
COLOCATED COLLABORATIVE CARE
CARE MANAGEMENT
Varying requirements for CBOC based on size Slide13
USH requirementsMedical Centers, Very Large CBOCs (10,000 +)must have full time CCC + Care ManagementLarge CBOCs (5000-10,000) must have blended model – variable hoursMid sized CBOCs (1500-5000) must have onsite MH care
Small CBOCs must have access to MH services
“Adequate) MH staffing required for
Polytrauma
, SCI, blind rehab, Palliative Care, TBISlide14
INTEGRATED CARE RFPFUNDING BEGAN 200794 FACILITIES FUNDED IN INITIAL ROUND131 OF 139 FACILITIES CURRENTLY HAVE PROGRAMS AT END OF FY 2009
MANY FUNDED LOCALLY OR REGIONALLYSlide15
NATIONAL OFFICE OF PRIMARY CARE-MENTAL HEALTH INTEGRATIONOFFICE OF PC-MH INTEGRATION OVERSEES IMPLEMENTATIONhttp://vaww4.va.gov/pcmhi/Monthly conference calls, Newsletters
Regional trainings
Site consultation/technical assistance
PCMHI dashboard
GROWING WORKLOAD
Over 1,300,000 encounters Slide16
NEXTA single brand of PC-MHIStaffing guidelinesDevelop the Evidence Base for Brief Tx
Rural Models
Integration with the rest of MH
Integration with PACT
Integration with SACSlide17
PACT?PATIENT ALIGNED CARE TEAMPC-MHI IS PART OF THE DISCIPLINE SPECIFIC TEAM (AKA EXPANDED TEAM)SPECIALITY MH IS SPECIALTY CARESOME SPECIAL POPULATIONS, INCLUDING SMI MAY BECOME INDEPENDENT PACTS OR TEAMLETSSlide18
AND THEN…PCMHI? WHAT’S THAT?