What is your role A conversation with colleagues held at the Maryland Addiction Directors 2014 Annual Conference Annapolis Maryland Johanna Ferman MD Principal with Integrus Health Group amp ID: 417303
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Slide1
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 with
Integrus Health Group &
Moran & AssociatesSlide2
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 discussionIn “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.Slide3
Word Salad VideoVideo developed by Kevin PardoSunnyvale, CaliforniaClick 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 demandsSlide4
A Conversation in four parts:
I. By way of introductionII. The vision and wisdom in health reform
III. Pillars of Support and Sustenance
IV. A Change
ProcessSlide5
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 with
Parity
Community and
resources including
employment, housing &
‘connectivity’
Hospitals, Nursing homes, Rehab
Triple AIM: Cross Silo 3 Dimensional Measures
QUALTY OUTCOMES, COST AND EXPERIENCE OF CARE
Whole-person centered Care
Part IISlide6
6
Cycle of
Untreated behavioral illness,
Disability
& Poverty
Out of home placement
Social
Emotional
Developmental
Delays
Untreated
Addiction & mental
Illness
(Behavioral illness
)
Disruption of family
as
“
developmental
”
Environment
Repeated 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 IISlide7
Mental Health
Addictions
Primary Care
Chronic
,
complex conditions
and
costs
Acute and crisis ‘system’ overload
Transinstitutional
shifts into homelessness and justice system
Demoralization
7
Reimbursement
for volume and procedures
Infrastructure: HR, IT, telecomm, space planning, training, quality assurance
Silos: Creation of the ‘revolving door’
Part IISlide8
Pillars of Support and Sustenance
Pillars of Support and Sustenance
Whole-person
centered care
PAY-FOR-PERFORMANCE (P4P)
TRIPLE AIM – CROSS-SILO 3 DIMENSIONAL MEASURES
INTEGRATED DESIGN, FLOW & INFO USE with IT TO SUPPORT
INFRASTRUCTURE
HUMAN RESOURCES
QUALITY
IMPROVEMENT TELECOM SPACE
WITH RAPID
CYCLE
FEEDBACK
TRAINING
Part IIISlide9
BEHAVIORAL HEALTH 2nd
floorPRIMARY
CARE
1
st
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 AmCare
Contra Costa County DHS
Integrating Primary Care
into Behavioral Health: VISUAL MAPPING
FQHC and MH
Funding streams
and same day
services
Part IIISlide10
INITIAL VISIT W/INTEGRATED TEAMAnnual 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, reversal
of acute or chronic illness
Referral
Problem list with brief Plan
Ancillary
testing (labs, EKG, etc.)
Conference (multi-
disciplinary; reconciliation and integration
of data)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
TRUST
Formation 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 AmCare
Contra Costa County DHS
Flow Chart for Integration into BH
Part IIISlide11
Capturing Critical InformationWhen IT is
Siloed
PC
MH
SUD
NPO
Pharmacy
Functions crossing IT apps
Quality
Practice Transformation
Strict HIPAA compliance
Management
incl
follow-up
Reimbursement
Seeing
MANY
Seeing ONE
Part IIISlide12
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 IIISlide13
TRIPLE AIM’s 3 dimensional
Performance Measures – quality, cost and experience of care – can be readily accessed and used at all levelsInteroperability 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 Support
Part IIISlide14
Part IVSlide15
A Change ProcessPart IV
Role of leadershipvaluing & making room for ‘creative time’moving towards pay-for-performance (P4P)identifying organization and staff strengths and weaknesses and building internal expertisetargeting greatest area of needremoving obstacles, support for championswise investment in information technology due to planning on design, flow and info useSlide16
Part IVRole of ChampionsDeep knowledge of evolving field: standard bearers and developersPassion 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 partnersMaintenance of effort – keeping the ship moving forwardContinued learning within existing systemCooperation with change efforts being pilotedSecond generation adapters Slide17
Brief Summary Part I: By way of introduction In the midst of barrage, remembering who we are
Identifying strengths within the sector to move forwardPart II: Whole Person Care as the central driver, the heart, of health reformPart III: Pillars of Support and Sustenancespecial reference to design and the use of informationPart IV: A Change ProcessSlide18
Open discussionContact 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) or
jfermanMD@gmail.com
Cell: 510 789-7270