Mapping Primary and Behavioral Healthcare Integration: eSolutions, July 2011
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral health care integration from across the United States.
Jeff Capobianco, MA, Coordinator, Evaluation and Performance Measurement, SAMHSA-HRSA, Center for Integration Health Solutions
While providers in today’s healthcare environment may struggle to determine what to measure, choosing well will create a story about the services an agency provides. Process mapping helps gain the stakeholder buy-in needed to determine what to measure. However, before mapping can begin, it is important to understand the three types of people served by behavioral health agencies. In the simplest of terms these people can be described as “Satisfied,” “Dissatisfied,” and “Delighted”; they focus on creating delighted customers who will buy more of their service or product. In healthcare, the focus is on engagement, treatment and education, and the goal is to encourage customers to become "activated" to improve their own health and develop collaborative relationships with their healthcare team.
The “delighted consumer” is analogous to the healthcare customer who is activated. The “satisfied consumer” has a relationship with the healthcare team and shows up when he or she feels the need, or to get a prescription filled. The “dissatisfied consumer” sees no value in engaging and is often forced to receive treatment due to a disability requiring acute treatment, or even a court order that mandates treatment.
So what does this have to do with process mapping?
Process mapping involves describing how a process looks from beginning to end from the customer's perspective. The process may seem foreign to many behavioral health employees who see their services as necessary and helpful. While this may be true, customers must also value the services provided – or they may become “no shows,” or dissatisfied consumers.
The concept of value is the cornerstone of process mapping. “Value” is defined by the customer and can help guide service flow. If an agency understands what a customer values, it is better positioned to develop a service flow that will lead to an activated customer. After all, the tremendous success of motivational interviewing is due to its one singular focus: what the consumer values in his or her life.
Process mapping, also known as Value Stream Mapping
(VSM), is a necessary tool for engaging both customers and staff in healthcare system design and redesign. The steps are as follows:
- Understand what the customer values in healthcare services and how this intersects with the agency’s mission and strategic plan.
- Identify one key area of service delivery to map out from within the overall flow a customer experiences from intake to discharge.
- Draw a current state map on the wall with the team who does the work (ideally with large pieces of paper, sticky notes, and markers).
- After the current state is mapped, draw a future state map outlining the optimum flow.
- Identify the key process variables that need to be changed or created to move from the current state to the future state.
- Develop an implementation plan to move from the current to the future state, including details regarding accountable staff, resources required, objectives, measures, timelines, and a communication plan.
Every detail a customer experiences should be mapped − from advertising and referral source engagement, to how front desk staff interacts with customers on the phone, right through to discharge. This is part of continuous quality/performance improvement. As customers become more activated, new approaches to care will emerge to better meet customers’ needs. An agency’s quality improvement employees are often the best resource to help with process mapping.
The Center for Integrated Health Solutions can assist in process mapping for integrated primary and behavioral healthcare. There are also an abundance of resources online, most of which can be found at websites dedicated to "Lean” process improvement. Process map created by Shawnee Mental Health Center, Inc.
For more information, visit www.CenterforIntegratedHealthSolutions.org or call 202.684.7457.
CIHS provides training and technical assistance to the Substance Abuse and Mental Health Services Administration’s Primary and Behavioral Health Care Integration grantees. Each issue of eSolutions profiles a grantee’s work.
The Providence Center
Since 1998, the Providence Center has incorporated exercise and nutrition activities into standard clinical practices for 450 Assertive Community Treatment team consumers. In 2007, TPC expanded wellness programming to all of its consumers through a grant from the Rhode Island Office of Minority Health. Consumers benefit from bilingual, culturally-competent services at TPC and exercise classes at the YMCA. They take walks in local parks, participate in an annual family barbecue and join health promotion events.
To address the need for integrated primary and behavioral healthcare, TPC partnered with community health centers to provide co-located services. Through these programs, consumers reduced risk factors that lead to chronic disease in people with serious mental illness and decreased behavioral health symptoms.
Achieving consumer engagement in the community was a turning point for TPC’s wellness programming. Bilingual Health Mentor Jetzabel Mills found that through community-based wellness activities, “consumers have the opportunity to connect with both their bodies and their communities. Many of our participants had never been exposed to exercise in a positive way before. It improves their outlook and their health.”
Owing to the positive outcomes that resulted from the TPC services with a community reach and the wide range of people served, TPC began providing population-specific wellness programs along with the integrated wellness services that are available to all TPC consumers. In Shape Seniors, a program funded by Tufts University, identifies the needs of seniors with behavioral health problems and integrates wellness activities and social engagement with behavioral health treatment and primary care using health mentors to guide participants toward achieving their goals. Fit2BHealthy, funded by the Rhode Island Foundation, teaches overweight children and their families behavioral, environmental, and physical approaches to reduce weight in collaboration with the child’s pediatrician.
For more information on the Providence Center’s efforts, visit www.providencecenter.org.
An “Access Redesign Initiative” run by the National Council for Community Behavioral Healthcare and MTM Services has helped to substantially reduce lengthy wait times for assessments. Analyses have shown that for each day a consumer must wait for an appointment, his/her likelihood of showing up decreases by 1%. Open access scheduling significantly reduces ‘no-shows’ and, in some cases, eliminates them entirely.
Consumer engagement increases, improving the likelihood that consumers will show up at timely, subsequent appointments. Service capacity increases as employees spend less time with “busy work” and more time providing services, thus improving the bottom line. And intake costs decrease, further improving the bottom line.
Five change techniques used in the initiative are:
- Streamline documentation: Help organizations reduce their documentation requirements by focusing on the removal of repetitively captured data elements and data elements that are not required by funding or accreditation organizations and changing the answer formats used to capture data elements to reduce overall documentation time.
- Concurrent collaborative documentation: Eradicate post-session documentation time while increasing person-centered engagement of clients in their recovery by involving them in the creation of their clinical documentation.
- Walk-in access models: Implement a zero no-show model to offer more expedient access to care and increased engagement.
- No-show management: Use policy changes, policy enforcement, engagement specialists, and reminder back-filling programs to help clients increase their show rates and engagement levels.
- Employee engagement and maximization of staff productivity: Help providers get staff to buy-in to change so that they can achieve their direct service staff’s productivity targets.
For more information on accessing Training and Technical Assistance from the Center for Integrated Health Solutions, visit www.CenterforIntegratedHealthSolutions.org.
Using State Claims Data to Evaluate Impact of IDDT on Service Utilization and Cost
Tuesday, August 2, 2011, 2:00-3:00 PM EDT
Hosted by Co-Occurring Disorders Integration and Innovation Task Order
Click here to register for this webinar
The implementation of evidence-based practices (EBPs) has become an expectation of many state and local mental health authorities. As behavioral health dollars shrink, and with healthcare reform a reality, policymakers are increasingly interested in the most clinically- and cost-effective interventions. While EBPs have been shown to produce better clinical outcomes, they are perceived to be more expensive services. This webinar presents the results of a cost-effectiveness study of Ohio’s implementation of Integrated Dual Disorders Treatment (IDDT, a SAMHSA-recognized EBP).
Check out recordings and presentations of the following recent webinars you may have missed:
Introduction to Effective Behavioral Health Service Delivery in Primary Care Settings
Recorded June 1, 2011
Hosted by the National Association for Community Health Centers, a CIHS subcontractor
Presenters: Dr. Alexander Blount, Dr. Miguel Olmedo
Looking for clarification on the differences between co-located behavioral health services and truly integrated care? This webinar provided an introduction for clinicians in Federally Qualified Health Centers and Community Behavioral Health Organizations interested in evidence-based practices for integrating behavioral health into primary care.
Person-Centered Health Homes
Recorded May 16, 2011
Presenters: Chuck Ingoglia, Larry Fricks
This webinar provided an overview of the history and components of the person-centered health home model, including whole health and inclusion.
Visit www.CenterforIntegratedHealthSolutions.org for archived recordings and presentations of past webinars.
Motivational Interviewing Website
The Mid-Atlantic ATTC and the ATTC Network launched their new Motivational Interviewing (MI) website, www.motivationalinterview.org. The website contains materials designed to facilitate the dissemination, adoption, and implementation of MI among clinicians, supervisors, program managers, and trainers, and improve treatment outcomes for clients with substance use disorders.
Words of Wellness Newsletter
The July 2, 2011 edition of the Institute for Wellness and Recovery Initiatives newsletter is available at www.welltacc.org. The monthly newsletter features valuable information and resources, including details about educational events, to help people achieve and maintain wellness.
The National Prevention Strategy
On June 16, 2011, the National Prevention, Health Promotion, and Public Health Council released the National Prevention Strategy to focus the nation on prevention and wellness. The Strategy’s four strategic directions and seven priorities include evidence-based recommendations fundamental to improving the nation’s health.
National Wellness Week: LIVING WELLNESS
As part of National Recovery Month, SAMHSA will launch the first National Wellness Week from September 19-25, 2011. The inaugural theme, “Living Wellness,” will promote the many ways wellness can improve quality of life and increase life expectancy for people with mental and substance use disorders.
Stay tuned for more information about National Wellness Week in future issues of eSolutions or receive information directly by subscribing to the 10x10 Wellness Campaign E-Newsletter at www.10x10.samhsa.gov.
SAMHSA's New Website on Co-Occurring Disorders
SAMHSA redesigned and updated its website on co-occurring disorders to better share important information, events and news on co-occurring disorders and treatment. Visit www.samhsa.gov/co-occurring.
Medicare Proposes Coverage of Screening and Counseling for Alcohol Misuse & Screening for Depression
The Centers for Medicare & Medicaid Services (CMS) proposed adding alcohol screening and behavioral counseling, and screening for depression, to the preventive services now covered by Medicare. Under the new proposals, Medicare would cover an annual alcohol misuse screening by a beneficiary’s primary care provider, as well as four counseling sessions per year if a beneficiary screens positive for alcohol misuse. Medicare would also cover an annual screening for depression in primary care settings that offer staff-assisted depression care.
CMS announced the proposals on July 20 and is accepting public comments for 30 days; the agency will issue final decisions later this year.To receive this newsletter and other CIHS e-mail updates, click here to enter your e-mail address and select “News from the SAMHSA–HRSA Center for Integrated Health Solutions” from the options listed.
To receive this newsletter and other CIHS e-mail updates, click here to enter your e-mail address and select “News from the SAMHSA-HRSA Center for Integrated Health Solutions” from the options listed.
Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.centerforintegratedhealthsolutions.org, e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks; Editor, eSolutions: Heather Cobb
The SAMHSA–HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.