4/8/2014 Eceptionist Referral and Service Delivery Tarzana Treatment Centers Integrated Healthcare Outline of Presentation • Overview of Tarzana Treatment Centers • Importance of Integrated Care • Planned use of Eceptionist INTRODUCTION TO TARZANA TREATMENT CENTERS 1 4/8/2014 Tarzana Treatment Centers Demographics • Founded in 1972 • 501 (c) (3) Non-profit Corporation • 600+ Employees and Contract Staff • 9 locations in Los Angeles County • Persons served in Calendar 2013: – Primary care = 11,041 persons – Substance use disorder specialty care = 4,687 – HIV/AIDS specialty care = 1,072 – Mental health specialty care = 1,059 4 Primary Care – Five Primary Care Clinics Integrated with Other Services – 11 Providers (MD, NP, PA) – All patients assigned to one of 11 Care Teams 5 Specialty Care – Substance Use Disorder Treatment – Mental Health Disorder Treatment – HIV / Medical Care and related services – Housing – Assessment and Referral Services in Hospital EDs – In Home Services 6 2 4/8/2014 Specialty Substance Use / Mental Health Treatment – 14 Treatment Facilities – Acute Psychiatric Hospital: 60 beds w/ 2300 discharges / year – Residential Treatment SU/MH and Co-occurring Disorders: 314 beds w/ 1275 discharges / year – Outpatient SUD/MHD and Co-occurring Disorders: 100,000+ group plus individual sessions /year – Medication Assisted SUD Treatment – 20+ Sober Living and Transitional Housing Facilities – Case Management – Needle Exchange 7 Acute Psychiatric Hospital • 60 bed unit staffed 24 / 7 by psychiatrists and other medical staff • Referral Sources – Step downs from Acute Hospitals - Medicare – Contracts with LA County Department of Public Health – Kaiser and other Managed Care Organizations • Average Length of Stay – Insurance funded - 3 days – Block Grant funded – 7 days Specialty HIV/AIDS Care – HIV/AIDS Medical Clinics • Palmdale • Reseda – Prevention and Testing – Case Management – Jail In-Reach – MH/SU Disorder Treatment – Transitional Housing – Home Heath Care 9 3 4/8/2014 Specialty Hepatitis C Care • Initiated with grant from CDC Psychology Training / Internship Program • Started 1999 • California Psychology Internship Council Accreditation • Association of Psychology and Internship Centers Accreditation • American Psychological Association Accreditation • About 20 students, interns and post-docs in training program overseen by licensed psychologists Revenue Sources • Federal, State, Foundation Grants • Los Angeles and Ventura County Contracts • Cities of Los Angeles and West Hollywood Contracts • Veterans Administration Contracts • U.S. Probation and SASCA Contracts • Managed Care Contracts with all major private insurance carriers • Medicare and Medi-Cal fee for service • Medicare Advantage and Medi-Cal Managed Care via Health Care LA IPA • Private Pay • Sliding Fee and Charity Care 12 4 4/8/2014 Joint Commission Certification Certified under: • Hospital Standards • Behavioral Health Standards • Opioid Treatment Standards Scheduled during triennial survey in 2014: • Patient Centered Medical Home • Behavioral Health Home 13 Integrated Healthcare 5 4/8/2014 Lowering the Total Cost of Care Impact of Mental Illness & Substance Use Disorders on Cost and Hospitalization for People with Diabetes Per Capita Cost Per Year 2 $30,000.00 1.5 $20,000.00 1 $10,000.00 0.5 Per Capita Hospitalization Per Year 2.5 $40,000.00 0 $Diabetes Only Diabetes + MI Diabetes + SUD Diabetes + MI + SUD Beneficiaries with Diabetes Per Capita Cost Per Year Per Capita Hospitalization Per Year SOURCE: C. Boyd et al. Faces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services. Center for Health Care Strategies, December 2010. Integrated Healthcare Home (IHH) • Primary Care and Specialty MHD / SUD treatment in a single organization • Supplemented by services needed by Safety Net MHD/SUD patients – Case Management – Housing – HIV/AIDS Care 6 4/8/2014 Capitated and Incentivized Care • Members of Health Care LA IPA (HCLA IPA) • Composed of Safety Net Clinic Organizations • HCLA IPA Contracts with Safety Net Health Plans in Los Angeles • 350,000 Lives under capitated Managed Care contracts • Clinic Compensation County – Per Member Per Month Capitation – Quality of care incentives – Share of net revenue 19 Controlling Total Cost of Care • Unnecessary emergency department visits and avoidable hospital admissions largest contributor to cost of care • IPA notification of hospital admission dependent on claim processing • Health information exchange • TTC Case managers in emergency departments of 4 San Fernando Valley hospitals TTC Integrated Programs & Services 7 4/8/2014 SAMHSA - Primary Care Behavioral Health Integration • Four Year - $2 Million Grant • To integrate primary care with MH/SUD services for patients with a chronic physical health condition and a serious mental illness Department of Mental Health- Full Service Partnership (FSP) • For individuals with severe and persistent mental illness who meet criteria based on prior psychiatric hospitalizations, homelessness and/or incarceration • Intensive case management, mental health and psychiatric services with the aim of keeping patients out of the hospital, stabilization, and movement to a lower level of care • Most have concomitant SUDs and chronic medical conditions, which are all addressed Department of Mental Health- ISM • Individuals not currently seen by MH System • Engagement in non-traditional health settings (e.g. faith based institutions) • Focus on Latinos who are monolingual • Patient enrolled in TTC’s primary medical care services • Wellness classes, group education, MH therapy, psychiatric services, nontraditional services (curandero, sobador, botanica) and integrated case management 8 4/8/2014 Department of Mental HealthHealthy Way LA (HWLA) • Mild to moderate mental health problems • Short-term, evidenced-based model – Mental Health Integration Program (MHIP) • Referred by primary care based on mental health screen for depression, anxiety, and/or trauma • Psychiatrist consultant with mental health and primary care providers (PCPs) • PCPs prescribe psychotropic meds, if needed • Case conferences with PCP, psychiatrist and mental health clinicians to coordinate care Information Technology and Telehealth Electronic Health Record • 1st Patient Information System implemented in 1996 • Behavioral Health EHR implemented in 2004 • Hospital Pharmacy Management / Order Entry / MAR implemented in 2008 • e-Prescribing implemented in 2009 • Laboratory results imported into EHR 2012 • Primary Care EHR implementing in June 2013 – iPad – based – Integrated with Behavioral Health EHR 9 4/8/2014 Telehealth • • • • • • • 3 Nodes on CTN 9 CTN Connect licenses Dermatology, Diabetic Retinopathy Remote glucometers eConsult MDLiveCare eCeptionist CTN Connect Sessions 2014 Jim Sorg, PhD Director of Information Technology Tarzana Treatment Centers www.tarzanatc.org jsorg@tarzanatc.org 10