Outline of Presentation 4/8/2014 Eceptionist Referral and Service Delivery

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
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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
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Primary Care
– Five Primary Care Clinics Integrated with Other
Services
– 11 Providers (MD, NP, PA)
– All patients assigned to one of 11 Care Teams
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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
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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
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Acute Psychiatric Hospital
•
60 bed unit staffed 24 / 7 by psychiatrists and other medical staff
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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
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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
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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
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Integrated Healthcare
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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
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$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
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Capitated and Incentivized Care
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Members of Health Care LA IPA (HCLA IPA)
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Composed of Safety Net Clinic Organizations
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HCLA IPA Contracts with Safety Net Health Plans in Los Angeles
•
350,000 Lives under capitated Managed Care contracts
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Clinic Compensation
County
– Per Member Per Month Capitation
– Quality of care incentives
– Share of net revenue
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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
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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
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Individuals not currently seen by MH System
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Engagement in non-traditional health settings (e.g. faith based institutions)
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Focus on Latinos who are monolingual
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Patient enrolled in TTC’s primary medical care services
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Wellness classes, group education, MH therapy, psychiatric services, nontraditional services (curandero, sobador, botanica) and integrated case
management
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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
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Telehealth
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•
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•
•
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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
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