Updated+Mental+Health+coverage


 * 1) New MH benefit for ALL CCHP patients as of Jan 1rst!**

You heard that right. This means that, after Jan 1rst **CCHP must offer MH benefit "at parity" with their medical benefit by offering psychotherapy services to all patients who are assessed to need it**. Since most patients will be CCHP, those patients who the provider/BH team assess to need therapy can get it! CCHP sent out 100,000 letters last month letting patients know this and they were told to either contact their provider or the MH Access Line to get services. Now, there are at least two subsequent changes that need to happen in order to meet this goal-- **changes to the Access Line and changes to internal and external provider therapy capacity.**

Yes, the Access Line is under scrutiny right now in order to improve it. At this point, **CCHP will staff up the Access Line in order to receive phone calls**. Each person who is authorized to get therapy will be given a list of 3 names. If the patient calls these 3 providers and cannot get in, then CCHP is required to offer another list of providers. These providers will come from the commercial provider list if the Medical provider list is at capacity at that time. CCHP will then call the patient within 1 week to ensure the patient got in. The point is, per requirement, **eligible patients must be offered therapy as well as //actually get it// in a specified amount of time.**

I am not clear what the exact criteria is as it is still being developed but I believe this new MH benefit can offer a pathway to help address the burden of moderate-severity anxiety and depression in our clinics. **Our patients and providers will benefit from having a more developed BH team in clinic to help route patients to these services if they are refractory to clinic care.**


 * 2) New Clinic BH team in March/April!**

There will be **new BH team members in clinic with the potential to offer both improved BH services in clinic and help patients navigate appropriate external resources.** The BH integration collaboration is currently **hiring four (!) "behaviorists" who will be LCSWs dual-trained in mental health and substance use therapy services**. One will go to WCHC, one to MTZ, one to PHC, one to AHC or Brentwood. The hope is that, once there is demonstrable value, more will be hired given the burden of behavioral health problems in our very full clinics. In addition, **Wright Institute is expanding to include PHC** as a site of service in addition to MTZ and WCHC.

The behaviorist job description is under development but will likely include two main roles: **1) assessment and/or therapy (total of 6-8 sessions) for patients with mild or moderate behavioral health problems and 2) health navigation services for moderately and severely mentally ill into MH clinics or external MH providers.**


 * Yes, the hope is that the behaviorist will work WITH the services already in place in clinics rather than just be an add-on service** . This BH integration model of care is under development as well. It will likely reinforce the work ambulatory care redesign team is already doing. In the large clinics (MTZ, WCHC, PHC) where Wright is in place, Wright administrators are looking at possibly embedding Wright students in pods rather than with providers. The pods would do daily huddles and, in addition to SBIRT (discussed below), the huddles would identify potential people for intervention. The behaviorist might carry a pager and float between pods in this example. The behaviorist would be available for "warm handoff" from providers, nurses or Wright students to do the appropriate behavioral health assessment/intervention.


 * 3) SBIRT (Screening, Brief Intervention, Referral to Treatment) rollout soon!**

As part of another initiative, **every patient will undergo an annual screen for behavioral health problems called the SBIRT**. I have heard the SBIRT discussed as a brief, evidence-based intervention to address BH problems in clinic and as a funding-driven mandate that will add work to our already busy staff. Either have the potential to be true depending on how empowered local providers feel to shape the SBIRT rollout in each clinic site. I like to think of **SBIRT as a way to cue the clinic providers to use the new BH team** to address behavioral health problems that can sometimes overburden the clinic visit. In other words, if we get it right, this does not have to add work to your already busy clinic and can actually empower the clinic towards team-based care.

Nishant Shah championed SBIRT rollout in the county and started the process in North Richmond. **Currently, it is being trialed at WCHC to adapt it to larger scale and to different local resources/team structure.** The screen itself is a short questionnaire given to the patient by registration to be filled out in the waiting room. If a patient screens positive on initial paper screen then a further screen is delivered by the nurse during intake. The screen itself is thought to be much of the intervention--"you have screened positive for depression"--and, in some sites, referral to Wright groups will be made if appropriate. Unless the behavioral health problem is an urgent or priority chief complaint (which would have been true without the screen), the provider will not need to take any action. Many of the screen positives are already known to the provider.


 * The "standard workflow" for this will be developed with nursing, Wright, registration and physician input with great attention to flow and workload issues.** Currently, we are trialing reducing the number of screens to no more than 3 screens per provider per half-day clinic to help with this issue. In addition, nursing and Wright are developing their partnership to help address screen positives in a systematic manner. There will likely be another email about just SBIRT workflow in coming weeks.


 * 4)BH pilots**

As many of you know, the county has a **fully integrated Behavioral Health clinic in Concord** with 2 behaviorists, 1 psychiatrist, 1 PHN in addition to regular clinic staff. This has served as a successful example of how the county clinics can be a laboratory for running BH integration pilots for potential spread countywide.

The much anticipated **Martinez Wellness Center will be opening March/April.** The mental health component of this building was originally conceived as a way to better transition patients same day from PES to outpatient. The Center will be open 7 days a week and up to 16 hrs/day. It is not intended as a medical home but a place for acute assessments, brief intervention and transition into the county clinics. I think the most exciting part is that it will be the **first example of MH using EPIC documentation for their services and billing under the FQHC.** If successful, this could be a big deal for integration of EHR and other services down the road.

One of the most exciting ideas on the table right now is **Intensive Outpatient Therapy for patients with substance use issues within county clinics.** The site for this is still to be decided. Other pilots include coordinated hospital discharge planning for med-surg and psychiatric patients.

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