Transcript of Audio File:
2013-07-31 13.04 Integration Innovations_ A Discussion with Federal Agencies (Webinar Part I of II)
______
The text below represents a professional transcriptionist's understanding of the words spoken. No guarantee of complete accuracy is expressed or implied, particularly regarding spellings of names and other unfamiliar or hard-to-hear words and phrases. (ph) or (sp?) indicate phonetics or best guesses. To verify important quotes, we recommend listening to the corresponding audio. Timestamps throughout the transcript facilitate locating the desired quote, using software such as Windows Media player.
BEGIN TRANSCRIPT:
MODERATOR: Welcome to today’s webinar titled “Integration Innovations: A Discussion with Federal Agencies.” My name is Rose Leaker (ph), and I’ll start as a moderator for today’s webinar. Today’s webinar is being recorded, and all participants will be kept in listen-only mode. You can find the call number for the webinar on the right-hand side of your screen. Questions may be submitted throughout the webinar by typing your question into the dialog box to the right of your screen and sending it to the organizer. We’ll answer as many of your questions as time allows. Today’s webinar is jointly sponsored by the SAMHSA-HRSA Center for Integrated Health Solutions and the AHR: The Academy for Integrating Behavioral Health and Primary Care. The goal of today’s webinar is for each of you to discover how to access practical resources available, just [pauses] a few of the federal targets according to state and local integration efforts. [00:01:00]
Today’s speakers will include: Garrett Moran, Vasudha Narayanan, and Ben Miller, and Glynis Jones. I will now turn it over to AHRQ to begin today’s presentation.
GARRETT MORAN: Thank you, Rose. My name is Garrett Moran. I’m the Project Director for the AHRQ Academy for Integrating Behavioral Health and Primary Care. Next slide, please… [Pauses] Or did you want to cover these questions, Rose?
[Pauses]
MODERATOR: Uh, yes, we just have to ask the moderator and organizer questions throughout the webinar, so, again, feel free to type your questions into that box.
GARRETT MORAN: OK, and there is our pretty blue and green colors. The focus of the AHRQ Academy is on integrating behavioral health primary care. [00:02:00]
I’m going to start off the presentation today and give you a brief introduction to The Academy and how we came to be, and a very quick overview of our major activities and products. Then, I’ll turn it over in just a few minutes to Dr. Ben Miller, who is Principal Investigator in our project, and he’ll dive into more detail about a couple of the products, specifically the Lexicon and our Survey of Workforce Practices. And then he will, in turn, turn it over to Vasudha Narayanan, who is going to talk to you about our quality measures Atlas and a survey of primary care physicians that we’re just wrapping up.
AHRQ has had a history now of several years of doing work in the area of integrating behavioral health and primary care. This sort of started in 2008 with a comprehensive literature review that was published. [00:03:04]
And all of these materials are available on our website, which we’ll show you the link to a little bit later, and which is part of the AHRQ website.
In 2009, AHRQ funded a research conference, which resulted in the early draft of Lexicon. “Lexicon” is a term we’ll explain more, but it is a language for talking about this, the field of integrated behavioral health and primary care. In 2010, under Ben’s leadership, there was a paper on the future research needs for integrated behavioral health and primary care, and a conference in 2011. The Academy was initially funded in 2010, and then we got additional funding for our quality measures, survey, and workforce tasks the next year. Next slide… [00:04:00]
AHRQ’s vision is the – for The Academy to function as a coordinating center and a resource for anybody interested in integrated care. The focus is particularly on integrating behavioral into primary care, and the – we try to promote a collaborative dialog among leaders and stakeholders, and really focus on collecting and synthesizing information that will be useful to the field; and providing tools and materials to help move integrated care forward. Next slide… [Pauses]
The vision of The Academy from the beginning – this is such a rapidly moving and advancing field, we knew that a sort of static plan would never suffice, so they came up with, I think, a very clever idea for the National Integration Academy Council. [00:05:01]
This is really a panel of national leaders and experts in integrated care, that acts almost like a board of directors for The Academy helping keep us in touch with what is happening throughout healthcare reform and the changes in the area, and helping us identify activities, places that we could act in ways that will have an impact to help move the field forward. Web Portal – I want you to give it a couple of minutes – is our chief communication device, and it is where we put everything we’ve done, and it is out there for all of you to use. We have a collection of literature that includes more than 1,900 citations, and we have a process of continually scanning the literature so that, as soon as anything new comes out, we get it and we post it, and we’ll explain more of that capacity (ph) in a moment, as well. Next slide, please… [00:06:00]
The – I already mentioned briefly the Lexicon, and we’re going to hear quite a bit more about that by Dr. C.J. Peek, who is a member of the NIAC, our expert panel, along with the whole project team worked on this - our project team and others outside – to help get some conceptual clarity, and C.J. always talks about how we’d be in meetings, and [there is something] (ph) about integrated behavioral health and primary care, and it wouldn’t take very long for people to realize when they were using different terms for the same thing and the same terms for different things, so this has continued to help address that problem. The Workforce Competencies project that we’ll talk more about, but it is a fascinating project where we’re actually, in sort of anthropological style, going into exemplary practices – places that are doing a really good job of integrating behavioral health with healthcare – and seeing how it works and how the various team members interact, and how they – what they have to do to succeed in providing quality care to those they serve. Next slide… [00:07:17]
As I mentioned, Vasudha will talk more about our survey of smaller independent practices, but this is a pilot effort but a very informative one that is sort of collecting a baseline where, early on in this effort to integrate behavioral health and the primary care. And this study is talking to physician practices to see what they’re doing now, how they’re currently addressing the behavioral health issues of their patients. And we have questions about the extent to which they’re interacting with community behavioral health and others, so it will be really interesting when that – those results come out in just a couple of more months. [00:08:01]
And we just published – [brought in] (ph) Vasudha will talk a lot more about this – the Atlas Integrative Behavioral Quality Measures [rolling sound] is a presentation of the available measures. It is less comprehensive than we hoped, but it does reflect what is out there now to check on the quality of integration efforts. Next slide…
[Pauses] This is our – the homepage of The Academy portal. You can see our URL at the top of the page – integrationacademy.ahrq.gov. And this – you can see the green banner going across with: research, education, workforce, policy and financing, the Lexicon, clinical community issues, health information technology. And we’re featuring, in the lower-left corner, the Lexicon, and you can click right away there to the literature collection. So this is where you go for everything we’re going to be talking about today. Next slide... [00:09:13]
And this is the page that features the NIAC members, our expert panel of national leaders. I see that handsome Dr. Mac Baird from Minnesota and Dr. Sandy Blount who, probably, a number of you are familiar with, who has done a lot with training for people who work the integrative care centers. And the other members are all featured there, as well. Next page…
This is the page that has The Academy literature collection. And, as I said, it has got 1,900 publications currently, and these are growing, essentially, daily. [00:10:02]
We get live feeds, anything that fits that criteria. You can see that it is searchable by: title, author, the type of publication, the year, keywords. And it is a very useful tool. It does include both the published peer-reviewed literature as well as what is called “gray literature” – government reports and websites and the like - so it is comprehensive. If you want to do some research or publish, or write a grant, then the literature – this is a place to come and find it. Next slide…
[Pauses] Now I’m going to turn it over to Ben Miller, to talk with you about the Lexicon. Ben?
BEN MILLER: Thanks, Garrett, and thanks, everybody, for the opportunity to talk to you about some very important stuff that we are absolutely passionate about. [00:11:00]
In 2009, a field-defining moment occurred. Under the leadership of Charlotte Mullican at AHRQ, an R-13 (ph), a small conference grant, was funded that really started to ask the question about what is the research agenda that needs to be created to help advance the field of integrating behavioral health and primary care. And, in the process of that grant and in the process of developing that research agenda, there were a couple of things that came up, and Garrett alluded to one of these already. But in some of the planning calls, we would literally sit on the call, and people would say, “You know what? We’re doing integrate care, and this is what it looks like.” And then someone else would say, “Well, we’re doing collaborative care, and this is what it looks like,” and someone else would talk about it – a various integrated primary care effort. And what we found was that there was such inconsistency in the language that it was virtually impossible to create a research agenda because we had not – never defined certain core terms. The lexicon that grew out of that conference grant and now has expanded into the document that you see here on the slide in front of you is almost a five-year project of taking experts in the field, working with community members, talking to the native speakers, as I’ll mention in just a second, on what we mean by a “genuine artifact of integrated behavioral health and primary care.” [00:12:16]
This document - as you can see on the link there, the goal of this document, when it was finally created and has now been revised, was to develop conceptual and definitional clarity. How can you measure something if you’ve never defined it? How can you say you’re doing something if you don’t know what that is and you’ve never defined the components of it? It provided a basis for us to do more effective research and be able to discriminate between some of those components of integration that had previously been very nebulous. So we’re now getting more specific with our language, hence the field-defining moment. As Dr. Peek describes this oftentimes, the goal here was the quiet the cacophony so that those of us that are living in this world, that are working in integration have consistency in what we mean when we talk about integrated care. Next slide, please… [00:13:05]
So what is integrated behavioral health and primary care? Well, you can see here on the slide in front of you – and I’ll just read it for those of you that may not have the slides in front of you – the way that this has been written about in the Lexicon is that:
“Integrated behavioral health and primary care is the care a patient experiences as a result of a team of primary care and behavioral health commissions working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address both mental health and substance use conditions, health behaviors including their contribution to chronic medical illness, life stressors and crises, stress-related physical symptoms, and ineffective patterns in healthcare utilization.”
Within this definition and how this has been written, you can see here there is a lot of variability as to what this would look like in practice. [00:13:58]
The Lexicon encapsulates this definition and allows practices to have a variety of ways that they’ve implemented while staying true to a definition, while staying true to the Lexicon. Next slide, please…
So the requirements for the development of the Lexicon – and this is where this gets a little bit academic, and I’ll – bear with me here, but this is grounded in a proven methodology on developing consensus with language. But the requirements that we use for the Lexicon were as follows:
It needed to be consensual but analytic. So this is not about who has the loudest voice in the room or who has got the most grant funding, or who has got the biggest practice; this is a disciplined process that gets each person sitting at the table defining what they mean by “integration,” and lets their voice be heard. A very different process. [00:14:50]
B) Involving native speakers – and, in the case you can see here, it would be 24 diverse implementers and users of integrated care. So the native speakers in this case are folks that are on the ground doing this, not folks that have just conceptually thought about it but actually people that have seen it in real-time, that have been in the trenches, and have actually watched this work, folks that have researched this for years, patients that have experienced this. Looking further beyond just one group that may have an idea about what we think it is, this is going to the native speakers in the field. [00:15:22]
C) Focused on what functionalities look like in practice, not just principles, values, and abstractions. This is a function-based tool. When we back away from the construct of integrated behavioral health and primary care, and we start to think about the various functions and components necessary to pull off the model, that is where the Lexicon hits its sweet spot. It is not just about, idealistically, “This is where we want to go”; this is really about those core functions. [00:15:51]
D) Amenable to gathering an expanding circle of owners and contributors. One of the coolest things about this project, and where I think it does add a lot of value to the field is that it is not just about the core group that started the process; it is open to having other folks say, “You know what? We took the Lexicon, and this is how we used it in our community.” I can give you an example from Colorado – we are using the Lexicon to help us think through how we redesign primary care practices in the State. We are thinking about how to have the Lexicon as a framework that we know which practices are integrated and which ones are not. It requires us to take the Lexicon and to modify some of the ways that it can be utilized, and it is a very pragmatic tool in that case. Next slide, please…
So the communities that this Lexicon intends to unite – you can see here - we start at the top – with those that are most important – our patients and our families. How can we begin to talk to our patients and our families about integrated behavioral health and primary care if we have no consistency there? [00:16:56]
So when we talk about the Lexicon in the context of patients and families, how can we give them language so that they can say things like, “That was an integrated practice and that was not. I experienced true comprehensive primary care that included behavioral health in that practice, and this is what it looked like?” Looking at a clinician and speaking to a clinician? What exactly is it that I’m implementing? What are those core components that I have to have to be integrated? What are the core functions that I can locally adapt to make best use of the model for my community? This is not a top-down, this-is-how-it-must-be approach; this is that your community has various needs. The Lexicon has flexibility in it to allow models and various permutations so that practices can create, using the core components, ways that their models meet the needs of their patients. Purchases and plans – and this is huge – those of you that live in this world, you understand what I mean by this – folks want to know what they’re buying, and if we just abstractly refer to the concept of integration without giving more specificity to those components, there is not enough there for people to say, “I’m interested in purchasing now,” or, “I’m interested in developing a benefit redesign that includes comprehensive integrated behavioral healthcare and primary care.” [00:18:13]