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Michigan Health and Wellness Initiatives:Peer Services in Federally Qualified Health Centers
and Integrated Health Settings
Lynda Zeller, Deputy Director
Behavioral Health and Developmental Disabilities Administration
Pam Werner, Recovery Oriented Systems of Care
Behavioral Health and Developmental Disabilities Administration
Mary Beth Evans, CPSS
Mid-Michigan Community Health Services
Michigan Department of Community Health(Public Health, Medicaid, Behavioral Health and Developmental Disabilities, Aging)
Strategic Priorities Promote and Protect Health, Wellness and
Safety Improve Outcomes for Children Transform the Healthcare System Strengthen Workforce and Economic
Development
Key Strategic Action Items:“Transform Health System” Integrated Care for Dual Eligible
Demonstration (Medicaid/Medicare) Healthy Michigan Plan (Medicaid Expansion) State Innovation Model “Blueprint for Health
Integration” testing payment and delivery
Michigan Managed Care & Specialty Services System
Physical Health and Behavioral Health General Population(Mild-Moderate BH)
Specialty Behavioral Health & Developmental Disabilities
Managed Care-Medicaid
(Majority in managed care plans=except NH-LTC)
-Competitively Bid-13 Medicaid Health Plans-Multiple plans within regions-Includes Mild/Moderate BH-Model consistent for over a decade
-CMH First Opportunity through regional PIHP-PIHP Sole Sourced in 10 Regions-Shared Risk, A-87 -1915 (b)(c) concurrent-CMH SMI, SUD, DD, SED Services
Healthy Michigan Plan (Medicaid Expansion)ABP-SPA & 1115
-Repeat items above-Added: Savings Acct, Personal Incentives, Contributions
-Repeat items above-Added: Broader addiction & recovery services
Non Medicaid Funds -Michigan Marketplace (Exchange-EHB include BH)
-SUD federal, state, local (SUD Coordinating Agency merging with PIHP)-CMH state, local, federal SMI, DD, SED
Michigan’s Peer Trained Workforce 2005 - 2014
2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-20140
200
400
600
800
1000
1200
1400
91
235
405
595
729
859
999
1150
1283
MDCH 1915 (b)(c) Managed Care Specialty Services Waiver Medicaid Provider Description for Peer
Specialist Covered Services Developing health and wellness plansDeveloping advance directivesIntegration of physical and mental health careDeveloping, implementing and providing health and
wellness classes to address preventable risk factors for medical conditions
Transformation Transfer Initiative (TTI) Project Employment of 3 CPSS as Healthcare Navigators and
Wellness Coaches Selection of two Federally Qualified Health Centers
(FQHC). One urban and one rural serving 1,552 and 423 individuals with behavioral health needs respectively.
Utilization rates for behavioral health needs at Michigan FQHC sites 2011: 26,382 served with mental health needs
1,953 for persons with Substance Use Disorders
Number of Mental Health & Substance Abuse Visits in Michigan FQHCs*
Alcohol Related Disorders
Other Substance Related Disorders(ex. tobacco use disorders)
Tobacco Use Disorder
Depression and Other Mood Disorders
Anxiety DisordersIncluding PTSD
Attention Deficit and Disruptive Behavior Disorders
Other Mental Disorders (Ex Drug or Alcohol Dependence)
SBIRT
2963
6649
4202
47606
23548
26041
26058
150
14355
24990
52347
132450
73393
39987
78261
159
20122011
*2012 was the first year Health Centers were required to report for all diagnoses, not just primary. Dramatic increases more accurately reflect the population prevalence.
Number of Mental Health & Substance Abuse Patients in Michigan FQHCs*
Alcohol Related Disorders
Other Substance Related Disorders (ex. tobacco use disorders)
Tobacco Use Disorder
Depression and Other Mood Disorders
Anxiety DisordersIncluding PTSD
Attention Deficit and Disruptive Behavior Disorders
Other Mental Disorders (Ex Drug or Alcohol Dependence)
SBIRT
1553
2528
3454
20448
12181
10072
12739
103
5490
6195
31393
46295
28563
14356
24104
114
20122011
*2012 was the first year Health Centers were required to report for all diagnoses, not just primary. Dramatic increases more accurately reflect the population prevalence.
TTI Program Objectives
Enhance knowledge and access to primary care
Increase self-management of chronic conditions
Enhance physical and behavioral health and wellness
Improve quality of life Enhance recovery
Peer Roles and Responsibilities
Health Navigation Assistance with appointments, follow up with
specialty services and managing complex health and service systems
Identifying community resources, benefits, and referral to outside agencies
Linking to community based formal and informal supports
Peer Roles and Responsibilities
Health and Wellness Coaching Developing Wellness Recovery Action Plans Facilitating classes and support groups in smoking
cessation, Whole Health Action Management (WHAM), diabetes, pain management, and increasing physical activity.
Providing individual support related to managing two or more chronic conditions
TTI Individual Patient Outcomes Anecdotal Evidence Teaching benefits of diabetes self-management
including walking and healthy eating – one individual lost 18 pounds, reduced insulin and in Hemoglobin A1c test dropped from 8.2 to 5.9
Teaching navigation - supported an individual who had a goal of employment how to navigate the public bus system to go to Michigan Works, a job placement/GED organization
TTI Individual Outcomes Anecdotal Evidence Teaching better self-management of finances – supported one
individual who was homeless and on disability how to budget to rent her own apartment – also supported the same individual to locate and lease an affordable apartment
Introducing the Wellness Recovery Action Plan (WRAP) for recovery self-management – worked one-on-one with an individual to create a WRAP plan identifying early warning signs, triggers and how to build a wellness toolbox.
Continuing Education
Smoking Cessation/Tobacco Recovery: University of Colorado and CHOICES of New Jersey
Wellness Recovery Action Planning Trauma Informed Peer Services and Supports Emotional CPR (e-CPR), National Empowerment
Center Leadership Whole Health Action Management
Peer Specialist and Recovery Coach Innovations and Opportunities 2010 Association of State and Territorial Health
Officials Vision Award for Peer-led Health and Wellness Initiative
Michigan Cancer Consortium 2012 Spirit of Collaboration Award for Peer to Peer Tobacco Recovery Program
Stanford CDSMP research study Spotlight Agency for Health Care Research and
Quality Innovations Exchange
Vision and MissionOur Guide on the Journey Toward Population Health
Our Vision is to improve the experience of health care, improve the health of populations, and reduce per capita costs of health careOur Mission is to protect, preserve and promote the health and safety of the people of Michigan with particular attention to providing for the needs of the vulnerable and under-served populations
Georgia’sHealth Integration through
Peer Support
Georgia Department of Behavioral Health & Developmental Disabilities Frank W. Berry, Commissioner
Wendy White Tiegreen, Director of Medicaid and Health System Innovation
and
Georgia Mental Health Consumer NetworkSherry Jenkins-Tucker, Executive Director
for the
National Association of State Mental Health Commissioners
July 2014
Georgia’s Foundation
Peer Support approved in Summer 1999
•First specific “Peer”-delivered Medicaid approved service in nation
•Approximately 1000 Certified Peer Specialists certified in GA
•Medicaid approved Peer Support Whole Health and Wellness Medicaid-billable service to Medicaid State Plan in 2012 (implemented January 2013)
Peer Support Whole Health and Wellness
Key Modification: PreventionModified Medicaid Rehab Option State Plan to add:
“…support and coaching interventions to individuals to promote recovery and healthy lifestyles and to reduce identifiable behavioral health & and physical health risks and increase healthy behaviors intended to prevent the onset of disease or lessen the impact of existing chronic health conditions by teaching more effective management techniques that focus on the individual’s self-management and decision making about healthy choices which ultimately extend the members’ lifespan.”
Georgia: New & Now
Georgia: New and Now
Specific Interventions Include:
• Skills development for sharing basic health information;
• Promoting awareness regarding health indicators;
• Assisting the individual in understanding the idea of whole health and the role of health screening;
• Supporting behavior changes for health improvement;
• Building skills on the use of wellness tools (e.g. relaxation response, positive imaging, wellness toolboxes, daily action plans, stress management, etc.) to support the individual’s identified health goals;
Specific Interventions, continued:
• Working with the individual in his/her selection of incremental health goals;
• Teaching/modeling/demonstrating skills such as nutrition, physical fitness, healthy lifestyle choices;
• Promoting and offering healthy environments and skills-development to assist the individual in modifying his/her own living environments for wellness;
• Supporting the individual as they practice creating healthy habits;
• Personal self-care, self-advocacy and health communication;• Assisting in the coaching related to disclosing history, discussing
prescribed medications, asking questions in health settings
Georgia: New and Now
Georgia: New and Now
TECHNICAL ELEMENTS
Requires Professional Supervision in accordance with CMS-SMDL #07-011
Requires goal(s) on the official Treatment (Recovery) Plan
Requires health-related training for the Certified Peer Specialist (CPS)
Georgia: New and Now
CPS Training: Whole Health Action Management (WHAM)
o Engaging in person-centered planning to identify strengths and supports in 10 science-based whole health and resiliency factors;
o Supporting the person in writing a whole health goal based on personal motivation and person-centered planning;
o Supporting the person in creating and logging a weekly action plan;
o Facilitating WHAM peer support groups which create new health behaviors;
o Building the person’s Relaxation Response skills to manage stress;
o Building the person’s cognitive self-management skills to avoid negative thinking.
http://www.thenationalcouncil.org/cs/press_releases/eight_weeks_to_whole_health_national_council_offers_wham_peer_trainings
Georgia: New and Now
TECHNICAL ELEMENTS
• Health-trained CPSs are the lead practitioners
• Partnered with an agency-designated Behavioral Health Registered Nurse/s who provides technical medical advice, referral, and support as requested and as necessary
Georgia: New and Now
TECHNICAL ELEMENTS:
• HCPCS Billing Code: • Health and Wellness Supports, H0025
• Rate for 15 minute unit: • Ranges from $15.13 to $24.36 depending on
CPS education level and location of service
Georgia: New and Now
Health-Certified CPSs have the ability to function in a variety of settings
Health-Trained Certified Peer Specialist
RN providing medical technical support
EmergencyRoom
FQHC
Community BH Center
Georgia’s Foundation
Model Billing:Emergency Rooms: Negotiations with
MedicaidFQHCs:
Per Diem billingOptions for consideration:
CMHC PartnershipSpecialized Medicaid Enrollment for Peer SupportOutcomes Orientation
BehavioralHealth*
Medical
FQHCs
WHOLE HEALTH
“Medical history, physical examination, assessment of health status and treatment of a variety of conditions amendable to medical management on an ambulatory basis by a physician”*
“Evaluation and Diagnostic services”
“Services and supplies incident to a physician services including pharmaceuticals “
“Centers may offer additional services that are beyond the scope of FQHC core…”
• Psychiatric Diagnostic or Evaluative Interview Procedures
• Psychiatric Therapeutic Procedures
• Office or Other Outpatient Services
• New Patient • Established
Patient
Core
Optional
*Substance Abuse Center Services are non-covered
BehavioralHealth
Rehabilitation
Medical
Behavioral Health
Diagnosis/ Treatment*
FQHCs PerformanceBased
WHOLE HEALTH
Points of DialogueDialogue:
Mutual goalsRole discernment
Our role, their role, combined roles
Behavioral Health Treatment and Rehabilitation
Complementary functions/strengths
Medicaid penetration
Georgia’s Foundation
Lived Experience PerspectiveImproved LivesHealth EngagementPatient Activation
Georgia’s Foundation
Emerging Outcomes:
Health and Recovery Peer (HARP) Program study (Druss, et.al): “…significantly greater improvement in patient activation than those in usual care.”
Cobb/Douglas Community Service Board (SAMHSA PBHI
grantee):Significant improvements in cardiometabolic risk factors were
seen (hypertension, smoking status (breath CO), and A1C). Individuals with high blood pressure: % in sample group normal
range increased from 33% to 41%8% in sample group (n=21) quit smoking
Improvements were also seen in BMI, total and LDL cholesterol (statistically insignificant).
