PROGRAM DEVELOPMENT AND

INTEGRATED HEALTHExploration of developing programs and integrated health clinical practice

CONTRACT – WHAT IS A CONTRACT

A contract is an agreement between two parties that can be enforced by law…

1. A contract can be verbal or a handshake2. A contract can be a written agreement 3. A contract does not have to be fair

A contract contains three parts: 1. An offer, 2. An acceptance

of an offer, 3. Consideration of the offer

CONTRACT WHAT TO INCLUDE1. Who does it cover?2. What is exchanged?3. When will it be done?4. Where will it be done?5. How will it be done?6. Who much will it cost?7. What if…?

CONTRACT BETWEEN PSYCHOLOGISTS AND MEDICAL PROVIDERS Four Major Options…1. Rent Space from provider or practice: Two small pitfalls are avoid conflict of

interest through clarity of your practice rules and make sure you pay market rate fo rent.

2. Partnership/Corporations (LLC, Partnerships, LLP, S-Corp, Sole Prorpritor, B-Corp, 501.c3/non-profit): Typically a partnership allows for a percentage of income, some responcibility for administrative fees and percentage is based on value you bring and often percent of profit.

3. Become Employee: Limitations are that you typically will not be involved in material and organizational decisions. However, contracts are negotiable and you can include this in your contracts.

Non-Contractual Relationship: Referral network development. Remeber kick backs and any quid-pro-qou is unethical.

CONTRACT: PARTNERSHIPS1. Business Decisions – A partner should have involvement in financial

decisions2. Share of Profits – Partners should have a share of profits in the organization

What you bring e.g. 15% of profits are due to billing, additional value your work brings, and what your

costs are to the organization.

Watch Out For:

Non-Competition ClauseNon-moonlighting Clause

Watch Out For (cont.):

Mal-Practice Insurance Testing Equipment

Watch Out For (cont.):

Admin CostsOn Call TimeConferences and Academic Work

CONTRACTSWatch Out For1. It is ok to negotiate contracts

even with managed care companies…

2. Terms like “the highest standards”

3. One sided indemnity4. Confidentiality matches your

profession 5. Gag Clauses

What to Include1. Term of contract (time limits)2. Termination with and with out

cause 3. When the contract can be

terminated4. Evaluation of success5. Liability 6. Appeals process

PROGRAM DEVELOPMENT

SBIRT – IMPLEMENTATION While SBI towards adult alcohol use ranks among the highest-performing preventive services based on cost effectiveness and health impact, it also remains among the least implemented.

Common perceived barriers include limited time during the patient visit, lack of knowledge and training, fearing negative patient reactions, and feeling uncomfortable discussing substance use.

http://www.sbirtoregon.org/

SBIRT – BILLING MONETIZED ADDICTION ASSESSMENT

INTE

GRAT

ED C

ARE

WHY

…

PRIV

ATE

PRAC

TICE

?

INTEGRATED CARE W

HY…

PRIVATE PRACTICE?

•More than 60% of PCP visits are initiated by behavioral health need.

• Nearly 50% of all mental health care in US is provided by PCP

• 92% of all mental health care for elders is provided by PCP

Stats Matter

INTEGRATED CARE – FINDING THE RIGHT LEVEL Level 1: Minimal collaboration (referrals only), Level 2: Collaboration at a distance (referrals and some

direct communication), Level 3: Basic on-site collaboration, Level 4: Close collaboration in a partly

integrated system, Level 5: Close collaboration in a fully integrated system.

Patient Centered Care and Functional Improvem

ent

Primary Care

Provider

Nursing

Care Manager

Behavioral Health

Specialty Care

(PT/OT, Surgens

etc.

PATI

ENT

CENT

ERED

CH

RONI

C PA

IN T

REAT

MEN

T TE

AM –

PIL

OT C

LINI

CS

INTEGRATION CASE EXAMPLES… Chronic Pain Clinic

1. Develop collaborators

2. Identify need3. Work with

relationships4. Develop plan5. Create funding

plan6. PDSA 7. Monitor

Private Practice

1. Define treatment2. Identify team

members3. Level of

collaboration4. Lunch and learns5. Contract/

Colocation6. Change

management 7. Monitor

INTEGRATION CASE EXAMPLES…

Primary Care ProvidersIntegrated Health

PsychologistBehavioral Health Team TherapistsMental

Health ClinicsP

ES

Developing the Treatment Funnel Improves Access and Patient Care

Reduced Number of Referrals at Each

Level

Increased Ability to Provide Care through Increased Collaboration and

More Appropriate Referrals

ZONE SCORES Nursing ACTIONSZONE 4

SEVERE SYMPT.Acute Tx Needed

Beh. Health Team Miller

PHQ-9 Depression Score = 20 - 27

DAST Drug Risk W&M Score > 6

AUDIT (Alch. Risk M) Score > 20

AUDIT (Alch. Risk W) Score > 20

I. Refer to Wright Health Psychologist II. Transfer Care to Behavioral Health

Team at MillerIII. If positive for addiction (DAST/AUDIT) refer

to ACCESS 1-800-846-1652

ZONE 3 MOD. SYMPT.

Tx NeededReferral or Warm H/O

PHQ-9 DepressionScore = 15-19

DAST Drug Risk W&M Score = 3-5

AUDIT Alch. Risk WScore = 15 -19

AUDIT Alch. Risk M Score = 13 - 19

I. Refer to Wright Health Psych.II. If Wright Health Psychologist is treating

other PTs put on referral Queue: amb health coaching

III. Referral to groups (use fliers)IV. Offer ZONE 3 services (see patient handout)V. If positive for addiction (DAST/AUDIT)

refer to ACCESS.

ZONE 2 MILD/NO SYMPT.

Watchful Waiting

PHQ-9 Depression Score = 10-14

DAST (Drug Risk W&M) Score = 1-2

AUDIT (Alch. Risk W)Score = 4-12

AUDIT (Alch. Risk M) Score = 5- 14

I. Watchful waitingII. Consider further assessment w/ health

psychologist if other indications are present.

ZONE 1 NO SYMPTOMS I. No Treatment Needed

HIGH RISK PATIENT SCORE PHQ9 QUESTION 9 > 2 CONTACT MH/WRIGHT IMMEDIATELY FOR RISK ASSESSMENT

INTEGRATED COLLABORATIVE SERVICES

Identifying key services that you might provide to a pcp or provider team can help organize your practice.

Define the scope of your services and level of integration

Common Services• Individual treatment (health/Beh

Health)• ADHD screening and Tx• Autism Screening and Tx• Medical Group Visits (pain,

diabetes etc).• Consultation Servie

Common Services• Psychological Testing• Addiction treatment• Specialty care collaboration

e.g. asthma/cardiology

DEFI

NE Y

OUR

NETW

ORK

AND

COLL

ABOR

ATIO

N LE

VEL

Private Practice Referral

Team

Primary Care

Provider

Psychiatrist

Social Worker

Behavioral Health

Specialty Care

(PT/OT, Surgens

etc.Develop

communication processes that

match your level of

collaboration…

Health

Home

Medical Provider

PCP

Integrated

Health Psycholo

gist Mental Health

Specialists

Behavioral

Health Division

Specialty Providers

Integrationist Collaboration Across Silos

Treat Mod. to Sev. MH SymptConnection to CareContinuity of Care W BH Division

Behavioral Aspects – Health ConditionConsultation & Psycho-educationTreat Mild to Moderate MH