Oregon : Integrating Health Services for People with Mental Illness or Substance Use Disorders

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Oregon : Integrating Health Services for People with Mental Illness or Substance Use Disorders Jeanene Smith MD, MPH Administrator, Oregon Health Policy and Research Oregon Health Authority June 2010

Why Integration? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Morbidity and Mortality in People with Serious Mental Illness Oct. 2006 http://www.nasmhpd.org/publicationsmeddir.cfm

Oregon’s current “Complicated” System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Demand versus ability to serve Age/Category Prevalence # served in Oregon’s public system Percent of need met Addictions 17 and under 26,765 6,635 25% Over 17 235,516 56,138 24% Mental Health 17 & under 105,306 34,617 33% Over 17 154,867 71,204 46% Problem Gambling All 76,839 4,743 6%

Why make changes now ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Oregon’s Path to Reform Improve the lifelong health all Oregonians Increase the quality, reliability and availability of care for all Oregonians Lower or contain the cost of care so it is affordable to everyone “ Triple Aim”

How will we know success? Mental Health/Substance Abuse “Triple Aim” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Guiding Principles for Oregon’s Demonstrations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Guiding Principles set the framework of demos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Governance Services Financing

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Central Oregon – “Links 4 Health” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Central Oregon Integration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Utilization in Central Oregon ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Northeastern Oregon Integration Demo ,[object Object],[object Object],[object Object],[object Object],[object Object]

NE Oregon Data ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Source: DHS/OHA - MMIS Fiscal Year 08-09

NE Oregon High Utilizers Patient Diagnosis Number Percent All three categories 12 63% Only PH and Pain 5 26% Only PH and MH 2 11% 47% 68% 74% 1st 1st or 2nd 1 st , 2 nd or 3rd Mental Health In Diagnosis Category

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Running head: ELECTRONIC MEDICAL RECORDS 1 ELECTRONIC MEDICAL RECORDS 4 ELECTRONIC MEDICAL RECORDS Student’s name: Professor’s name: Course title: Date ELECTRONIC MEDICAL RECORDS The public health department is faced with the challenge of record keeping since the state's health department will soon cease to maintain the electronic medical record system (EMR). The department is, therefore, having a hindrance in its workflow and supporting quality healthcare. The department will soon be unable to generate medical records about treatment gaps, immunization status reports and pharmacy utilization reports when the state cuts out its service. The department's revenue may not be enough to cater for the services, given that most of its revenue is generated from patients within the community where a majority are uninsured while the others are re in Medicaid or mediocre programs. From the given situation some questions need to be resolved. One is how to continue maintaining an electronic medical record without the state's services. The other is on how to raise revenue to cater for information technology services and training that the will no longer be given for free. Another question would be as for whether to join the insurer's network. Other than the uninsured, the department seems to serve patients who are in the insurer's Medicaid or Medicare program, hence joining the network would probably provide quality healthcare delivery. To improve the population health, one of the principles to be utilized is identifying priorities through looking at the health trends and the burden of illness by use of the population data. The action will allow the implementation of evidence-based actions to which will facilitate positive health outcomes. The current situation requires that proper management is observed to ensure that the limited available resources cater for the prioritized needs. Additionally, there should be created sustainable funding method which rewards improvement in population healthcare and prevention (Woolf et al. 2015). Funds directed towards population healthcare should be explicitly described for prioritized healthcare intervention. The department can increase its revenue by joining the insurer's network where there will be more insured patients and stop relying on direct patients. It can also improve financing through cost transparency which will reduce pharmaceutical costs by allowing drug costs negotiations by Medicare.It can also improve its quality healthcare through maintaining healthy healthcare systems; this means that evidence-based management must support the delivery of evidence-based care. The primary factor will, therefore, be information. Thus patients' real-time data must be obtained for purposes of maintaining a smooth workflow. Information will lead to making better decisions which will have a direct impact on better health outcomes. An integrated healthcare system will also be vital in improving health ...

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Community Needs Assessment Marion County Marion County Florida Located in Central Florida with a population of 343, 778. Marion county is in central Florida. 2 Social Determinants Factors included in this category, generational poverty, widespread homelessness, persistent issue of overweight and obesity, lack of affordable housing, shortage of healthcare and dental care providers, water fluoridation is lacking in most communities, struggling and failing schools, and built environment impedes access to recreation areas and safe places for physical activity. Addressing social determinants of health is important for improving health and reducing health disparities. 3 Marion County Most Utilized Hospitals Hospital NameNumber of DischargesFlorida Hospital Ocala15,739Ocala Regional Medical Center8,940West Marion Community6,532 Medical Resources Available Clinical and nutrition services Wellness programs Environmental health Infectious Disease services Clinical and nutrition services include - Supplements for women and children, immunizations throughout various locations within the county, dental services, family planning, and centers which treat sexually transmitted diseases. Wellness programs which include – disease prevention and management such as diabetes. Weight programs, children healthy promotional programs, and health education. Environmental health which includes - Environmental Health programs are essential to public health. They work to achieve a safe and healthy environment for the community. Environmental Health staff monitor conditions that could present a threat to health and safety of the public. Infectious Disease services which involves, The Florida Department of Health in Marion County is responsible for the surveillance of reportable communicable diseases, including enteric diseases, vaccine-preventable diseases, invasive bacterial diseases, arthropod-borne diseases, and others. Infectious disease control programs are designed to protect the residents and visitors of Marion County 5 Community Needs Assessment Marion County community needs include, access to primary prevention and healthcare, oral health, mental and behavioral health, education and training. Primary prevention efforts are focused on preventing illness and injury before it happens. Prevention includes environmental and policy change as well as education, behavior revision and lasting investments in systems that encourage healthy living. Oral health influences physical, emotional, and social well-being. Poor oral health causes pain and disability. With pain and disability hinders work and school which causes issues with attendance and performance. Oral issues will in turn costs residents, taxpayers and healthcare systems millions of dollars to treat. Mental and physical health are equally important factors for overall health and quality of life. Mental and behavior health includes emotional, psychological and social we ...

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