What is MHI

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What is MHI? What are key successes? How do we
engage families and the community?
Pascal Briot , MBA Brenda Reiss-Brennan, MS,
APRN, CS Brent James, MD, MStat Intermountain
Healthcare, USA The Future of Primary Care in
Europe October, 2006
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• What is Mental Health Integration?
• A process of care targeted at organizing a
  complex health concern .
• Clinical road map for diagnosis and EB treatment
  based on objective measures MHI team
• Operational work flow including timely
  affordable consultation and collaboration with
  mental health specialists and care management
• Coordination and consistency of clinical care
  and communication among all staff who have
  contact with the patient and family MHI Tools
• Family self management relational support
• Evaluation MHI Registry

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WHAT MATTERS MOST

• Reach Reduce Restore

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Primary Care (7 min.) Office Visit

• 58 y/o Cymbalta 60 mg Wellbutrin 150 mg Xanex
  prn
• Insomnia, pain agitation panic
• She has called your MA everyday requesting a
  medication change.
• Asthma, fibromyalgia and past substance abuse
  Previous failed MH and PCP
• She reports that her family and friends are tired
  of listening to her
• I cant work and I fail everything I try..my
  cravings are back

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Difficult to Reach Families

• Clinicians working with these families in a
  primary care setting become
• Exhausted
• Confused
• Apathetic
• Vulnerable to stigma
• Clinicians and support staff are
• in need of
• Support
• Consultation
• MH Map
• Family Pattern Profile

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The Clinical ModelTeam Roles Who does What
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MHI Treatment Cascade Care Management Sorting
Case Identification
MHI Packet
ROUTINE CARE PCP CM Responsive Family
Support GS1-3
COLLABORATIVE MHI TEAM Complex Co morbid
Family Isolated/Chaotic GS4-6
MHS Psych Co Morbidity Family Support Burden
Danger Risk GS6,7
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Mental Health Integration Treatment Cascade Model
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THE USE OF DATA TO MEASURE OUTCOMES
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MHI DEPRESSION REGISTRY OVERVIEW 2000 - 2005
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IMPROVED RATE OF DETECTION AT MHI CLINICSRate of
Detection for Adult Patient in Primary Care
Setting between Integrated and Non-Integrated
Clinics
1 ½ Year Lag
Pre-Intervention
Post-Intervention
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IMPROVEMENT IN PHQ-9 AT MHI CLINICSFOR ADULT
PATIENTS IN THE DEPRESSION REGISTRY FROM 2000 -
2005
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Differential in SSRI refill rates at MHI clinics
IMPROVEMENT IN THE REFILL RATE OF SSRI AT MHI
CLINICSFOR ADULTS PATIENT NEWLY DIAGNOSED WITH
DEPRESSION
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CONTAINMENT OVER MEDICAL COSTSTotal Claims Costs
for Adult Patients treated in MHI and non-MHI
clinics
1 ½ Year Lag
Pre-Intervention
Post-Intervention
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COST SHIFTING FOR PATIENTS AT MHI CLINICSCosts
of Patients in the depression registry in 2003 -
2005

• Health Plans commercially insured adult patients
  (lt 55 yoa) continuously enrolled 12 months
  before and 12 months after month of first
  selection in depression registry.
• Patients have no chronic comorbidities (diabetes,
  asthma, chf) and life events (maternity, cancer,
  trauma).
• All costs are allowed charges per patient per
  month in 1998 dollars discounted for medical
  trend and utilization.

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INTEGRATED MHI CLINICS vs NON-INTEGRATED
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HOW DATA IS USED AT AN MHI CLINIC (Example of a
Clinic Report)
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Employer Clinic (EAP patients)
Charity Care Clinic (uninsured patients)
Fed. Community Health Clinics (multi-ethnics
pts)
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ON THE INTERNET1 FOR PHYSICIANS
http//intermountainhealthcare.org/xp/public/clini
calprograms/primarycare/mentalhealth2 FOR
PATIENTS http//intermountainhealthcare.org/mental
health3 FOR CLINICAL TOOLS http//intermountai
nhealthcare.org/MHIBY VISITING INTERMOUNTAIN
HEALTHCARE IN SALT LAKE CITYCONTACT
pascal.briot_at_intermountainmail.org and
brenda.reiss-brennan_at_intermountainmail.org

THANK YOU
WHERE TO FIND MHI RESOURCES