# Presentation: 788895

## Overview of Presentation

**Overview of the VISN 16 PCMH Program**
**Description of PCMH models**
**VISN 16 PCMH program outcomes**
**The Rest of the Story**

## South Central VA Health Care Network—VISN 16

## VISN 16 PCMH

- All ten sites participated
- Implementation of PCMH in at least one clinic in each VAMC
- Option of implementing:
- Care Management through TIDES
- Co-located integrated care
- Facilitation at the Network Level

**Notes:**
External Facilitator (0.25 FTEE)
Provider training and clinical support
Resource for tools that have been developed to facilitate PCMH implementation
Serves as an expert in the PCMH programs and general implementation facilitation techniques
Link to model developers
Provides analysis of barriers and facilitators to implementation

Internal Facilitator (0.5 FTEE GS-13 and 0.5 FTEE GS-9)
Resides within the VISN level clinical structure
Familiar with organization structures, climates, cultures and clinical settings within the network
Works directly with site level personnel
Ensures that programs incorporate new initiatives to maximize uniformity of services and fidelity to the programs
Allows the institutional knowledge gained from the implementation process to remain within the clinical network

## Scope and Clinical Roles:Co-Located Integrated Model

- Usually consists of a prescribing provider and therapist team
- Same Day visits
- See All Comers – with few restrictions on diagnosis
- Become part of the Primary Care Team
- 15-45 min structured assessment
- Medication and/or brief Psychotherapy
- Consultation with Primary Care Providers
- Chronic Severe patients referred to Specialty MH

## Scope and Clinical Roles

- Care Manager Model
- MDD, Alcohol Use
- Patient Education
- Symptom and Side Effect tracking
- Brief, Structured intervention
- Consultation/Weekly Supervision
- Primary Care Physician
- Team Psychiatrist

## Key TIDES Features 

- Focus is on patients with depressive disorders
- Mostly telephone
- Much appreciated by patients
- CPRS/VistA tools based
- Emphasis on patient self-management support
- Initial decisions and prescribing primarily in primary care
- Strong ties to mental health supervision

## VISN 16 PCMH Programs

## PCMH Provider Workload(June 2007 – May 2008)

| Site | Program |  Uniques | Encounters |
| --- | --- | --- | --- |
| 502 | Co-located |             42 |                61 |
| 520 | Co-located |         2,208 |            3,443 |
| 564 | Co-located |         1,292 |            2,003 |
| 580 | Co-located |           497 |              977 |
| 586 | Co-located |           433 |              515 |
| 623 | Co-located |           548 |              790 |
| 635 | Co-located |         1672 |            2813 |
| Total | Co-located |         6,692 |          10,602 |
| 598 | Care Management |           237 |              679 |
| 629  | Care Management |           288 |              572 |
| 667 | Care Management |           912 |            2,087 |
| Total | Care Management |         1,437 |            3,338 |

**TOTAL****	****	****	****                             8,129                      13,940**

## Uniques seen in PCMH

**91%**

**9%**

**10%**

**90%**

## PCMH Uniques Monthly

## MH Consults per Quarter

**Notes:**
As the program has progressed, this has not been as significant. 

## Program Evaluation

**VISN 16 PCMH Program**
**Received 5.3% of the FTEE supported nationally**
**Comprised 9.44% of PCMH productivity to date**