GOBHI Gazette October 2018

Greetings! We here at GOBHI are working hard to support you in improving access, quality, and experience of care for all of our members. We would like to use this opportunity to familiarize you with programs that are available through GOBHI as well as ways that quality of care being measured, so that together we can find opportunities for improvement and track better care, better health and lower costs. We will also use this venue to share with you articles relevant to our works as providers on mental health in rural areas.

In this issue:

Federal grant spurs GOBHI telehealth expansion

Providers equipped with patient engagement software

In the era of smartphones and tablets, most patients still find themselves required to physically travel to clinics for health care services.

However, behavioral health professionals in rural Oregon are looking to buck the trend.

A three-year federal grant has helped position Greater Oregon Behavioral Health, Inc. to reduce the gap between patients and care by expanding telehealth services through GOBHI’s Community Mental Health Programs (CMHPs), and directly to patients’ homes.

The U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) has committed to GOBHI a total of $972,430 — effective from Sept. 1. 2018 to Aug. 31, 2021.

GOBHI will purchase and implement patient engagement software titled “Mend,” and make it available to its providers for use as part of their service delivery strategy, increasing outreach.

Mend’s secure video connection can share files, send messages, and collect any forms, photos, or data from a patient from a smartphone, tablet, or computer.

“The whole idea is connecting with patients wherever they are,” said Bonnie Thompson, GOBHI Director of Health System Improvements.

Telehealth implementation: ‘where’ and ‘when’

Sites participating in the first year of GOBHI’s telehealth expansion include:

Center for Human Development, (Union County), Community Counseling Solutions (Gilliam, Grant, Morrow, and Wheeler Counties), Lake District Wellness Center (Lake County), Lifeways (Malheur, Umatilla Counties), Mid-Columbia Center for Living (Hood River, Sherman, and Wasco Counties), New Directions Northwest (Baker County), Wallowa Valley Center for Wellness (Wallowa County), and GOBHI’s direct services.

In the program’s second and third year, services will expand to additional CMHPs. While GOBHI’s providers have a history of using telehealth technology, this program will represent a significant expansion.

GOBHI staff will take preparatory steps this fall to launch the telehealth expansion.

“We’re honored to take the lead on the project, keeping in mind that this is just the start,” said GOBHI CEO Kevin Campbell. “Nobody should feel isolated, or cut off from the help they need. Thankfully, telehealth opens a new range of innovative possibilities for reaching the population we serve.”

Provider considerations

The integration of telebehavioral health (TBH) into outpatient mental health facilities has been shown to increase member participation and reduce the number of barriers for member access.

Oregon does not provide many regulations or guidelines, however, there are national guidelines and best practices that should be followed to potentially increase member safety and decrease provider liability.

With the integration of TBH into standard practice, here are some things to consider when designing program structure, as well as delivering and documenting care:

  • Staff Competency– Who is appropriate to deliver TBH, and how do you document competency?
  • Policies and Procedures- Do you have P&P in place to inform staff, meet minimum national guidelines, and provide clients with accurate information about TBH service delivery?
  • Informed Consent- Does your current IC cover risks and benefits of TBH and incorporate elements to inform and protect your clients and agency?
  • Client Responsibilities- Are you going to include additional responsibilities for clients who receive TBH? What will they include? What will be an outcome of not meeting expectations?
  • Initial Assessments– Do you assess for all potential risks and provide evidence of TBH medical necessity?
  • Treatment Planning– Do your treatment plans include goals and objectives that can be met through the use of TBH?
  • Emergency Planning- Do you have appropriate emergency planning documented for each member?
  • Service Delivery Documentation– Do you take all safeguards to initial each session and ensure confidentiality with safe provisions of care? Do you have medical record templates/training to ensure all required elements are included for billing/encounter purposes?
  • Termination– Do you have a termination plan with the appropriate process for coordination of care?

Questions? Please contact:

Bonnie Thompson: 503-338-9074 | Bonnie.thompson@gobhi.net

GOBHI Membership Profile Highlights: Social Determinants of Health

GOBHI takes an in-depth look at the population it serves with its Membership Profile. The major goals are to assess the characteristics and needs of Members, including vulnerable subpopulations such as children and adolescents, individuals with disabilities and/or those diagnosed with Serious and Persistent Mental Illness (SPMI).

The profile (aka Population Assessment) is part of GOBHI’s National Committee of Quality Assurance processes.

In 2018, NCQA required managed behavioral health organizations like GOBHI to examine the Social Determinants of Health (SDOH) of their Members. This new requirement follows increasing attention to SDOH around the nation — including Oregon. To profile its Membership, this assessment looks at Members’ demographics, social and living settings, as well as clinical and cost-utilization profiles.

Profile highlights:

  • Among the 15 counties where GOBHI is the only organization that manages the behavioral health portion of the Oregon Health Plan, the portion of the entire county’s population is between 25% to 30%. However, in one county it is only 20% and in another 40%.
  • About one-third (33%) of GOBHI Members are part of its sub-delegate contract with Columbia Pacific CCO (CPCCO) while under two-thirds (62%) belong to Eastern Oregon CCO (EOCCO) — almost 5% of its Members are part of its Mental Health Organization (MHO).

  • Under 5% of GOBHI Members are over 65 years old while adults (19 to 64 yrs.) and children/youth (18 yrs. or under) are almost evenly divided (52% vs. 44% respectively). However, these developmental stages look different by Lines-of-Business. as shown in the Chart

Demographic details

  • Approximately one-third of all members belong to an ethnic minority group or to an “unknown” ethnic category, between 10% to 14% report using a language other than English.
  • The portion of children/youth under 18 years of age who live in households under 100% of the Federal Poverty Line in GOBHI-served counties ranges from 19% to 44%; five counties are notably higher (5% points or more) than the State and U.S. averages of about 20%.
  • Over one-third (35%) of CCO-enrolled GOBHI members were diagnosed with a behavioral health condition
  • Among its Members diagnosed with SPMI, 41% had a chronic health condition. The likelihood of having a chronic health condition was higher by a factor of 2 times or more among Members with SPMI compared to all Members.

Complex Care Management systems

The GOBHI Complex Care Management Program uses a customizable care management software platform which provides software tools, data analytics and support services to help streamline clinical and administrative processes. Those features include but are not limited to:

  • Risk Stratification and Predictive Modeling – an integrated predictive modeling engine using imbedded algorithms driven by evidenced-based guidelines and diagnosis-based risk methodology to automatically stratify patients by level of severity
  • Identifying Care Gaps –has more than 300 clinical care, behavioral health and medication-related evidence-based indicators to help identify gaps and other opportunities to improve member health
  • Up-to-date Care Management Framework – superior clinical content based on the Milliman Care Guidelines are updated annually to effectively guide the daily workflow of clinical staff

Specifically, the CCM Program uses a client-centric, holistic approach, encourages self-determination and self-care, integrates behavioral change science and principles, links with community resources and assists with navigating the health care system –within the framework of cultural competence and professional excellence. The program also promotes quality outcomes and has established periodic assessments to measure and track the outcomes. The roles of the Complex Care Managers are consistent with those outlined in the guidelines: assessment, care planning, communication and coordination, education, empowering and advocacy. The program also follows the Care Management process detailed in the guidelines: Member identification and selection, assessment and problem/opportunity identification, development of care plan, implementation of interventions, and evaluation of progress and termination of the Care management process.

For more information, view our Complex Care Management page →

GOBHI joins national effort targeting Quality Measures of Adolescent Depression

GOBHI is collaborating with the National Committee of Quality Assurance (NCQA), New York Office of Mental Health, New York University and Youth M.O.V.E National in a new quality improvement collaborative.

The National Collaborative for Innovation in Quality Measurement (NCINQ) is a consortium of organizations committed to advancing measurement of pediatric health care and is led with NCQA. With funding from AHRQ/CMS under the Pediatric Quality Measures Program, NCINQ will use national HEDIS measures to conduct a quality improvement collaborative to encourage judicious use of antipsychotic medications and better depression management in youth.

NCINQ is leading a quality improvement (QI) learning collaborative focused on depression management in adolescents. The two-year collaborative began in August 2018. Participants will use data gathered through national HEDIS reporting and electronic clinical data systems to examine performance and improvement on several quality measures. NCINQ will work with states and plans to conduct special data studies addressing key measurement and improvement questions. At the end of the collaborative, NCINQ will have: refined measure specifications with scientific acceptability, feasibility and usability at the provider, health plan and state levels; collected approaches for quality improvement including strategies, toolkits, successes and challenges; provided technical assistance and recommendations on the measures’ use in public reporting, accountability at different levels of reporting, and defined methods for benchmarking progress.

With the increased prevalence in adolescent depression and attention on patient-reported outcome measures, the NCQA adapted existing provider and practice level depression care quality measures for inclusion in HEDIS using data from electronic clinical data systems (ECDS). The measures were designed to address the continuum of care for depression — from population screening and follow-up for those who screen positive, to routine monitoring of symptoms using a standardized tool among those diagnosed with depression, to assessing important patient outcomes such as remission or improvement in symptoms over time.

Depression Care Measures for Adolescents

  • Depression Screening and Follow-up for Adolescents
  • Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents
  • Depression Remission or Response for Adolescents

Five Health plans:

  • Affinity Health Plan – New York
  • AmeriHealth Caritas – District of Columbia
  • CenCal Health – Santa Barbara & San Luis Obispo Counties, CA
  • Excellus – New York
  • GOBHI – Oregon

Spotlight Updates in Utilization Management

A change takes effect in Psychological and Neuropsychological Testing Authorization

Did you know that GOBHI now requires a pre-authorization for psychological and neuropsychological testing? As a specialty service, GOBHI’s Board of Directors approved the change, which took effect on April 1. Authorization decisions for psychological and neuropsychological testing are managed by GOBHI’s Utilization Management Team.

In order to submit an authorization request for psychological or neuropsychological testing, please visit the green “For Providers” tab at www.gobhi.org, then download and complete the “Utilization Management Psychological/Neuropsychological authorization form.”

Authorization forms and clinical documentation may be submitted to the GOBHI UM team by fax: (541) 298-7996 or secure email: um@gobhi.net.

Please enter CPT (Current Procedural Terminology) codes 96101 for psychological testing or 96118 for neuropsychological testing when filling out the authorization form. If you have any questions, please call the GOBHI Utilization Management Team at (541) 298-2101.

Vegetable prescription service expands in ‘frontier’ Oregon

GOBHI begins managing Frontier Veggie Rx in Gilliam, Harney, Sherman counties

A fruit and vegetable prescription program is sprouting up in rural Oregon.

Since July 1, Greater Oregon Behavioral Health, Inc. (GOBHI) has begun managing Frontier Veggie Rx in three counties.

GOBHI supported the program’s launch in Gilliam and Harney counties, and its continuation in Sherman County, where Gorge Grown Food Network previously operated the service.

The voucher program combats food insecurity in rural areas by connecting eligible low-income individuals and their families with prescriptions to buy fresh, healthy produce.

Local Community Advisory Councils (LCACs) affiliated with Eastern Oregon Coordinated Care Organization (EOCCO) identified the need for Frontier Veggie Rx. The LCACs provided funding for prescriptions and partnered with GOBHI as a contracted administrator to implement the program. LCACs are a group of volunteers in each EOCCO county. The councils advise on improving services and programs through the CCO and its providers. They also organize activities that engage EOCCO members in addressing health issues.

Caitlin Blagg, Sherman County Health District Administrator, said, “Veggie Rx has been very successful in our community and has helped bridge a gap in access to fresh fruits and vegetables. The local markets, both in Moro and Wasco, have been incredible partners in making sure fresh fruit and vegetables were available to patrons coming into the stores.”

Through Frontier Veggie Rx, individuals meet with their provider to discuss household eating and food shopping habits. If eligible, people may receive prescriptions to buy healthy fruits and vegetables at participating stores or farmers’ markets.

Teddy Fennern, Gilliam County Family Services Coordinator, explained that the LCAC heard about the
service’s success in neighboring Sherman County and decided to pursue the program.

“We wanted to do something to help the food insecure in our county and felt that this would be a great program to try out in Gilliam County,” Fennern said. “Overall, we hope to help in making families feel more secure and we also hope that people will become healthier overall by eating nutritious foods.”

Jennifer Bold, Condon Child Care Executive Director, said, “I am eager to launch programs that improve the quality of life for frontier families.”

“I’m ready to get started and look forward to seeing how this can work hand in hand with the enhanced food card for summer, as well as the take home bags for weekend meals,” Bold said, referring to how

Frontier Veggie Rx will supplement existing programs.

Participating retailers:
Gilliam County: Thrifty Food Center, Arlington. Two Boys’ Meat and Grocery Farmers’ Market, Condon.
Harney County: Grocery Outlet, Hines.
Sherman County: Huskey’s 97 Market, Mobile/Farmers’ Market; Moro. Grass Valley Country Market, Grass Valley. Wasco Market, Mobile Market; Wasco.
For questions about whether certain food items are approved or not, please speak with your cashier or call GOBHI at 541-298-2101.

Marci McMurphy, GOBHI, 541-298-2101

‘Camp GOBHI’ begins

Behavioral health nonprofit launches Wraparound program youth camp

Every youth should get the opportunity to experience summer camp, regardless of barriers they face in everyday life.

That belief helped inspire Greater Oregon Behavioral Health, Inc. to hold its first ever “Camp GOBHI” event in July.

The three-day camp brought together youth participants in the GOBHI Columbia County Wraparound program. Several dozen campers — ranging from ages 6-18 — took a 20-mile trip from the GOBHI St. Helens office to Camp Wilkerson.

Through nature, campers learned about the importance of trust, teamwork and self-expression.

Jamie Hamsa, GOBHI Wraparound Program Manager, described the camp as a secluded, safe place for youth to express themselves and take healthy risks.

“We wanted to give these youth a positive experience in a place where they can create a healthy, positive connection with caring adults and peers,” Hamsa said.

“That’s why we looked to the outdoors, knowing we had to take technology out of the picture. It’s all about helping them establish a connection with nature — and a space that’s all their own.”

“We wanted to give these youth a positive experience in a place where they can create a healthy, positive connection with caring adults and peers”
-Jamie Hamsa, GOBHI Wraparound Program Manager
Wraparound is an intensive, team-based planning process that follows a series of steps to help children, young adults, and their families accomplish their family vision. The voluntary program serves youth who may have complex behavioral health needs.

GOBHI, a nonprofit managed behavioral health organization, is an Oregon Health Plan administrator for Eastern Oregon Coordinated Care Organization and Columbia Pacific CCO. It also offers direct services like Wraparound, Therapeutic Foster Care and Applied Behavioral Analysis.

About 30 GOBHI staff members teamed up to chart “Camp GOBHI” logistics and make it a reality. Camp instructors led students in a series of rotating group activities and various stations enhancing youths’ connection to mind, body, spirit, nature and peers.

Crafts, athletics, and creative activities abounded.

Camper safety was a top priority for GOBHI when the organization took on this endeavor. Participants were assigned an animal group to ensure staff supervision and to give campers emotional safety in building trusting peer relationships that might continue after camp.

June Longway, camp nurse, cared for campers at a specialized medical tent. She noted the program was a success, in which all participants’ health needs were covered. SAFE of Columbia County Executive Director, Ellyn Bell, volunteered her time and skills as a Certified Trauma Informed Yoga Instructor.

Local Columbia County businesses generously donated meals and supplies to the program, including: The Bread Store, Columbia River Food Bank, Dahlgren’s, IGA, Pacific Stainless Products, Safeway, and Stano Chiropractic.

“We are grateful to have such caring staff and community members willing to put in the hard work to have made this undertaking possible,” Hamsa said. “You can’t always correlate preventative community based programs in making a difference, but we can only hope our positive intentions made
an impact for youth that attended camp.”

GOBHI, St. Helens 503-397-7919 | The Dalles 541-298-2101 info@gobhi.net