- Paul Thomlinson, PhD, Psychologist, Executive Director, Research, Compass Health Network, Springfield, MO
- Alan Stevens, MHA, Chief Operations Officer, Compass Health, Jefferson City, MO
- Michaela Muehlbach, PsyD, Deputy CCO Outpatient & Psychological Services, Compass Health Network, Jefferson City, MO
- Jennifer Lee, MSW, LCSW, Chief Quality Officer, Compass Health, Linton, MO
Background: Launched in 2017, Certified Community Behavioral Health Organizations (CCBHO) are required to provide evidence-based, integrated care for patients with complex health and behavioral health problems. Unlike FQHCs, CCBHOs have not been well understood by the larger national integrated care community. As such, our presentation will describe, from the perspective of Compass Health Network, the nation’s largest CCBHO as well as a multi-site FQHC: (1) CCBHO integration-related certification requirements, (2) evidence-based screening and treatment practices within the CCBHO/FQHC, (3) organization-wide CCBHO quality improvement metrics impacted by integrating care; and (4) improvements in quality measures and outcomes of patients receiving integrated care compared to those receiving exclusively primary care (PC) health services. Population sampled, procedure, measures, and design: Our data are pulled from two existing EHR systems, for a one-year window, and comprise the entirety of the patient population in the two programs (CCBHO/FQHC) that receive a single (PC) service (n=7,200) compared to the patients in both programs that receive PC and at least one additional integrated service (n=3,400; behavioral health, whether therapy, psychiatry, rehabilitation, and/or SUD treatment, is counted as one service). Our evaluation of CCBHO performance is based on required quality metrics, including SUD treatment engagement, medication adherence, hospitalization follow-up rates, and suicide risk assessment. Our FQHC analysis compares the standard UDS clinical measures defined by HRSA (e.g., BMI screening, tobacco screening and cessation, A1c, screening and follow up for depression, use of appropriate asthma medications). Patient ages for this analysis range from five to 65+, and include somewhat more females (55%) than males. The study design is an organization-wide quality improvement evaluation, assessing changes in a number of metrics longitudinally, corresponding to the implementation and ramp up period for CCBHO activities. Key results & conclusions: A comparison of the two groups on a set of 13 HRSA clinical metrics reveals that performance was significantly better for those patients receiving an additional service integrated with PC, according to a z-test for proportions (p<.05). Among that group five of 13 measures exceeded targets, whereas only one of 13 did so in the PC-only group. Additionally, each of the six CCBHO quality metrics exceeded targets by a statistically significant margin according to a series of z-tests (p<.05). Our conclusions are: (1) CCBHO standards are helping drive greater integration of services, (2) the organization is exceeding quality standards across the board, (3) a concerted focus on integration across CCBHO and FQHC appears to consistently lead to better outcomes, and (4) patients who engage in only PC are less likely to improve than those involved in more than one service line.
- Explain the significance, impact, and requirements of the Certified Community Behavioral Health Organization (CCBHO) movement regarding integration of care and deployment of relevant evidence-based practices (EBP).
- Describe the performance of a large CCBHO on a series of organization-wide quality improvement metrics including SUD treatment engagement, antipsychotic medication adherence, hospitalization follow-up rates, and suicide risk assessment.
- Describe the differences in outcome metrics at a large CCBHO between patients receiving integrated or collaborative care vs. relevantly similar patients receiving single-sector care.