The responses from the PCMHs after the last Learning Sessions informed us that due to COVID they where screening and responding to more mental health concerns and wanted to have more resources, especially via the managed care
organizations or other alternate roles for their staff or initiation of hiring for integrated care to respond to this demand. The data shows an increase in tobacco use and the PCMHs are wanting workflows and counselling information to
standardize their processes.

Agenda:

8:30 a.m. to 8:45 a.m. – Welcome – Robert Ferguson, MPH, Chief Policy Officer, Pittsburgh Regional Health Initiative (PRHI)

8:45 a.m. to 9:45 a.m. – Presentation: Tobacco Cessation Counseling Services – Yvonne Kuhenbeaker, Manager, Health Promotions, American Lung Association in Pennsylvania

9:45 a.m. to 10:00 a.m. – Break

10:00 a.m. to 10:45 a.m. – Panel: Examples of How PCMHs, MCO Special Needs Units (SNUs), and the Behavioral and Physical Health Integrated Care Plan (ICP) Program Collaborate to Improve Whole Person Health 

Amie Hoffman, LCSW, MHA, Director of Behavioral Health Management, Geisinger Health Plan 
Scott Constantini, AVP of Primary Care and Recovery Services, The Wright Center

10:45 a.m. to 11:00 a.m. – Break

11:00 a.m. to 12:00 p.m. – Working Session: How to Refer Patients to Special Needs Units (SNUs) and Coordinate Whole Person Care with Integrated Care Plans (ICPs) to Improve Outcomes – Facilitated by Carol Frazer, LPC, Jen Condel, SCT(ASCP)MT, Pauline Taylor, and Robert Ferguson, PRHI 

MCOs: please be prepared to discuss:
How does your MCO send the ICPs to PCMHs?
If this process involves obtaining consents at the MCO-level to share information for care coordination purposes, which consent forms are used and for what purposes?
Does your MCO SNU team have a process for closing the loop on referrals from PCMHs?

PCMHs: please be prepared to discuss:
When you receive the ICP Plan, what actions and roles does this trigger to help patients follow-up on referrals to behavioral health treatment and community services?
How and when do you call the MCO SNU hotlines for your patients? What has been your experience when you make this referral and how have the SNUs helped your patients?

12:00 p.m. to 1:00 p.m. – Lunch

1:00 p.m. to 3:00 p.m. – Working Session: Why and How to Establish Roles and Competencies within Primary Care Settings to Follow-up and Care for Mental Health – Facilitated by Carol Frazer, LPC, Jen Condel, SCT(ASCP)MT, Pauline Taylor, and Robert Ferguson, PRHI 

PCMHs: please be prepared to discuss:

How does your PCMH introduce and describe the depression screen to patients either verbally, on the electronic screening form, or on the paper screening form?
What key messages and patient education materials do your providers use when reviewing positive depression screening results with patients?
What is your PCMH’s process and protocols for screening for and responding to suicide risk? Based on the regional sessions in the spring, what changes is your team considering?
How is your integrated care team configured (including credentials/type of provider and roles)? What challenges has your PCMH encountered and what has worked well?
If your PCMH team includes a behavioral health consultant or care manager, what is their standard work?
If your PCMH team includes a consulting psychiatrist, what is their standard work?
How does your PCMH team track the outcomes of the mental health treatment plan to inform adjustments to the care plan (e.g., contact frequency, treatment type such as psychotherapy and/or pharmacotherapy, medication changes, community services/supports, etc.). As a follow-up to the spring sessions, how is your team incorporating the Response and Remission measures into this process?

3:00 p.m. to 3:15 p.m. – Break

3:15 p.m. to 4:00 p.m. – Key Takeaways, Next Steps, and Wrap-Up

The PCMHs will have an opportunity to reflect and report out on their key takeaways, and complete the Depression Screening and Follow-up Survey for July 2022 to help prioritize next steps