1. BH Integration: from the ordinary to the extraordinary Beverly Hammerstrom MPCA Conference Traverse City, Michigan September 17, 2007

10. Prevalence of Psychiatric Disorders in Low-income PC Patients 7% 10% Eating Disorder 7% 17% Alcohol Abuse 11% 36% Anxiety Disorder 16% 33% Mood Disorder 28% 51% At least one psych DX General PC Low-income Disorder

16. Prevalence of Psychiatric Disorders in Low-income PC Patients 7% 10% Eating Disorder 7% 17% Alcohol Abuse 11% 36% Anxiety Disorder 16% 33% Mood Disorder 28% 51% At least One Psychiatric Dx General PC Population Low-income Patients Psychiatric Disorder

49. Doherty’s FIVE LEVELS OF COLLABORATION Doherty’s Five Levels, FULLY INTEGRATED ELECTRONIC HEALTH RECORD; NEED-TO-KNOW ACCESS FOR ALL PRACTITIONERS SHARED ALLEGIANCE TO BIOPSYCHOSOCIAL SYSTEMS PARADIGM NO COMMON LAN-GUAGE OR UNDER-STANDING OF OTHERS’ CULTURE LITTLE UNDERSTAND-ING OF OTHERS’ CULTURE SHARED VISION BASIC APPRECIA-TION OF OTHERS’ ROLE & CULLTURE APPRECIATION OF OTHERS’ ROLES LITTLE SHARED RESPONSIBILITY LIMITED COMMUNICATION REGULAR COLLABORATIVE TEAM MEETINGS SOME DATA SHARING BUT SEPARATE DATA SETS NO SYSTEMIC APPROACH TO COLLABORATION LINE STAFF WORK TOGETHER ON SOME CASES SEPARATE DATA SYSTEMS; LIMITED SHARING INTEGRATED FUNDING WITH RE-SOURCES SHARED ACROSS NEEDS; MAXIMIZATION OF BILLING AND SUPPORT STAFF SEPARATE FUNDING WITH SHARED ON-SITE EXPENSES; SHARED STAFFING & INFRASTRUCTURE COSTS PRIMARY CARE PHYSICIAN WORKS WITH CLINICIAN ON SITE RATHER THAN PSYCHIATRIST SEPARATE FUND-ING SYSTEMS SEPARATE FUND- ING SYSTEMS; NO RESOURCE SHARING SAME SYSTEMS; SEAMLESS; ONE TREATMENT PLAN; ON-GOING CONSULTATION COORDINATED TREATMENT PLAN; REGULAR FACE-TO-FACE INTERACTION TWO PHYSICIANS; TWO TREATMENT PLANS; SOME INTERACTION DUE TO PROXIMITY OCCASIONAL PLAN SHARING; SEPARATE & DISTINCT SERVICES SEPARATE AND DISTINCT TREATMENT PLAN AND SERVICES ONE FRONT DOOR; SHARED SITE; ONE VISIT FOR ALL NEEDS SHARED SITES SHARED FACILITY; MAY SHARE RECEPTION AREA TWO FRONT DOORS; SEPARATE FACILITIES TWO FRONT DOORS; SEPARATE FACILITIES CLOSE-FULLY INTEGRATED CLOSE-PARTLY INTEGRATED BASIC ON SITE BASIC AT DISTANCE BASIC

53. Continuum of Integration BH specialists primary care team members +++++ Integrated Care On-site/shared cases With BH specialist +++ Collaborative Care On-site BH Unit but Separate Team ++ Co-location Preferred Provider Some info exchange + Referral Relationship Traditional BH Specialty Model -- Separate Location and Mission Attributes Desirability Model

72. “ There is no try; only do.” Yoda Thank you.