Mental Health Screening and Case Management

Overview

Using in New, Referred & Testing/Tracking/CM Use Case - to be employed in testing, telehealth, phone triage, office visits, apps, and HIT communication & outreach to proactively screen populations for pandemic-related to:

1. Behavioral Health (PTSD, depression, anxiety, self-harm & suicidality)

1. Substance Use Disorders (Drugs & Alcohol)

1. Social Needs (Disease, Life & Living Density, Groceries & Hunger, Transportation, Access, Care, Medications, Equipment (NEW), Financial, Housing, Utilities & Other)

1. Safety Concerns (Domestic Violence, Intimate Partner Safety, Child Abuse & Community Violence)

Original CM Concept

Screening content to include demographic (age, gender), clinical (MH history, medical comorbidities) & SDOH [race, ethnicity, financial insecurity (housing, heat, food, medications) data elements. Patients with COVID-19 infection or community restrictions, etc.-- could include follow up for existing MH, housing/food/meds & safety related to health patients and for ill patients and family members.

Approach

1. Create a proactive Bio Psycho -Social Assessment of patients as a result of a pandemic from a wholistic case management perspective.

1. Use the

PHQ-2 Depression Screening Questionnaire - which could trigger a broader MH/D&A/Safety Screening Use Case.

1. Focus of existing content and structured data elements for rapid development & implementation. (e.g., PHQ-2 already part of an eCQM and implemented in EHRs)

2. Prioritize screening targets and implement in ambulatory care.

3. Questions

Prioritize screening targets

Our preference would be to screen everyone, yet that is not practical. Here is a list of potential priorities in no specific order:

·           Existing MH, Dual Diagnosis (MH & D&A) & D&A populations

·           Communities Significant Living & Disease Density, Social Distancing Restrictions & Violence

·           Patients with known healthcare access

·           Patients & Families with known severe C19

·           Referred from other providers Testing/Tracking/CM Use Case Telehealth

·           Other

Assessments

Psycho- 

Social -

Safety Concerns (NEW) -

Bio - Medical

Is there value to attempting to assessing Bio-Medical concepts on a cursory level? 

 Patient Identifiers and Contact Information:

·            Name

·            Address-- physical, facilities

·            Email

·            Cell phone

·            Phone 2

·            Emergency Contact

·            EC phone

·            DOB

·            MRN/ID

·            Link to family members?

Social Determinants of Health (SDOH) – intended to parallel the Triage/Testing/CM Use Case

eData Resources

 Look up COVID-19 Interoperability Alliance for Alignment/Supportive Content - from 8/28/2020

·            2020 MIPS eCQMs for MH

o    Eligible Clinicians

·            CMS2v9 0418e 134 Preventive Care and Screening: Screening for Depression and Follow-Up Plan

·            CMS128v8 Not Applicable 009 Anti-depressant Medication Management

·            CMS136v9 Not Applicable 366 Follow-Up Care for Children Prescribed ADHD Medication (ADD)

·            CMS137v8 Not Applicable 305 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

·            CMS159v8 0710e 370 Depression Remission at Twelve Months

·            CMS161v8 0104e 107 Adult Major Depressive Disorder (MDD): Suicide Risk Assessment

·            CMS177v8 1365e 382 Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment

o    Eligible Hospitals/CAHs

·            None

·            HEDIS Measures (not included in 2020 MIPS eCQMs)

Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS)

 ·            Need to look up other MH measures in CHIP, Claims/Registry, APA, etc

 ·            Consider using the PHQ-2 Depression Screening Questionnaire in the Testing/Tracking/CM Use Case - which could trigger a broader MH, D&A, & Safety Screenings (already part of an eCQM and implemented in EHRs)

 ·            AMA & UnitedHealth have created Z Codes for Social Determinants of Health may guide other health disparities content.

·            Other SDOH data elements

Testing/Tracking/CM Use Case (use as example as of 06.26.2020)

 YOUR HELP IS NEEDED!!!!

There is an increased interest in developing the Mental Health/Social/Safety Use Case (MHSS UC) for COVID-19.  To further explore the MHSS UC details, the Digital Ambulatory Solution (DAS) group needs your help identifying testing sites and interested stakeholders. To review, the MHSS UC is a diagnostic, social and safety assessment of population needs within the pandemic that may be triggered by the use of the PHQ-2 in the broader Case Management Use Case (CM UC), broad population screenings, or as part of “routine” care delivery with in-person and virtual care modalities. The premise of the MHSS UC is to develop content based on feasible electronically submitted data elements for DAS efforts. To meet this requirement, utilization of eCQM data elements will be employed. To develop and test the MHSS UC, we need to identify parties interested in developing and testing. The DAS Team would greatly appreciate your ideas and potential collaborators to invite to the 8/5 meeting to drill down the content.  

Meeting Content

8/12/2020 @ 2pm Initiate Requirements Build Out

1. Stakeholder Engagement (Clinicians, Informaticists, Programmers, Students, Measure Developers)

2. Communication

3. Requirement Documentation

4. Process Engine/Workflow Requirements

5. FHIR Resources or Data Models

6. Building Scripts

7. Data Elements & Value Sets

8. Graphic Design & User Interface

08.28.2020 @ 10am

Sharon provided Overview of Concept Development & Evolutions

Team Comments

Some sites are doing screening at various sites

We should consider a high threshold for screening - how do we identify high risk patients, isolation, increased comorbidities, anxiety-related, OCD beyond baseline, neurologic sequelae, etc?

PHQ-2/9 integrated and into processes in W. Texas.

Capture partnerships with APA - SAMHSA, VA

Decrease in documentation burden, challenge during surge or crisis

Pilot using technology approaches - text the patient - aligns with pandemic response network - incorporate into their approach

Who are the stakeholders? APA, SAMHSA, VA

NEXT STEPS

Sharon will to lead group to further explore, capture stakeholder partners, possibly create a survey to capture existing activity, consider level of inclusion into Case Management & Testing Use Case.