7/6/2015
Turning Recovery & Resiliency Into Living Well℠
Integrated Community Healthcare
iCollaborative Care Approach
Pharmacy-Managed Treatment
Promising Impact
Pilot Results
Presenters today are:
 Richard Cervántes, PhD – People of Color Network, Evaluation Consultant and
President & CEO Behavioral Assessment, Inc. (BAI)
 Laurie Pierce, MA– Development Director
People of Color Network
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Background – Medication Compliance Issues
Serious Mental and Co-Occurring Disorder
Pilot Program Study funded by Magellan Health, Inc.
Background – Medication Compliance Issues
Serious Mental and Co-Occurring Disorder
 Participants are taking 3 behavioral and 4 physical
health medications on average
 Medication compliance issues are among the top
reason for re-admission and ED utilization
 Access to consultation, education for participants and
staff not readily available
 Communication and coordination of care among
healthcare professionals is fragmented
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Background – Medication Compliance Issues
Serious Mental and Co-Occurring Disorder
Medication Adherence: The patient’s conformance with
the provider’s recommendation with respect to timing,
dosage, and frequency of medication-taking during the
prescribed length of time
Compliance: Patient’s passive following of provider’s orders
Persistence: Duration of time patient takes medication,
from initiation to discontinuation of therapy
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Pilot Program Study funded by Magellan Health, Inc.
Background – Medication Compliance Issues
Serious Mental and Co-Occurring Disorder
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Background – Medication Compliance Issues
Serious Mental and Co-Occurring Disorder
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Pilot Program Study funded by Magellan Health, Inc.
iCollaborative Care Model
What makes this model different?
PCP/Specialist/
Hospital
Participant
Care Manager/
Coordinator/
Health Navigator
Other Behavioral
Health
Professionals
Substance Treatment, Housing,
Vocational, Rehabilitation,
Dental, Vision & Other
Community Resources
Core
Program
New Roles
Consulting
Psychiatrist,
Pharmacist,
PharmTech
Additional Clinic
Resources
Community
Resources
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7/6/2015
iCollaborative Care Approach
What makes this model different?
 Identify polypharmacy, super-utilizers
 Incorporate pharmacy treatment and managed care
strategy into the integrated collaborative care model
 Enhance coordination of care through Community
Health Coordinators and Health Navigators
 Facilitate collaborative care team communications
through GSI HealthCoordintor and NextGen
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
iCollaborative Care Approach
What make this model different?
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7/6/2015
Goals of the Study
Goals & Study Objective
Purpose of the Study is to determine the effectiveness of
the Coordinated Team approach toward managing SMI
patients
1.
2.
3.
4.
5.
6.
Aims include:
Increase compliance in use of medications
Decrease re-admissions to hospital and ER visits
Decrease psychiatric symptoms
Improve Quality of Life and Health Status
Improve Recovery Support
Increase Social Support Systems
Pilot Program Study funded by Magellan Health, Inc.
Goals of the Study
Evaluation Goals are to:
1. Reduce psychiatric symptoms in tx group A
2. Demonstrate better outcomes in tx group A when
compared to TAU group (B)
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Methods and Measures Used
 We have conducted a random sampling assignment from
over 600 cases.
 N=99 participants with SMI have been selected for the
iCollaborative Care Team approach while an additional
N=99 participants with SMI have been assigned to case
management services as usual.
 Participants are asked to complete a set of evaluation
forms when the program begins and then 6 months later.
 All records related to their participation will remain
strictly confidential.
Pilot Program Study funded by Magellan Health, Inc.
Methods and Measures Used




GSI data on hospital admissions
GSI data on ER visits
Increased Medication Compliance
Medical Outcomes Study (MOS) Social Support Survey – A 19item survey of functional support that represents multiple
dimensions of support: emotional/informational, tangible,
affectionate and positive social interaction.
 WHO Quality Of Life (WHOQOL-BREF) Survey - A crosscultural 26-item survey that is aimed at assessing the
individual's perceptions in the context of their culture and value
systems, and their personal goals, standards and concerns with
respect to health.
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Methods and Measures Used
 Staff CROS 3.0 Questionnaire – A 38-item questionnaire
that is comprised of subscales that measure the domains:
Hope for the Future, Daily Function, Coping with Clinical
Symptoms, and Quality of Life. It has 3 additional items
that relate to medication and substance use. The items are
rated on a 4-point Likert scale.
 Brief Symptom Inventory (BSI) Survey - A 48-item
mental health survey that contains a listing of common
behavioral and emotional problems with separate subscales derived to measure somatization, depression,
anxiety, obsessive-compulsive behavior, and psychoticism.
Pilot Program Study funded by Magellan Health, Inc.
Baseline Findings to Date
Characteristics of Study Patients
(Diagnosis; other behavioral problems)
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Baseline Findings to Date
Compliance Data and
Reasons for Non-Compliance
Medical Outcomes Study (MOS) Social Survey
Pilot Program Study funded by Magellan Health, Inc.
Baseline Findings to Date
Characteristics of Study Patients
WHO Quality of Life (WHOQOL-BREF) Survey
Subscales
Group A
Group B
Independent-Samples TTest
Physical
22.76
24.88
.350
Psychological
21.39
21.44
.945
Social
9.86
10.41
.358
Environment
26.76
28.48
.839
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Baseline Findings to Date
Characteristics of Study Patients
Staff CROS 3.0 Survey
Subscales
Group A
Group B
Independent-Samples TTest
Hope Scale
19.87
18.31
.063
Daily Function
22.78
22.12
.381
Coping
17.09
16.22
.688
Life Satisfaction
27.30
26.64
.746
Pilot Program Study funded by Magellan Health, Inc.
Baseline Findings to Date
Characteristics of Study Patients
Brief Symptom Inventory (BSI) Survey
Subscales
Group A
Group B
Independent-Samples TTest
Somatization
8.02
6.40
.757
ObsessiveCompulsive
9.35
8.53
.219
Interpersonal
Sensitivity
5.39
4.49
.122
Depression
7.33
6.35
.104
Anxiety
8.29
6.86
.071
Hostility
4.43
4.16
.220
Phobic Anxiety
6.70
4.47
.029
Paranoid Ideation
6.74
5.92
.408
Psychoticism
5.20
5.51
.379
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Baseline Findings to Date
Characteristics of Study Patients
Brief Symptom Inventory (BSI) Survey
Subscales
Group A
Group B
Independent-Samples TTest
Somatization
8.02
6.40
.757
ObsessiveCompulsive
9.35
8.53
.219
Interpersonal
Sensitivity
5.39
4.49
.122
Depression
7.33
6.35
.104
Anxiety
8.29
6.86
.071
Hostility
4.43
4.16
.220
Phobic Anxiety
6.70
4.47
.029
Paranoid Ideation
6.74
5.92
.408
Psychoticism
5.20
5.51
.379
Pilot Program Study funded by Magellan Health, Inc.
Baseline Findings to Date
Compliance Data and
Reasons for Non-Compliance
 30 patients
 Age Range 20 – 66
Pilot Program Study funded by Magellan Health, Inc.
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7/6/2015
Pharm. Case Management Reliability
Estimates (n=99)
WOHOQL
Constructs/Scales
# Items
Reliability
Physical Domain
(WOHOQL)
7
.752
Psychological Domain
(WOHOQL)
6
.810
Social Relationships
Domain (WOHOQL)
3
.716
Environment Domain
(WOHOQL)
8
.831
Neighborhood
Pharm. Case Management Reliability
Estimates (n=99)
BSI
# Items
Reliability
Somatization (BSI)
Constructs/Scales
7
.673
Obsessive-Compulsive
(BSI)
Interpersonal Sensitivity
(BSI)
Depression (BSI)
6
.843
4
.849
6
.902
Anxiety (BSI)
6
.885
Hostility (BSI)
5
.814
Phobic Anxiety (BSI)
5
.848
Paranoid Ideation (BSI)
5
.765
Psychoticism (BSI)
5
.656
Additional Items (BSI)
4
.691
Neighborhood
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7/6/2015
Pharm. Case Management Reliability
Estimates (n=99)
MOS
Constructs/Scales
# Items
Reliability
Emotional/Information
al Support (MOS)
8
.916
Tangible Support
(MOS)
4
.878
Affectionate Support
(MOS)
3
.922
Neighborhood
Pharm. Case Management Reliability
Estimates (n=99)
CROS
Constructs/Scales
# Items
Reliability
CROS -Hope Scale
7
.885
CROS - Daily Function
8
.804
CROS -Coping
6
.859
Neighborhood
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7/6/2015
Group A- With Missing Values
Replaced (n=46)
Outcome
Pretest
Mean
Posttest
Mean
T Statistic
Df value
Significance
Emotional/In
formational
Support
(MOS)
Tangible
Support
(MOS)
Affectionate
Support
(MOS)
Positive
Social
Interaction
(MOS)
31.04
28.18
1.55
44
.127
12.17
11.87
.35
45
.726
10.17
9.67
.68
45
.499
9.66
9.55
.17
44
.866
Neighborhood
Group A- With Missing Values
Replaced (n=46)
Outcome
Physical
Domain
(WHOQOL)
Psychological
Domain
(WHOQOL)
Social
Relationships
Domain
(WHOQOL)
Environment
Domain
(WHOQOL)
Physical
Domain
(WHOQOL)
Pretest
Mean
Posttest
Mean
T Statistic
Df value
Significance
22.76
23.40
-.83
45
.407
21.39
19.76
2.45
45
.018
9.87
9.28
1.32
45
.191
26.76
26.52
.23
45
.813
22.76
23.40
-.83
45
.407
Neighborhood
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7/6/2015
Group A- With Missing Values
Replaced (n=46)
Pretest
Mean
Posttest
Mean
T Statistic
Df value
Significance
Hope Scale
(CROS 3.0)
19.87
19.49
.52
45
.605
Daily
Functioning
(CROS 3.0)
22.77
23.57
-1.29
44
.203
Coping
(CROS 3.0)
17.08
16.46
.94
45
.350
Outcome
Neighborhood
Group A- With Missing Values
Replaced (n=46)
Outcome
Pretest
Mean
Posttest
Mean
T Statistic
Df
value
Significance
Somatization
(BSI)
ObsessiveCompulsive
(BSI)
Interpersonal
Sensitivity
(BSI)
Depression
(BSI)
Anxiety (BSI)
8.02
5.82
2.64
43
.011
9.34
7.65
2.14
45
.037
5.39
3.73
2.78
45
.008
7.32
5.21
2.44
45
.019
8.28
5.22
3.56
44
.001
Hostility (BSI)
4.43
3.62
1.31
45
.196
Phobic
Anxiety (BSI)
Paranoid
Ideation (BSI)
Psychoticism
(BSI)
Additional
Items (BSI)
Neighborhood
6.70
4.11
3.08
43
.004
6.74
5.53
1.58
45
.121
5.20
3.99
1.85
43
.070
4.93
3.24
2.93
44
.005
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7/6/2015
Group B- With Missing Values
Replaced (n=52)
Outcome
Pretest
Mean
Posttest
Mean
T Statistic
Df value
Significance
Emotional/In
formational
Support
(MOS)
Tangible
Support
(MOS)
Affectionate
Support
(MOS)
Positive
Social
Interaction
(MOS)
31.74
26.33
4.70
50
.000
12.23
12.74
-.638
51
.526
10.02
8.56
2.29
50
.026
10.21
9.12
1.97
51
.054
Neighborhood
Group B- With Missing Values
Replaced (n=52)
Outcome
Pretest
Mean
Posttest
Mean
T Statistic
Df value
Significance
Physical
Domain
(WHOQOL)
Psychologica
l Domain
(WHOQOL)
Social
Relationship
s Domain
(WHOQOL)
Environment
Domain
(WHOQOL)
24.88
23.93
1.32
51
.191
21.44
20.88
.800
51
.427
10.41
9.96
.887
47
.379
28.48
27.27
1.34
51
.185
Neighborhood
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7/6/2015
Group B- With Missing Values
Replaced (n=52)
Outcome
Pretest
Mean
Posttest
Mean
T Statistic
Df value
Significanc
e
Hope Scale
(CROS 3.0)
18.31
18.86
-1.72
50
.091
Daily
Functionin
g (CROS
3.0)
Coping
(CROS 3.0)
22.12
23.53
-1.58
49
.119
16.22
19.19
-4.26
49
.000
Life
Satisfaction
(CROS 3.0)
26.64
30.01
-3.13
50
.003
Neighborhood
Group B- With Missing Values
Replaced (n=52)
Outcome
Pretest
Mean
Posttest
Mean
T Statistic
Df value
Significance
Somatization (BSI)
6.40
5.57
.891
49
.377
ObsessiveCompulsive (BSI)
Interpersonal
Sensitivity (BSI)
Depression (BSI)
8.53
7.32
1.60
50
.114
4.49
3.84
1.04
50
.300
6.35
4.87
2.01
50
.050
Anxiety (BSI)
6.86
6.21
.78
50
.436
Hostility (BSI)
4.15
3.78
.655
50
.515
Phobic Anxiety
(BSI)
Paranoid Ideation
(BSI)
Psychoticism (BSI)
4.47
4.50
-.047
50
.963
5.92
5.40
.76
49
.451
5.51
4.06
2.50
48
.016
Additional Items
(BSI)
4.53
3.91
1.13
50
.263
Neighborhood
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7/6/2015
Conclusions
 Collaborative Team approaches for managing
medication adherence are needed
 Results from the randomized study show promise for
iCollaborative PharD. Case management
 Extended findings needed to determine cost savings
in terms of reduced hospitalizations and ER visits
Neighborhood
Questions & Answers
Ready. Set. Integrate!
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