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August 2012
Chats on Change: Integrating Behavioral Health and Primary Care
Thank you for participating in the Chat on Change held August 29th. During the TweetChat, we were joined by Dr. Ben Miller and Dr. Gary Oftedahl to discuss challenges and advances in Integrating Behavioral Health and Primary Care, as well as the DIAMOND initiative that Dr. Oftedahl works on at ICSI. The Innovations Exchange also provided several examples of innovations and tools that relate to behavioral health and primary care during the chat.
Dr. Ben MillerBen Miller, PsyD is an Assistant Professor and the Director of the Office of Integrated Healthcare Research and Policy at the University of Colorado Denver School of Medicine. He focuses on studying the impact of colocated mental health, behavioral health and substance use in primary care settings. Dr. Miller is also responsible for integrating mental health across all three of the Department’s core mission areas: clinical, education, and research. He received his doctorate degree in clinical psychology from Spalding University in Louisville, Kentucky and completed his predoctoral internship at the University of Colorado Health Sciences Center, where he trained in primary care psychology.
Dr. Gary OftedahlGary Oftedahl, MD is the Chief Knowledge Officer at the Institute for Clinical Systems Improvement in Minneapolis where he helped develop DIAMOND, a new way to deliver and pay for care for patients with depression in primary care settings. His goal is to continue the journey of incorporating new ideas, concepts, and approaches into the health care system, working with others to make changes, and linking those who should and need to know each other in this work.

Complete Transcript of Event

AHRQIX: Our first TweetChat will begin shortly. We’ll be joined by @miller7 & @norskedoc to talk about behavioral health & primary care #ahrqix
Wed, 29 Aug 2012 19:53:13

AHRQIX: We're also joined by Judi Consalvo, Project Lead for the #Innovations Exchange. She'll be following along with us. #ahrqix
Wed, 29 Aug 2012 19:54:38

AHRQIX: We’re using #AHRQIX for the chat. Please include it in your tweets #ahrqix
Wed, 29 Aug 2012 19:56:12

AHRQIX: If you have a question and want to tweet during the chat, make sure your tweets are not protected. #ahrqix
Wed, 29 Aug 2012 19:57:31

IdaliaMassa: Looking forward to this discussion! #ahrqix
Wed, 29 Aug 2012 19:59:10

AHRQIX: We may collect, save & post transcripts from this chat on our site. See our privacy policy: http://t.co/Kli7t9Y6 #ahrqix
Wed, 29 Aug 2012 19:59:12

socialibriumm: Excited u r making a return for this chat! MT @norskedoc: have been away from Twitter for some time, will tweet away @ #AHRQIX chat #ahrqix
Wed, 29 Aug 2012 19:59:41

AHRQIX: . @miller7 and @norskedoc will be tweeting along with us, so please follow the stream of tweets at http://t.co/nPjhP01A #ahrqix
Wed, 29 Aug 2012 19:59:59

socialibriumm: RT @AHRQIX: We’re using #AHRQIX for the chat. Please include it in your tweets #ahrqix
Wed, 29 Aug 2012 20:00:38

AHRQIX: Welcome to our Twitter Chat to discuss behavioral health and #primarycare! #ahrqix
Wed, 29 Aug 2012 20:00:42

AHRQIX: I’m Nicole from the AHRQIX team & I’ll be moderating the @AHRQIX handle during this chat #ahrqix
Wed, 29 Aug 2012 20:01:07

AHRQIX: I’m also pleased to be joined today by Ben Miller (@miller7) and Gary Oftedahl (@norskedoc) #ahrqix
Wed, 29 Aug 2012 20:01:48

AHRQIX: Dr. Miller (@miller7) is an assistant professor at the Univ. of Colorado School of Medicine & will be hosting today’s chat #ahrqix
Wed, 29 Aug 2012 20:02:05

NACHC_Dirk: @AHRQIX Bill Reidy and Dirk Bokeloh listening in from @NACHC #AHRQIX
Wed, 29 Aug 2012 20:02:39

AHRQIX: He focuses on studying the impact of collocated mental health, #behavioralhealth & substance abuse in #primarycare settings #ahrqix
Wed, 29 Aug 2012 20:02:48

miller7: @NACHC_Dirk Welcome, Bill and Dirk! #AHRQIX Good to "see" you.
Wed, 29 Aug 2012 20:03:13

AHRQIX: Our guest is Gary Oftedahl (@norskedoc), who runs @ICSIorg’s DIAMOND program to improve #healthcare for people with #depression #ahrqix
Wed, 29 Aug 2012 20:03:18

AHRQIX: To learn more about DIAMOND, visit the website here: http://t.co/XQsHMLK2 #ahrqix
Wed, 29 Aug 2012 20:03:35

norskedoc: I'm here and as ready to go as I'll ever be. Welcome everyone. But it may be too strong to say I "run" the program. #AHRQIX
Wed, 29 Aug 2012 20:03:48

WestatHC: RT @AHRQIX: Welcome to our Twitter Chat to discuss behavioral health and #primarycare! #ahrqix
Wed, 29 Aug 2012 20:03:55

AHRQIX: . @miller7 and @ norskedoc will answer any of your more technical questions. Please note that we can’t provide medical advice. #ahrqix
Wed, 29 Aug 2012 20:03:59

AHRQIX: We're going to hand it off to @miller7 now -- take it away! #ahrqix
Wed, 29 Aug 2012 20:04:27

miller7: Welcome all to the first #AHRQIX tweetchat; I am looking forward to moderating today's exciting topic
Wed, 29 Aug 2012 20:04:35

2healthguru: @norskedoc what's this about Gary? #AHRQIX
Wed, 29 Aug 2012 20:04:38

norskedoc: DIAMOND is a huge example of a "collaborative approach, and we'll talk more about that as we go... #AHRQIX
Wed, 29 Aug 2012 20:04:42

miller7: @2healthguru @norskedoc Welcome, Gregg!! #AHRQIX
Wed, 29 Aug 2012 20:04:55

miller7: #AHRQIX stands for the AHRQ Innovations exchange: http://t.co/QOHsAFEe a place for #healthcare #innovation to be shared
Wed, 29 Aug 2012 20:05:01

norskedoc: STay tuned, we're trying something new... RT @2healthguru: @norskedoc what's this about Gary? #AHRQIX
Wed, 29 Aug 2012 20:05:10

miller7: #AHRQIX is an @AHRQNews sponsored project developed in partnership with @westatHC
Wed, 29 Aug 2012 20:05:16

miller7: Today’s #AHRQIX #healthcare #innovation will be on integrating #mentalhealth and #primarycare with a national expert, @norskedoc
Wed, 29 Aug 2012 20:05:40

WestatHC: RT @miller7: #AHRQIX is an @AHRQNews sponsored project developed in partnership with @westatHC
Wed, 29 Aug 2012 20:05:55

2healthguru: hey, hey, ho, ho! @miller7 @norskedoc #AHRQIX
Wed, 29 Aug 2012 20:06:12

miller7: For background on #mentalhealth and& #primarycare & why matters for #healthcare #innovation see here: http://t.co/TtQlO5fY #AHRQIX
Wed, 29 Aug 2012 20:06:22

DrFinnerty: RT @miller7: Welcome all to the first #AHRQIX tweetchat; I am looking forward to moderating today's exciting topic
Wed, 29 Aug 2012 20:06:25

DrFinnerty: RT @miller7: Today’s #AHRQIX #healthcare #innovation will be on integrating #mentalhealth and #primarycare with a national expert, @nors ...
Wed, 29 Aug 2012 20:06:32

miller7: @AHRQIX has addressed the integration topic directly here: http://t.co/sJkxmvbX #AHRQIX
Wed, 29 Aug 2012 20:06:44

ePatientDave: Hey Twitter: AHRQ Innovation Exchange has a live tweetchat going on right now! #AHRQIX URL: http://t.co/BYV6B5RY #ahrqix
Wed, 29 Aug 2012 20:06:49

ePatientDave: RT @miller7: Today’s #AHRQIX #healthcare #innovation will be on integrating #mentalhealth and #primarycare with a national expert, @nors ...
Wed, 29 Aug 2012 20:06:56

miller7: Let me tell you about today’s #AHRQIX tweetchat –focusing on integration, I will be asking our expert, @norskedoc questions as well as you
Wed, 29 Aug 2012 20:07:01

ePatientDave: RT @norskedoc: DIAMOND is a huge example of a "collaborative approach, and we'll talk more about that as we go... #AHRQIX
Wed, 29 Aug 2012 20:07:10

miller7: @ePatientDave Hey trouble, thanks for sharing! #AHRQIX
Wed, 29 Aug 2012 20:07:18

michaelrusso: RT @ePatientDave: Hey Twitter: AHRQ Innovation Exchange has a live tweetchat going on right now! #AHRQIX URL: http://t.co/BYV6B5RY #ahrqix
Wed, 29 Aug 2012 20:07:31

ePatientDave: RT @AHRQIX: Welcome to our Twitter Chat to discuss behavioral health and #primarycare! #ahrqix
Wed, 29 Aug 2012 20:07:34

norskedoc: @ePatientDave Hello Dave, not surprised to see you here...join in as you see fit. #AHRQIX
Wed, 29 Aug 2012 20:07:37

ePatientDave: RT @AHRQIX: To learn more about DIAMOND, visit the website here: http://t.co/XQsHMLK2 #ahrqix
Wed, 29 Aug 2012 20:07:41

socialibriumm: RT @ePatientDave: Hey Twitter: AHRQ Innovation Exchange has a live tweetchat going on right now! #AHRQIX URL: http://t.co/rNEPbl9i
#ahrqix
Wed, 29 Aug 2012 20:07:44

miller7: OK, let’s get this #AHRQIX tweetchat started with some introductions – who do we have here today?
Wed, 29 Aug 2012 20:07:44

2healthguru: RT @miller7: OK, let’s get this #AHRQIX tweetchat started with some introductions – who do we have here today?
Wed, 29 Aug 2012 20:07:57

ePatientDave: RT @miller7: #AHRQIX is an @AHRQNews sponsored project developed in partnership with @westatHC
Wed, 29 Aug 2012 20:08:24

MsWZ: Happy to join #AHRQIX today!
Wed, 29 Aug 2012 20:09:09

miller7: I am Ben, moderating #AHRQIX today; blog here: http://t.co/LVYjJlLk and jealous of @DanaMlewis #hcsm moderating skills
Wed, 29 Aug 2012 20:09:10

MsWZ: RT @ePatientDave: Hey Twitter: AHRQ Innovation Exchange has a live tweetchat going on right now! #AHRQIX URL: http://t.co/BYV6B5RY #ahrqix
Wed, 29 Aug 2012 20:09:17

miller7: @MsWZ Welcome, Whitney! #AHRQIX
Wed, 29 Aug 2012 20:09:26

HealthJusticeCT: @drzoobs, this may be of interest MT @miller7: Today’s #AHRQIX #healthcare #innovation will be on integrating #mentalhealth & #primarycare
Wed, 29 Aug 2012 20:09:51

yayayarndiva: RT @miller7: #AHRQIX stands for the AHRQ Innovations exchange: http://t.co/QOHsAFEe a place for #healthcare #innovation to be shared
Wed, 29 Aug 2012 20:09:52

norskedoc: I'm Gary, and I'm just jealous in general, but interested in sharing our experiences with DIAMOND and where it's going... #AHRQIX
Wed, 29 Aug 2012 20:10:05

MsWZ: RT @miller7: I am Ben, moderating #AHRQIX today; blog here: http://t.co/LVYjJlLk and jealous of @DanaMlewis #hcsm moderating skills
Wed, 29 Aug 2012 20:10:19

2healthguru: Tweep alert! follow #ahrqix for a tweetchat moderated by the very capable @miller7 & @norskedoc
Wed, 29 Aug 2012 20:10:26

norskedoc: Compliments appreciated... RT @2healthguru: Tweep alert! follow #ahrqix for a tweetchat moderated by the very capable @miller7 & @norskedoc
Wed, 29 Aug 2012 20:10:54

lauranewmanny: looking forward to more substantive discussion soon! #ahrqix
Wed, 29 Aug 2012 20:11:01

miller7: Let's get started here with Let’s start with @norskedoc – tell us why addressing #mentalhealth in #primarycare is so important #AHRQIX
Wed, 29 Aug 2012 20:11:07

norskedoc: Primary care is in reality the de facto mental health provider for many—need to become more proficient. http://t.co/eudGfWQ7 #AHRQIX
Wed, 29 Aug 2012 20:11:50

norskedoc: Experience in 2003-4 at ICSI identified huge gap in depression mgmt in primary care—drove early work. #AHRQIX
Wed, 29 Aug 2012 20:12:02

miller7: MT @norskedoc: #Primarycare is de facto #mentalhealth provider for many—need to become more proficient. http://t.co/L1KNwgk0 #AHRQIX
Wed, 29 Aug 2012 20:12:19

norskedoc: Unique “partnership research” approach of DIAMOND highlighted combining implementation science and research. http://t.co/kjjBF4Us #AHRQIX
Wed, 29 Aug 2012 20:12:32

miller7: Those joining us here what have your experiences been with #mentalhealth and #primarycare? #AHRQIX
Wed, 29 Aug 2012 20:13:18

norskedoc: We spent over 3 years identifying many challenges faced in managing depression in primary care, which required different approach. #ahrqix
Wed, 29 Aug 2012 20:13:38

2healthguru: RT @norskedoc: Experience in 2003-4 at ICSI identified huge gap in depression mgmt in primary care—drove early work. #AHRQIX
Wed, 29 Aug 2012 20:14:00

norskedoc: In visiting many of primary clinics in 2003-4, identified lack of interest or model for addressing depression. Quite frustrating. #ahrqix
Wed, 29 Aug 2012 20:14:49

laura3530: RT @ePatientDave: Hey Twitter: AHRQ Innovation Exchange has a live tweetchat going on right now! #AHRQIX URL: http://t.co/BYV6B5RY #ahrqix
Wed, 29 Aug 2012 20:15:04

miller7: @norskedoc What were some of the reasons they gave you as to why they were not interested? #AHRQIX
Wed, 29 Aug 2012 20:15:31

AHRQIX: Integrated #behavioralhealth reduces #depression & anxiety, improves quality of life and reduces costs http://t.co/YgIOTccR #ahrqix
Wed, 29 Aug 2012 20:15:52

laura3530: RT @AHRQNews: Join @AHRQIX live on the state of behavioral health & primary care. Today at 4PM ET. Use #AHRQIX to join!
Wed, 29 Aug 2012 20:15:53

2healthguru: @norskedoc Gary, you are talking to me my friend! #ahrqix
Wed, 29 Aug 2012 20:15:57

norskedoc: Perhaps that term actually represented discomfort with topic, lack of clear model or approach to use. #ahrqix
Wed, 29 Aug 2012 20:16:12

norskedoc: Also, for many, there had not been a great deal of training or experience with mental health conditions. #ahrqix
Wed, 29 Aug 2012 20:16:39

norskedoc: Third, the "stigma" which was associated with condition had a suppressive effect on even addressing. #ahrqix
Wed, 29 Aug 2012 20:17:10

miller7: MT @norskedoc: Also, for many (#primarycare), there was not great deal of training or experience with mental health conditions. #ahrqix
Wed, 29 Aug 2012 20:17:20

2healthguru: RT @norskedoc: Third, the "stigma" which was associated with condition had a suppressive effect on even addressing. #ahrqix
Wed, 29 Aug 2012 20:17:27

socialibriumm: RT @AHRQIX: Integrated #behavioralhealth reduces #depression & anxiety, improves quality of life reduces costs http://t.co/nWPDxWU1 #ahrqix
Wed, 29 Aug 2012 20:17:35

kennylinafp: Primary care clinicians are good at prescribing drugs for depression, not so good at cognitive therapy. #ahrqix
Wed, 29 Aug 2012 20:17:43

norskedoc: Also, in many cases, past history of "carve out" which precluded payment if prim care MD diagnosed depression...all contributed. #ahrqix
Wed, 29 Aug 2012 20:17:53

AHRQIX: Placing #mentalhealth specialists in #primarycare settings enhances engagement & produces favorable results http://t.co/GChmDNTy #ahrqix
Wed, 29 Aug 2012 20:18:04

norskedoc: @kennylinafp Your comment on prescriptions bespeaks of an additional issue, which we've confronted. #ahrqix
Wed, 29 Aug 2012 20:18:28

miller7: @kennylinafp This is often do to training and limitations placed on them by the #healthcare system? #AHRQIX
Wed, 29 Aug 2012 20:18:32

2healthguru: @norskedoc yup, carveout and cap. great way to pass buck! #ahrqix
Wed, 29 Aug 2012 20:18:58

miller7: @2healthguru What ways do you see to tackle the issue, Gregg? #AHRQIX
Wed, 29 Aug 2012 20:19:25

2healthguru: And completely miss point of behavioral medicine. #ahrqix
Wed, 29 Aug 2012 20:19:39

norskedoc: I could go on, but suffice it to say we identified many barriers, which supported what I call "learned helplessness." #ahrqix
Wed, 29 Aug 2012 20:19:42

kennylinafp: @miller7 Yes, agree. Would be great to be able to place mental health professionals in community primarycare offices. #ahrqix
Wed, 29 Aug 2012 20:20:03

AHRQIX: Collaboration between #mentalhealth & #primarycare: A planning & implementation toolkit for HCPs http://t.co/tPBPfcd1 #ahrqix
Wed, 29 Aug 2012 20:20:25

2healthguru: RT @miller7: What ways do you see to tackle the issue, Gregg? #AHRQIX > parity and real team based care. population perspective!
Wed, 29 Aug 2012 20:20:28

TDSHealth: RT @ePatientDave: Hey Twitter: AHRQ Innovation Exchange has a live tweetchat going on right now! #AHRQIX URL: http://t.co/BYV6B5RY #ahrqix
Wed, 29 Aug 2012 20:20:30

miller7: RT @kennylinafp: Yes, agree. Would be great to be able to place mental health professionals in community #primarycare offices. #ahrqix
Wed, 29 Aug 2012 20:20:38

kennylinafp: @AHRQIX This model can work in academic and govt settings - has it been tried outside of those? #ahrqix
Wed, 29 Aug 2012 20:20:42

norskedoc: DIAMOND arose from early work at ICSI in 2004-5, identified evidence based model, IMPACT http://t.co/egZvMZ6l #AHRQIX
Wed, 29 Aug 2012 20:21:18

2healthguru: @miller7 single driver of Rx or Tx compliance?? >> mood! #ahrqix
Wed, 29 Aug 2012 20:21:53

laura3530: Any tips for how providers can incorporate #BH integration into their other #PCMH practice change intiatives #ahrqix
Wed, 29 Aug 2012 20:21:55

miller7: @kennylinafp Absolutely! Look at the DIAMOND program @norskedoc is talking about http://t.co/9KLft96Z #AHRQIX
Wed, 29 Aug 2012 20:22:09

miller7: @laura3530 Welcome, Laura! #AHRQIX
Wed, 29 Aug 2012 20:22:19

norskedoc: Important to note that DIAMOND used psychiatrist as "liaison" in panel mgmt, care manager, not behavioral health trained... #ahrqix
Wed, 29 Aug 2012 20:22:41

2healthguru: @norskedoc for political or clinical reasons? just curious....#ahrqix
Wed, 29 Aug 2012 20:23:33

norskedoc: DIAMOND built on idea (Wagner's CCM), an invention (IMPACT) but moved to innovation--scalable, financially sustainable. #ahrqix
Wed, 29 Aug 2012 20:23:40

IdaliaMassa: why psychiatrists and not psychologists? #ahrqix
Wed, 29 Aug 2012 20:24:01

norskedoc: @2healthguru If you're questioning the use of psychiatrists, it was because that was the evidence based model available (IMPACT). #ahrqix
Wed, 29 Aug 2012 20:24:31

miller7: @laura3530 @AHRQNews had a nice white paper that discussed why integrate #mentalhealth and #PCMH http://t.co/r7CuU4Kh (pdf) #AHRQIX
Wed, 29 Aug 2012 20:24:40

norskedoc: Again, b/c we were attempting to take an EBM model, and implement...RT @IdaliaMassa: why psychiatrists and not psychologists? #ahrqix
Wed, 29 Aug 2012 20:25:18

norskedoc: Some questioned the use of psychology vs. psychiatrist, but felt need to have fidelity to Unutzer's IMPACT model to engage payers. #ahrqix
Wed, 29 Aug 2012 20:26:13

miller7: Those interested in the evidence for what @norskedoc is talking about can look here http://t.co/aT9Dq2DY #AHRQIX
Wed, 29 Aug 2012 20:26:19

2healthguru: RT @miller7: Those interested in the evidence for what @norskedoc is talking about can look here http://t.co/aT9Dq2DY #AHRQIX
Wed, 29 Aug 2012 20:26:51

norskedoc: I apologize if I'm jumping around but trying to keep up with the great comments, and challenged in 140 characters. #ahrqix
Wed, 29 Aug 2012 20:27:15

norskedoc: Also important to note that care manager role is served in many of DIAMOND clinics by CMA--with supervision, with great success. #ahrqix
Wed, 29 Aug 2012 20:27:54

miller7: @norskedoc With this unique approach what were some of the challenges of implementing DIAMOND? #AHRQIX
Wed, 29 Aug 2012 20:28:12

norskedoc: ICSI provided training, based on IMPACT training for all sites (over 80) which implemented DIAMOND, and have sustained support. #ahrqix
Wed, 29 Aug 2012 20:28:38

norskedoc: With regard to challenges, many, and I'll try to list a few... first, needed to get critical mass of payers to come to table . #ahrqix
Wed, 29 Aug 2012 20:29:39

norskedoc: Need to address needed payment model redesign in face of antitrust issues, and engaging multiple commercial payers #AHRQIX
Wed, 29 Aug 2012 20:29:45

norskedoc: Significant professional cultural differences between primary care and mental health are challenge to address. #AHRQIX
Wed, 29 Aug 2012 20:30:07

miller7: Yes! RT @norskedoc: Significant professional cultural differences between #primarycare & #mentalhealth are challenge to address. #AHRQIX
Wed, 29 Aug 2012 20:30:27

AHRQIX: To read more about Unutzer's IMPACT model, check out the Q&A on our website: http://t.co/SD4t6HWE #ahrqix
Wed, 29 Aug 2012 20:30:37

norskedoc: Engaging psychiatrist in a “liaison” role, managing patient panels, not direct pt. contact was major challenge to existing roles. #AHRQIX
Wed, 29 Aug 2012 20:30:45

ePatientDave: @miller7 What's the URL to the half-day town hall on integration, from AHRQ's annual meeting? #ahrqix
Wed, 29 Aug 2012 20:31:20

norskedoc: Providing set of tools for diverse primary care practices in different settings was challenge. http://t.co/269uX1sE #AHRQIX
Wed, 29 Aug 2012 20:31:25

miller7: @ePatientDave http://t.co/TLh1m1KC #AHRQIX
Wed, 29 Aug 2012 20:32:10

norskedoc: Despite successes, inability to engage CMS and provide coverage for Medicare patients limited implementation. #AHRQIX
Wed, 29 Aug 2012 20:32:12

norskedoc: While we had the commercial payers supporting this effort, not engaging CMS limited creating systemic approach needed for some. #ahrqix
Wed, 29 Aug 2012 20:32:49

norskedoc: Initially, we encountered some negative reaction from mental health providers, fearing we were intruding on their turf. #ahrqix
Wed, 29 Aug 2012 20:33:20

socialibriumm: RT @AHRQIX: To read more about Unutzers IMPACT model, check out the Q&A on our website: http://t.co/v2fSNwEn #ahrqix
Wed, 29 Aug 2012 20:33:22

miller7: @mellojonny Awesome! Do you have links we can see about this approach? #AHRQIX
Wed, 29 Aug 2012 20:33:31

norskedoc: However, we've overcome that and actually are training many BH clinics in MN in collaborative model, CQI. #ahrqix
Wed, 29 Aug 2012 20:33:56

mellojonny: Majority of our schizophrenic patients are managed by ourselves. We meet with local psychiatry every 6w @miller7 @kennylinafp #ahrqix
Wed, 29 Aug 2012 20:34:28

norskedoc: Important to understand ICSI role as "neutral convener" and catalyst for the multiple conversations needed over a 2 yr planning. #ahrqix
Wed, 29 Aug 2012 20:34:33

AHRQIX: Better access to care for low-income people with mental illness leads to improved physical & #mentalhealth http://t.co/ysAMZt56 #ahrqix
Wed, 29 Aug 2012 20:35:03

norskedoc: Unique “partnership research” approach of DIAMOND highlighted combining implementation science and research. http://t.co/kjjBF4Us #AHRQIX
Wed, 29 Aug 2012 20:35:23

MsWZ: RT @socialibriumm: RT @AHRQIX: To read more about Unutzers IMPACT model, check out the Q&A on our website: http://t.co/v2fSNwEn #ahrqix
Wed, 29 Aug 2012 20:35:30

miller7: @mellojonny Is 6 weeks sufficient? How much of this is due to system model vs. available workforce? #AHRQIX
Wed, 29 Aug 2012 20:35:30

mellojonny: We care for nearly 100 patients on methadone out of practice pop of 12k & 84 with schizophrenia plus diabetes @miller7 @kennylinafp #ahrqix
Wed, 29 Aug 2012 20:35:51

MsWZ: RT @norskedoc: Need to address needed payment model redesign in face of anti-trust issues, and engaging multiple commercial payers #AHRQIX
Wed, 29 Aug 2012 20:36:01

norskedoc: One of true accomplishments of DIAMOND was getting prim. care and BH into same room, beginning to address issues. #ahrqix
Wed, 29 Aug 2012 20:36:51

miller7: MT @norskedoc: One of true accomplishments of DIAMOND was getting #primarycare and BH in same room, begin to address issues. #ahrqix
Wed, 29 Aug 2012 20:37:23

MsWZ: what were the first steps to intro this new approach to payers @norskedoc? Did they want evidence? Partners? Patients? #AHRQIX
Wed, 29 Aug 2012 20:37:35

reitzrandall: I've been following the #AHRQIX tweet chat. Great data and resources. #CFHA
Wed, 29 Aug 2012 20:37:37

mellojonny: 6 weeks works fine. Here is gateway info for local #primarycare practices & mental health services @miller7 #ahrqix
Wed, 29 Aug 2012 20:37:43

norskedoc: Also, while some criticize for single disease approach, I believe this allowed prim. care to "succeed" in BH issue. #ahrqix
Wed, 29 Aug 2012 20:37:48

2healthguru: RT @norskedoc: Despite successes, inability to engage CMS and provide coverage for Medicare patients limited implementation. #AHRQIX
Wed, 29 Aug 2012 20:37:50

miller7: @reitzrandall Welcome, Randall. #AHRQIX
Wed, 29 Aug 2012 20:37:51

kennylinafp: MT @AHRQIX: Better access to care for low-income people with mental illness improves physical & #mentalhealth http://t.co/VcRR6LFG #ahrqix
Wed, 29 Aug 2012 20:37:56

JuliaPronx: RT @mellojonny: 6 weeks works fine. Here is gateway info for local #primarycare practices & mental health services @miller7 #ahrqix
Wed, 29 Aug 2012 20:38:06

AHRQIX: Re: methadone -- A #Baltimore initiative expands access to heroin treatment through partnerships & trainings http://t.co/XiFebTPu #ahrqix
Wed, 29 Aug 2012 20:38:22

2healthguru: RT @norskedoc: However, we've overcome that and actually are training many BH clinics in MN in collaborative model, CQI. #ahrqix
Wed, 29 Aug 2012 20:38:25

norskedoc: For many, successfully implementing DIAMOND was basis for proceeding with medical home work--many of same issues, different topic. #ahrqix
Wed, 29 Aug 2012 20:38:25

yayayarndiva: RT @AHRQIX: To learn more about DIAMOND, visit the website here: http://t.co/XQsHMLK2 #ahrqix
Wed, 29 Aug 2012 20:38:41

kennylinafp: Great! RT @mellojonny: We care for nearly 100 patients onmethadone out of practice pop of 12k & 84 with schizophrenia plus diabetes #ahrqix
Wed, 29 Aug 2012 20:38:45

2healthguru: RT @norskedoc: Need to address needed payment model redesign in face of anti-trust issues, and engaging multiple commercial payers #AHRQIX
Wed, 29 Aug 2012 20:39:07

miller7: It appears that experts have called for #mentalhealth #primarycare integration for some time http://t.co/meQRliir #AHRQIX
Wed, 29 Aug 2012 20:39:12

2healthguru: RT @norskedoc: One of true accomplishments of DIAMOND was getting prim. care and BH into same room, beginning to address issues. #ahrqix
Wed, 29 Aug 2012 20:39:16

norskedoc: In approaching payers, they wanted evidence of success, but extremely focused on total cost of care, potential savings. #ahrqix
Wed, 29 Aug 2012 20:39:19

2healthguru: RT @norskedoc: Also, while some criticize for single disease approach, I believe this allowed prim. care to "succeed" in BH issue. #ahrqix
Wed, 29 Aug 2012 20:39:40

norskedoc: We are still collecting cost data, and as often with research, that lags behind our implementation--can be a problem. #ahrqix
Wed, 29 Aug 2012 20:39:54

mellojonny: This is the medically unexplained symptom/ psychology service set up with the Tavistock http://t.co/J4MWndFr @miller7 #ahrqix
Wed, 29 Aug 2012 20:40:22

reitzrandall: Dr Lin's point about acad and safety-net is an important. The only system-wide solution is insurance reform of the PCMH variety. #AHRQIX
Wed, 29 Aug 2012 20:40:41

miller7: Wow, what excellent information - @norskedoc! Where is DIAMOND headed & how do you foresee changing #healthcare policy? #AHRQIX
Wed, 29 Aug 2012 20:40:42

norskedoc: In 2006, we were able to engage payers, b/c the gap btw where we were and where we needed to be was so huge.. #ahrqix
Wed, 29 Aug 2012 20:40:57

AHRQIX: Onsite care teams enhance access to medical & #mentalhealth / substance abuse services for the homeless http://t.co/hvQCy8c1 #ahrqix
Wed, 29 Aug 2012 20:40:59

bernmck06: Success stories?#ahrqix
Wed, 29 Aug 2012 20:41:05

miller7: @reitzrandall @kennylinafp Absolutely! Payment reform important for integration! #AHRQIX
Wed, 29 Aug 2012 20:41:32

norskedoc: I'm often amazed at where DIAMOND has brought us and where it's going....will highlight a few of what I think are outcomes. #ahrqix
Wed, 29 Aug 2012 20:41:32

kennylinafp: MT @reitzrandall: Point about acad and safety-net is important. Only system-wide solution is insurance reform of #PCMH variety. #ahrqix
Wed, 29 Aug 2012 20:41:55

norskedoc: First, if nothing else, there's less "stigma" surrounding depression b/c of our work, many don't even see that, but it's real. #ahrqix
Wed, 29 Aug 2012 20:42:03

miller7: @bernmck06 We are hearing more and more success stories weekly! One example from #Colorado http://t.co/QBSOEOq7 #AHRQIX
Wed, 29 Aug 2012 20:42:28

MsWZ: RT @miller7: @reitzrandall @kennylinafp Absolutely! Payment reform important for integration! #AHRQIX
Wed, 29 Aug 2012 20:42:35

norskedoc: Second, as a result of DIAMOND, we're extending this approach with 2 partners in AHRQ grant using SBIRT, for substance abuse. #ahrqix
Wed, 29 Aug 2012 20:42:58

mellojonny: Every generalist is (or ought to be) a medically-unexplained symptom specialist! http://t.co/erv3lyCV @miller7 #ahrqix
Wed, 29 Aug 2012 20:43:22

2healthguru: @norskedoc insome academic settings, family medicine considered not a real specialty. whereas psychiatry is merely tolerated..#ahrqix
Wed, 29 Aug 2012 20:43:23

norskedoc: Third, DIAMOND exemplifies the "team" approach, has prepped many for medical home. #ahrqix
Wed, 29 Aug 2012 20:43:31

MsWZ: RT @miller7: @bernmck06 We are hearing more and more success stories weekly! One example from #Colorado http://t.co/QBSOEOq7 #AHRQIX
Wed, 29 Aug 2012 20:43:32

miller7: RT @mellojonny: Every generalist is (or ought to be) a medically unexplained symptom specialist! http://t.co/ulyB6uYN #ahrqix
Wed, 29 Aug 2012 20:43:38

norskedoc: ICSI recently awarded CMMI Innovation Challenge grant to expand DIAMOND model with partners across country. http://t.co/QZSgUQm1 #AHRQIX
Wed, 29 Aug 2012 20:44:02

2healthguru: @norskedoc behavioral health, not even on the radar. has it changed? #ahrqix
Wed, 29 Aug 2012 20:44:08

kennylinafp: RT @mellojonny: Every generalist is (or ought to be) a medically unexplained symptom specialist! http://t.co/vEwqi7uP #ahrqix
Wed, 29 Aug 2012 20:44:26

MsWZ: #AHRQIX @norskedoc How are pharmacists included in the DIAMOND approach effort for the PCMH? cc: @Miller7
Wed, 29 Aug 2012 20:44:37

miller7: MT @norskedoc @ICSIorg recently awarded @CMSinnovates grant to expand DIAMOND model across country http://t.co/Byx3OFzX #AHRQIX
Wed, 29 Aug 2012 20:44:38

norskedoc: Also, DIAMOND has led to relationships btw prim care and BH which not seen before. #ahrqix
Wed, 29 Aug 2012 20:44:40

miller7: @MsWZ Great question! #AHRQIX
Wed, 29 Aug 2012 20:44:53

AHRQIX: Nurse-led visits promote self-care & improve the #health of diabetic adults with severe mental illness http://t.co/EtGAWF8W #ahrqix
Wed, 29 Aug 2012 20:45:03

norskedoc: While pharmacists not formally part of program, many are beginning to use them in working with patients. #ahrqix
Wed, 29 Aug 2012 20:45:15

norskedoc: I apologize but likely missing some of questions due to high volume, but greatly appreciate the discussion. #ahrqix
Wed, 29 Aug 2012 20:45:46

miller7: @norskedoc That's great as clinical pharmacists are being more integrated into #healthcare http://t.co/5ppWzfqI cc @MsWZ #AHRQIX
Wed, 29 Aug 2012 20:46:14

norskedoc: Personally, I believe this really addresses need for "relationship" based models, rather than frequent "expert" models used. #ahrqix
Wed, 29 Aug 2012 20:46:33

mellojonny: Apols, here is the primary care mental health gateway/ partnership model for our GPs http://t.co/IJkIX6oP @miller7 #ahrqix
Wed, 29 Aug 2012 20:46:37

2healthguru: RT @mellojonny: Apols, here is the primary care mental health gateway/ partnership model for our GPs http://t.co/IJkIX6oP @miller7 #ahrqix
Wed, 29 Aug 2012 20:46:48

reitzrandall: The research base is growing. Hot off the presses with largest ever study on relational correlates in heart dx http://t.co/clAPhOXD #ahrqix
Wed, 29 Aug 2012 20:47:04

norskedoc: It is important to understand this is much more than colocation...#ahrqix
Wed, 29 Aug 2012 20:47:39

MelissaColeHTR: RT @mellojonny: Apols, here is the primary care mental health gateway/ partnership model for our GPs http://t.co/IJkIX6oP@miller7 #ahrqix
Wed, 29 Aug 2012 20:47:46

miller7: MT @norskedoc: It is important to understand this (integration) is much more than colocation... #ahrqix
Wed, 29 Aug 2012 20:47:55

miller7: @norskedoc Right, it seems that only colocation of #mentalhealth would simply replicate some of problems seen on outside #AHRQIX
Wed, 29 Aug 2012 20:48:36

norskedoc: I've also had fascinating conversations with Judy Hibbard, creator of the Patient Activation Measure--linking this to depression... #ahrqix
Wed, 29 Aug 2012 20:48:42

kennylinafp: More details, please. RT @norskedoc: It is important to understand this (integration) is much more than colocation. @miller7 #ahrqix
Wed, 29 Aug 2012 20:49:06

miller7: Those not familiar with the Patient Activation Measure http://t.co/RRtgUqTU #AHRQIX
Wed, 29 Aug 2012 20:49:13

norskedoc: Many may be familiar with the "adaptive" model of Ron Heifetz which addresses adaptive challenges--we focused on that in DIAMOND. #ahrqix
Wed, 29 Aug 2012 20:49:43

miller7: @kennylinafp (1) If we only colocate a #mentalhealth provider in #primarycare and ask them to have same "function" as on outside #AHRQIX
Wed, 29 Aug 2012 20:49:53

2healthguru: RT @miller7: Those not familiar with the Patient Activation Measure http://t.co/RRtgUqTU #AHRQIX
Wed, 29 Aug 2012 20:50:00

AHRQIX: @laura3530 Check out this innovation on #mentalhealth services in health plan centers: http://t.co/PSYOiHSS #ahrqix
Wed, 29 Aug 2012 20:50:16

norskedoc: We were also successful in "retiring" HEDIS measures, and focusing on outcomes--based on PHQ-9, now used as state measure. #ahrqix
Wed, 29 Aug 2012 20:50:27

miller7: @kennylinafp (2) we see them deliver traditional #mentalhealth services rather than seamlessly collaborate on team #AHRQIX
Wed, 29 Aug 2012 20:50:29

norskedoc: Adaptive work require addressing existing beliefs, values, habits, and thinking outside the system--it created valuable framework. #ahrqix
Wed, 29 Aug 2012 20:51:25

MelissaColeHTR: Great reference via @ePatientDave RT @miller7: Those not familiar with the Patient Activation Measure http://t.co/zRckHpyK #AHRQIX
Wed, 29 Aug 2012 20:51:48

norskedoc: Media coverage has been useful in driving effort, not our usual approach in past. http://t.co/RsKH6D6B #AHRQIX
Wed, 29 Aug 2012 20:52:05

miller7: MT @norskedoc: Media coverage has been useful in driving #integration effort; not usual approach in past. http://t.co/44utgCgi #AHRQIX
Wed, 29 Aug 2012 20:52:44

MsWZ: RT @miller7: Those not familiar with the Patient Activation Measure http://t.co/RRtgUqTU #AHRQIX
Wed, 29 Aug 2012 20:52:47

norskedoc: Seeing some comments on PAM, and I'm very interested in pursuing learning more about potential value of that tool also.. #ahrqix
Wed, 29 Aug 2012 20:52:52

MsWZ: @kennylinafp @norskedoc @miller7 It's not just being in the same room, its about doing something together while you are there? #AHRQIX
Wed, 29 Aug 2012 20:53:30

AHRQIX: RT @miller7: @norskedoc Thats great as clinical pharmacists are being more integrated into #healthcare http://t.co/XlTER9MV cc @MsWZ #ahrqix
Wed, 29 Aug 2012 20:53:30

norskedoc: On occasion, I’ve addressed the potential value of DIAMOND in blog postings… http://t.co/i3xj2ptT #AHRQIX
Wed, 29 Aug 2012 20:53:39

miller7: @MsWZ @kennylinafp YES! All about collaboration! #AHRQIX
Wed, 29 Aug 2012 20:54:04

norskedoc: @kennylinafp Agree totally, which is the adaptive change I'm talking about, would love to discuss issues in this area further. #ahrqix
Wed, 29 Aug 2012 20:54:33

2healthguru: @MsWZ @kennylinafp @norskedoc @miller7 in other words, 'real team based' care. #ahrqix
Wed, 29 Aug 2012 20:54:42

norskedoc: And if not "collaboration" at least coordination and cooperation. RT @miller7: @MsWZ @kennylinafp YES! All about collaboration! #AHRQIX
Wed, 29 Aug 2012 20:55:02

miller7: We are running out of time on today's inaugural #AHRQIX chat with @norskedoc; let's start to wrap up with final thoughts
Wed, 29 Aug 2012 20:55:05

miller7: Interested in learning more about #integrated #mentalhealth & #primarycare? You can follow @AHRQAcademy http://t.co/pH0sj4F9 #AHRQIX
Wed, 29 Aug 2012 20:55:55

norskedoc: Final thoughts--we've obviously resonated, but what we don't know is much larger than what we know...need to work together. #ahrqix
Wed, 29 Aug 2012 20:56:02

AHRQIX: We’ll be closing the live chat in 5 mins but you can find more resources on this topic on our site: http://t.co/moc13738 #ahrqix
Wed, 29 Aug 2012 20:56:05

2healthguru: @norskedoc @miller7 @MsWZ @kennylinafp kinda like 'religious tolerance'? Need go further, no? Self righteousnous is a 'dis-ease' #ahrqix
Wed, 29 Aug 2012 20:56:45

norskedoc: For me, starting with a concrete topic--depression--enabled clinics to feel they could address it, not like tackling world peace. #ahrqix
Wed, 29 Aug 2012 20:56:46

kennylinafp: MT @miller7: Interested in learning more about #integrated #mentalhealth & #primarycare? Follow @AHRQAcademy http://t.co/LUzTg4wV #ahrqix
Wed, 29 Aug 2012 20:56:51

MsWZ: #AHRQIX re: Patient Voice - for the first time, my allergist asked me yesterday if I'd like a copy of the report to go to my PCP~Baby steps!
Wed, 29 Aug 2012 20:56:58

MelissaColeHTR: It takes a village :) RT @norskedoc: coordination & cooperation. RT @miller7: @MsWZ @kennylinafp YES! All about collaboration! #AHRQIX
Wed, 29 Aug 2012 20:57:09

AHRQIX: We have more than 90 #innovations & hundreds of online tools relating to #mentalhealth on our site http://t.co/moc13738 #ahrqix
Wed, 29 Aug 2012 20:57:19

miller7: Final thought - we need to create a #healthcare system that can support comprehensive patient-centered team-based care #AHRQIX
Wed, 29 Aug 2012 20:57:23

yayayarndiva: RT @miller7: Those not familiar with the Patient Activation Measure http://t.co/RRtgUqTU #AHRQIX
Wed, 29 Aug 2012 20:57:54

AHRQIX: If you would like to review this chat, please search under #AHRQIX on Twitter #ahrqix
Wed, 29 Aug 2012 20:58:15

miller7: Many thanks to @norskedoc @AHRQnews @AHRQIX for today’s first #AHRQIX chat
Wed, 29 Aug 2012 20:58:32

mellojonny: The best thing we did for #primarycare & #mentalhealth was introducing a ‘usual doctor’ system to ensure continuity @kennylinafp #ahrqix
Wed, 29 Aug 2012 20:58:35

norskedoc: I couldn't agree more, and let's remember we should include patients on team--they were part of all DIAMOND work.. #ahrqix
Wed, 29 Aug 2012 20:59:17

MelissaColeHTR: +1 RT @miller7 Final thought: we need to create a #healthcare system that can support comprehensive patient-centered teambased care #AHRQIX
Wed, 29 Aug 2012 20:59:19

AHRQIX: We'd like to thank @miller7 & @norskedoc for joining us for today's chat! Lots of great info discussed. #ahrqix
Wed, 29 Aug 2012 20:59:58

norskedoc: You're welcome, this has been a whirlwind hour...hope to do again... #ahrqix
Wed, 29 Aug 2012 20:59:59

kennylinafp: And thanks @miller7 too! RT @miller7: Many thanks to @norskedoc @AHRQnews @AHRQIX for today’s first #AHRQIX chat #ahrqix
Wed, 29 Aug 2012 21:00:02

miller7: Check out upcoming @AHRQconf that will address many of #mentalhealth #primarycare topics addressed today http://t.co/bRPaj1Hc #AHRQIX
Wed, 29 Aug 2012 21:00:04

miller7: Also, check out October #CFHA http://t.co/KEcjOdJC? meeting which focuses on integrated #mentalhealth & #primarycare #AHRQIX
Wed, 29 Aug 2012 21:00:32

2healthguru: @AHRQIX or you can click here: http://t.co/y7WNXmmZ 247 tweets generated 733,885 impressions with audience of 72,207 #ahrqix
Wed, 29 Aug 2012 21:00:37

miller7: Look for another #AHRQIX tweetchat next month with @tedeytan !! #healthcare #innovation
Wed, 29 Aug 2012 21:01:04

reitzrandall: Thanks for the informative chat all #ahrqix @norskedoc @miller7 @kennylinafp @mswz
Wed, 29 Aug 2012 21:01:05

2healthguru: RT @AHRQIX: We'd like to thank @miller7 & @norskedoc for joining us for today's chat! Lots of great info discussed. #ahrqix
Wed, 29 Aug 2012 21:01:54

socialibriumm: RT @miller7: Look for another #AHRQIX tweetchat next month with @tedeytan !! #healthcare #innovation
Wed, 29 Aug 2012 21:01:56

AHRQIX: Sept. 13, follow us for more info RT @miller7: Look for another #AHRQIX tweetchat next month w/ @tedeytan !! #healthcare #innovation #ahrqix
Wed, 29 Aug 2012 21:04:05

IanatPHP: RT @mellojonny: Every generalist is (or ought to be) a medicallyunexplained symptom specialist! http://t.co/erv3lyCV @miller7 #ahrqix
Wed, 29 Aug 2012 21:10:21

BHPCIntegration: Very important MT @norskedoc: 1st there's less "stigma" surrounding depression b/c of our work, many don't see that, but it's real. #ahrqix
Wed, 29 Aug 2012 21:22:15

tedeytan: RT @AHRQIX: Sept. 13, follow us for more info RT @miller7: Look for another #AHRQIX tweetchat next month w/ @tedeytan !! #healthcare #in ...
Wed, 29 Aug 2012 21:24:10

BHPCIntegration: RT @norskedoc: 2nd, as a result of DIAMOND, we're extending this approach w/2 partners in AHRQ grant using SBIRT for substance abuse #ahrqix
Wed, 29 Aug 2012 21:26:00

tedeytan: Excited to co-host @AHRQIX tweetchat next month w Brigid McCaw, MD - expert in family violence prevention #AHRQIX : http://t.co/2GnYN17i
Wed, 29 Aug 2012 21:27:31

BHPCIntegration: Great model to replicate/build upon RT @norskedoc: 3rd, DIAMOND exemplifies the "team" approach,has prepped many for medical home. #ahrqix
Wed, 29 Aug 2012 21:27:59

BHPCIntegration: Vital 4 imprvd outcomes,access&costs RT @norskedoc: Also, DIAMOND has led to relationships btw prim care & BH which not seen before. #ahrqix
Wed, 29 Aug 2012 21:30:07

DrPlumEU: @miller7 @norskedoc #Primarycare #mentalhealth #AHRQIX I am GP...
Wed, 29 Aug 2012 21:31:25

DrPlumEU: @miller7 @norskedoc #Primarycare #mentalhealth #AHRQIX arguably 90% clinical psychiatric conditions (cont) http://t.co/BQdG69yJ
Wed, 29 Aug 2012 21:33:08

BHPCIntegration: RT @norskedoc: It is important to understand this is much more than colocation... #ahrqix
Wed, 29 Aug 2012 21:37:43

jptingle: RT @AHRQIX: Sept. 13, follow us for more info RT @miller7: Look for another #AHRQIX tweetchat next month w/ @tedeytan !! #healthcare #in ...
Wed, 29 Aug 2012 21:47:59

PilgrimPip: RT @mellojonny: Every generalist is (or ought to be) a medically unexplained symptom specialist! http://t.co/erv3lyCV @miller7 #ahrqix
Wed, 29 Aug 2012 21:55:18

terrieynon: RT @mellojonny: Every generalist is (or ought to be) a medically unexplained symptom specialist! http://t.co/erv3lyCV @miller7 #ahrqix
Wed, 29 Aug 2012 22:07:36

SilvijaKrebs: RT @miller7: Final thought - we need to create a #healthcare system that can support comprehensive patient-centered team-based care #AHRQIX
Wed, 29 Aug 2012 23:06:53

KPpregnancydoc: RT @tedeytan: Excited to co-host @AHRQIX tweetchat next month w Brigid McCaw, MD - expert in family violence prevention #AHRQIX
Wed, 29 Aug 2012 23:28:06

burayw0a: RT @miller7: Final thought - we need to create a #healthcare system that can support comprehensive patient-centered team-based care #AHRQIX
Thu, 30 Aug 2012 04:19:25

ClinicalPosters: RT @kennylinafp: Primary care clinicians are good at prescribing drugs for depression, not so good at cognitive therapy. #ahrqix
Thu, 30 Aug 2012 05:21:14

AHRQIX: RT @tedeytan: Excited to co-host @AHRQIX tweetchat next month w Brigid McCaw, MD - expert in family violence prevention #AHRQIX
Thu, 30 Aug 2012 17:08:20