Site Visit - Cherokee Health Systems

Hello attendees of the Cherokee Health Systems site visit on 9/19! We would love for you to share key takeaways, learnings, and next steps from the site visit with the rest of the PHLN network! We ask that at least one member of your team that attended the site visit post here. All PHLN teams, feel free to comment and ask questions!

Please answer one or more of these questions:

  1. What is one of the most valuable takeaways you had from the site visit?

  2. What resource did you find useful? If you have a copy of it, please attach.

  3. What is a next step your team is planning to take as a result of what you learned at the site visit?

  4. Anything else you want to share?

Check out my Perspective Piece and what I learned at Cherokee: Lessons from Cherokee Health Systems: A Truly Integrated, and Inspiring, Model of Care - Center for Care Innovations

@aalvarez @egarcia @mcoble @hscaglione @leslie.kearney @sarahmi

If you don’t have a chance to read through my Perspectives Piece, some of my top insights from the Cherokee Health Systems site visit include:

  1. Integrated care is an ideology and culture, not a service or a program.

  2. Behavioral health and primary care staff are equally responsible for closing gaps in physical care.

  3. Cherokee offers addiction medicine as part of its continuum of services.

  4. Cherokee makes its integrated model work regardless of payment.

  5. Lots of time on the EHR backend saves on the frontend and provides the right pathway that makes clinical sense.

  6. They’ve developed a Bio-Psycho-Social Assessment (BPSA) that they use to guide the care they deliver.

  7. Telemedicine of “part of everyday life at Cherokee.”

  8. Cherokee’s mission is to provide quality training opportunities to both their staff and others in the safety net.

  9. Quick communication, not long meetings.

  10. They do healthcare and population health management “The Cherokee Way.”

To see photos from the site visit and learn more, check out the quick insights slides I put together. PHLN Site Visit Cherokee Reflections-compressed.pdf (737.4 KB)

Was there anything I missed that was inspiring about our PHLN site visit to Cherokee??

2 Likes

@aalvarez: Here were Cherokee’s responses to your follow up questions:

1. Is there any information about their Integrated Care Training Academy or example training materials available? We can include you in our emails about the Training Academies – I will ask Tish Quillen, our national training coordinator, to send you the information for you to disseminate to the group. We would love to see folks again for a deeper dive into integrated care.

2. How long is a behavioral health appointment there (I think I heard 30 minutes?) For our behaviorists in primary care, we typically schedule 3 patients an hour – new patients are typically 22 -25 minutes, and follow ups are usually 20 minutes. For our speciality mental health folks, appointments are usually 30 minutes or 45 minutes (for intakes).

3. And how long is a medical (PCP) appointment? 30 min for new, 15 min for follow up. In our Center City clinic (where you visited), we are experimenting with 3 patients an hour, regardless if they are new or follow up (e.g. 3 (15 min blocks) with 1 (15 min) open block to allow for provider flexibility. So far this seems to be working well.

4. What are the productivity standards for BH Providers and infrastructure supports in achieving that, and what are the percentages of direct service time versus follow up and admin? Behavioral Health Consultants in primary care – 12-15 per day; Traditional therapists – 7 per day. We usually have all time except for treatment team and supervision dedicated for direct clinical time. If someone has administrative responsibilities (e.g. clinical director), they do have admin time blocked. We do periodically block time for care coordination (e.g. all of our alcohol and drug treatment clinicians have some time weekly allocated for team huddles for continuity of care).

5. Would they be willing to do a webinar on their BPSA stratification? This is really an internal way we decided to approach measurement of complexity – we wanted a paradigm for assessment of social and psychological, as well as medical, factors associated with complexity. Overall stratification is a culmination of a multitude of clinical, operational, and community factors. In short, it would be a reach to rely solely on BPSA as a standalone tool or topic for a webinar. We wish it was that simple!

1 Like

Thank you so much! Do you think Cherokee would be willing to share their job description for the Chief Strategy Officer position?

@megan_cci Hi!
We have a few more asks of Cherokee, if they are willing to share:

  1. Job description for Chief Strategy Officer
  2. Job description for the behavioral health clinician and the job description for the specialty mental health clinicians to clarify the difference between the two

Thank you!

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Hi @aalvarez! I got a bunch of job descriptions, including:

  1. Community Health Coordinator
  2. Director of Primary Care
  3. Outreach Care Coordinator
  4. Behavioral Health Consultant
  5. Director of Integrated Care
  6. Case Manager
  7. Director of Psyc Services
  8. Regional Vice President

They didn’t send over the Chief Strategy Officer position but I’ll ask again.

community Health Coordinator JD.docx (54.4 KB)
Director of Primary Care.docx (52.9 KB)
Outreach Care Coordinator.doc (73.5 KB)
Behavior Health Consultant.doc (69 KB)
Director of Integrated Care.pdf (35.6 KB)
Case Manager.docx (52.9 KB)
Dir of Psyc Svcs.pdf (96.0 KB)
RegionalVicePresident.doc (63 KB)

@aalvarez

Here’s what I understand the differences between the two roles are:

Clinical Therapist/Psychologist/BHC

  • Communicates with prescriber to clarify diagnosis and unify treatment plan
  • Monitors symptoms and functioning and communicate concerns/progress to prescriber

PCP/Specialty Medical Provider

  • Assesses and treats acute and chronic health problems with assistance of a BHC or specialty behavioral health, as clinically indicated

Did anyone else that attended the Cherokee site visit have any more thoughts about what you remember the difference between these roles is?

@egarcia @mcoble @hscaglione @leslie.kearney @sarahmi

1 Like

Lots of Cherokee resources today :grin:

Here’s their Org Chart OrgChart20160601.pdf (232.1 KB)

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Finally, here are the slides from the site visit! @leslie.kearney, better late than never :wink:

California Care Innovations 9.19.18 FINAL Slide Deck-compressed.pdf (5.6 MB)

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Great, thanks! :smile:

@megan_cci …one more question! We thought that Cherokee had said they might be able to have a webinar with those interested in viewing the EHR templates they use for the BHC and the therapist. Is this possible? Thank you.

@aalvarez Our friends at Cherokee sent over the Chief Strategy Officer job description, hope it’s helpful to see!

And yes, I’m working to find a date for the EHR template webinar with Andy from their team. It’s a busy next few weeks so we’re looking at dates in mid to late November, stay tuned!

Chief Strategy Officer.docx (46.0 KB)

Hi Megan,

I believe they were going to send a job description for both positions. Correct? Thanks!

Michelle Coble

Licensed Clinical Social Worker

mcoble@cmcenters.org

Office:
209-940-5600

Fax:
209-940-5065

1031 Waterloo Road

Stockton, CA 95205

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@megan_cci Hello! We have a few more asks of Cherokee Health System:

  1. can they share the job description for the therapist? We received the jd for the behavioral health clinician.

  2. Can they share their workflow for the Well Child Check and Initial Health Assessment appointments? What does the behavioral health clinician do at these appointments?

  3. Do they utilize the PRAPARE tool and if so, how often is this done and is it done on every patient or a sub-set of patients?

  4. What patients do the BHCs see, and is this based on the patient BPSA score or is it based on their open schedules?
    Thank you!