Latest News

Staffing for Depression Care in Primary Care Clinics

Date: 
Thu, 12/04/14

The Depression Improvement Across Minnesota, Offering A New Direction (DIAMOND) collaborative care initiative, supported by the Institute for Clinical Systems Improvement, provided similar training and support for 87 primary care clinics but varied staffing and care manager positions. Care managers were registered nurses, certified medical assistants, or licensed practice nurses.

New published research indicates that clinics with care managers, regardless of type, that were solely dedicated to depression care had significantly higher enrollment rates and marginally significant higher remission rates than clinics with care managers with multiple roles. However, type of care manager was not associated with differing outcomes, suggesting that more highly trained and costly managers may not be necessary to provide cost-effective collaborative care.

 

Additional resources on the DIAMOND initiative may be found on the portal of the Academy for Integrating Behavioral Health and Primary Care at:

http://integrationacademy.ahrq.gov/search/node/DIAMOND

Rutgers Study Concludes Improved Integration Can Lower Hospital Utilization and Cost

Date: 
Thu, 12/04/14

A new Rutgers study, Role of Behavioral Health Conditions in Avoidable Hospital Use and Cost, focuses on the role of behavioral health (BH) conditions in potentially avoidable hospital use and cost.  The study builds on a series of publications, funded by The Nicholson Foundation, which examined opportunities provided by the Medicaid ACO Demonstration Program to improve health and lower costs in low-income New Jersey communities. Study authors found 

“Patients who are high users of hospital care and those with avoidable/preventable IP hospital use are disproportionately affected by BH conditions, and that BH conditions are associated with a substantial share of hospital costs.”

Further, they concluded that

“Improved integration of BH services with medical services among complex patients can lead to lower avoidable hospital utilization and cost savings.”

A news story mentioned the Federal initiative on behavioral health in primary care initiated by the Agency for Healthcare Research and Quality (AHRQ).  That initiative is The Academy for Integrating Behavioral Health in Primary Care.  Charlotte Mullican, AHRQ Senior Advisor for Mental Health Research and Contract Officer Representative (COR) for the Academy, stated that research increasingly shows that integration is cost effective.  She further said there are still a number of barriers to implementation of this model, including payment structures, varied provider perspectives, and the need to change the perception of patients about what kind of care they should ask for from their primary care provider.

Read the related report:

http://www.cshp.rutgers.edu/Downloads/10530.pdf

Integrated Care for Cancer Patients

Date: 
Thu, 12/04/14

Several leading medical organizations, including the Institute of Medicine and the American College of Surgeons, have issued reports to recommend access to behavioral health support for cancer patients. These recommendations are based on a variety of clinical research results that suggest cancer patients with depression care exhibit improved outcomes. For instance, one randomized control trial in Scotland, called SMaRT Oncology-2, compared cancer patients with integrated collaborative depression care delivered by a team of cancer nurses, psychiatrists and primary care physicians to standard care delivered by primary care physicians alone. The results indicated significant improvement in treatment response, depression, anxiety, pain, fatigue, general functioning, quality of life and perceived quality of depression care with the collaborative model. Similar results were reported by the SMaRT Oncology-3 program, which focused care on patients with lung cancer.

 

For recent features on integrated collaborative depression care for patients with cancer, see the Academy Integrating Behavioral Health and Primary Care at:

http://integrationacademy.ahrq.gov/search/node/depression%20care%2C%20cancer

Staffing for Depression Care in Primary Care Clinics

Date: 
Thu, 12/04/14

The Depression Improvement Across Minnesota, Offering A New Direction (DIAMOND) collaborative care initiative, supported by the Institute for Clinical Systems Improvement, provided similar training and support for 87 primary care clinics but varied staffing and care manager positions. Care managers were registered nurses, certified medical assistants, or licensed practice nurses.

New published research indicates that clinics with care managers, regardless of type, that were solely dedicated to depression care had significantly higher enrollment rates and marginally significant higher remission rates than clinics with care managers with multiple roles. However, type of care manager was not associated with differing outcomes, suggesting that more highly trained and costly managers may not be necessary to provide cost-effective collaborative care.

 

For additional resources on the DIAMOND initiative, see the Academy for Integrating Behavioral Health and Primary Care at:

http://integrationacademy.ahrq.gov/search/node/DIAMOND

New York Studies Three Models of Integrated Care

Date: 
Thu, 12/04/14

The New York Health Foundation, through its Advancing Primary Care Initiative, recently funded a report by the RAND Corporation to examine the strategies used by New York State Community Mental Health Centers to improve integration of behavioral health and primary care services for adults with serious mental illness (SMI).  The 3 integrated care initiatives operating in the State system include:

  • Substance Abuse and Mental Health Services Administration’s  (SAMHSA’s) Primary and Behavioral Health Care Integration grants program;
  • New York State Office of Mental Health’s Medicaid incentives for health monitoring and health physicals; and
  • New York’s Medicaid health homes.

The three models are characterized, compared, and contrasted in the report.

The purpose of undertaking this project

“was to generate information that will help state policymakers streamline the adoption of strategies for improving the overall wellness and physical health status of people with serious mental illness by making primary medical services available in, or coordinated by, staff in settings where the population already receives mental health care.”

According to the most recent National Surveys on Drug Use and Health (NSDUH) Report, those with SMI account for only about 3.6 percent of the total population in New York State. However, they have significant behavioral health and medical problems, and require a broad range of services.  Integrated behavioral health care and primary care is an important strategy for seeing that those needs are met.

For more information on the NY State perspective on integrated care, see the Academy for Integrating Behavioral Health and Primary Care at: http://integrationacademy.ahrq.gov/node/5832

Academy’s Products Featured in Robert Wood Johnson Foundation-Funded Program on Team-Based Care

Date: 
Thu, 12/04/14

Effective collaboration within the practice team is essential in becoming a Patient-Centered Medical Home and improving overall health and efficiency. The Primary Care Team Guide ensures practices achieve improved care, productivity, and career satisfaction when shifting toward a team-based approach. The guide provides practice team members with advice, case studies, and necessary tools, such as modules and assessments to self-measure practices’ current status on team-based care. Topics cover the roles of care team members and essential functions of the team to meet patient needs.

The Academy’s products were referenced in the team guide as toolkits and resources:

  • Framework for Measuring Integration of Behavioral Health and Primary Care: “This website presents a framework for understanding what behavioral health integration involves. Functional domains include care team expertise, clinical workflow, patient identification, patient and family engagement, treatment monitoring, data collection and use, and desired outcomes.”
  • IBHC Atlas: “Find tools for measurement and tracking, compiled by the Atlas of Integrated Behavioral Health Care Quality Measures.”
  • The Lexicon: This resource is used to describe examples of collaborative care role functions.

The guide is a program of the Primary Care Team: Learning from Effective Ambulatory Practices (LEAP) project, funded by the Robert Wood Johnson Foundation.

 

See an overview of the resources and tools: http://www.improvingprimarycare.org/work/behavioral-health-integration

Accountable Care Organizations and Integrated Behavioral Health and Primary Care

Date: 
Mon, 11/17/14

Accountable Care Organizations (ACOs) are uniquely poised to provide integrated behavioral health and primary care. However, evidence from a recent Health Affairs article suggests that few ACOs are pursuing integrated efforts.

Researchers used data from the National Survey of Accountable Care Organizations, followed up with purposively sampled interviews of ACO leadership to examine the contextual factors influencing ACO decisions on whether or not to manage behavioral health services, and if so, how to go about it. Results point to three issues:

  1. ACOs with large patient populations experiencing behavioral health needs were more likely to provide primary care and behavioral health services. One interviewee noted that of their top five patient emergency department users, all five had a behavioral health diagnosis, four of the five had chemical dependency diagnoses, and three of the five had traumatic brain injury.  This data played into the ACO’s decision to examine the services provided in their clinic.
  2. ACOs in regions with a low supply of behavioral health providers were more likely to provide such services in house.
  3. Payment mechanisms motivated ACO decisions to provide integrated behavioral health and primary care services. For example, Medicare includes a quality measure on depression that is linked to payment.

In summary, most ACOs are not currently providing universal integrated behavioral health and primary care services. Evidence suggests that contextual factors, such as patient population, regional supply of behavioral health providers, and payment mechanisms, influence ACO decisions on whether to integrate behavioral health and primary care.

View an abstract of the article at: http://www.ncbi.nlm.nih.gov/pubmed/25288427

National Strategy for Quality Improvement in Health Care 2014 Annual Progress Report to Congress

Date: 
Mon, 11/17/14

In September 2014, the Agency for Healthcare Research and Quality (AHRQ) published the National Strategy for Quality Improvement in Health Care2014 Annual Progress Report to Congress.  As stated in this report’s Executive Summary,

“The National Quality Strategy [NQS] serves as a framework for aligning stakeholders across the private and public sectors at the Federal, State, and local levels….The initial National Quality Strategy, published in March 2011, established three aims and six priorities for quality improvement, with real implications for the person receiving the care, advocating for a loved one, or becoming healthier as part of a community-wide effort.”

The U.S. Department of Health and Human Services supports the implementation of the NQS. More about these plans can be found at http://www.ahrq.gov/workingforquality/index.html

Read the new AHRQ Report to Congress at http://www.ahrq.gov/workingforquality/reports/annual-reports/nqs2014annlrpt.pdf .

Additional information on public and private efforts to support the NQS are found at: http://www.ahrq.gov/workingforquality/index.html

Integration Roadmap for Maximizing Triple Aim in CINs and ACOs

Date: 
Mon, 11/17/14

The Third Edition of Clinical Integration: Accountable Care and Population Health, is a forthcoming book that will provide fresh insights and new information on the evolution of clinically integrated networks (CINs) across the U.S. health care system. Chapter 11 of this book, Non-Traditional Mental Health and Substance Use Disorder Services as a Core Part of Health in CINs and ACOs, was released in October 2014, and is co-authored by Roger Kathol, M.D., D.F.A.P.A., F.A.C.P., C.P.E.; Susan Sargent, M.B.A.; Steve Melek, F.A.A.A.; Lee Sacks, M.D.; and Kavita K. Patel, M.D., M.S.

This chapter describes how behavioral health (BH) services are delivered in the health system today, the influence of current payment practices have on how and where BH services are delivered, the impact of isolated BH care delivery on the quality and cost of care in national health plan, and the BH delivery system changes needed to improve both health and cost outcomes of untreated BH conditions, and the opportunities associated with BH service implementation within CINs and/or accountable care organizations (ACOs).

The authors conclude by saying:

“This Chapter recognizes that the inclusion of BH professionals and services in CINs/ACOs creates several challenges for those that are developing them. Therefore, it provides a roadmap that will allow those willing to maximize the effectiveness of their CIN/ACO to achieve the Triple Aim” (Berwick, Nolan, & Whittington, 2008)

Information on purchasing this book chapter is at: http://www.amazon.com/Clinical-Integration-Accountable-Population-Edition/dp/0991234529.

Patient-Centered Care: $840 Million HHS Initiative

Date: 
Mon, 11/17/14

Coordinated patient-centered care is on the rise among medical providers aiming to improve health care quality while reducing overall costs. Last month, the U.S. Department of Health and Human Services announced an $840 million initiative to fund applicants who are transitioning to coordinated patient-centered care and are able to track progress toward measurable goals.

“The Transforming Clinical Practice Initiative is one of the largest federal investments uniquely designed to support clinician practices through nationwide, collaborative, and peer-based learning networks that facilitate large-scale practice transformation.”

The initiative will assist care providers in the following ways:

  • Gaining access to patient information and medical history;
  • Improving patient-provider relationships and communication;
  • Enhancing coordinated team efforts; and
  • Promoting the regular use of electronic health records.

The Centers for Medicare & Medicaid Services are seeking collaborative partnerships and will be awarding cooperative agreements to the following:

  • Practice Transformation Networks: Successful practices that are joined to serve as trusted partners in providing expertise, coaching, best practices, and guidance. These networks will work with a diverse range of practices, including those providing care to the medically underserved and rural communities.
  • Support and Alignment Networks: Networks of medical professional associations aligning memberships, communication, and continuing medical education credits to identify evidence-based practices and policies for dissemination. Their work will support the Practice Transformation Networks and practices.

Participation in the initiative ensures that practices will receive technical assistance and support, and will allow for overall success in the health care market due to increasing demand for efficient patient-centered care delivery by health care payers and purchasers.

Interested practices/clinicians should visit: http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/

View the official announcement: http://www.hhs.gov/news/press/2014pres/10/20141023a.html

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