Behavioral health disorders are a major public health problem in the United States. An estimated 26.4 percent of the U.S. population suffers from diagnosable mental disorders that are directly related to poor health outcomes, increased costs, and premature deaths. An estimated $113 billion was spent in mental health treatment in 2005, of which about $22 billion was spent in substance use treatment alone. It is expected that behavioral health disorders will surpass all physical diseases as the leading cause of disability worldwide by 2020.
The National Quality Forum (NQF) designed and implemented a multiphase program to improve the delivery of quality behavioral health services and improve behavioral health status of Americans. NQF has now endorsed behavioral health measures for depression, child and adolescent mental health, health screening and assessment, and substance abuse, and has made them available for public review. A complete list of endorsed measures can be viewed here.
Here is the appeal process: “Any party may request reconsideration of the 17 endorsed quality measures by submitting an appeal no later than April 7 at 6:00PM ET. To submit an appeal, go to the NQF Measure Database. For an appeal to be considered, the notification must include information clearly demonstrating that the appellant has interests directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests. All appeals are published on the NQF website.”
For more information, please contact Elisa Munthali at 202-783-1300 or via email at email@example.com.
Access Community Health Centers is a federally qualified health center that provides integrated behavioral health and primary care services. With three integrated care clinics in Madison, Wisconsin, the Agency for Healthcare Research and Quality (AHRQ) has identified Access Community Health Centers as a Service Delivery Innovation.
Access Community Health Centers began providing integrated care because of the realization that many patients referred to behavioral services in the community did not follow up on the referrals. The care clinics provide care to vulnerable populations, including patients who are impoverished, medically or socially complex, and mentally ill. A majority of patients receive Medicaid benefits, one-third of patients are minorities, and one-fifth of patients speak a language other than English.
To deliver integrated care, Access Community Health Centers has a behavioral health team consisting of five full-time psychologists, three full-time social workers, and a part-timer consulting psychiatrist. The psychiatrist spends 10 hours per week in the primary care clinics. Practicum students, medical residents in psychiatry, and postdoctoral fellows also work there. This staff is distributed among the three care centers. An initial assessment of behavioral health needs among the patient population led physicians to believe “they could handle many of the cases currently being referred if they had more support from psychologists or social workers.” In the beginning, only a part-time consulting psychologist was used. However, patients had more complex needs than expected which led the care team to introduce psychiatric services. The consulting psychiatrist sees patients for a one-time consultation rather than for repeat visits, which allows the psychiatrist to see more patients. All members of the care team have complete access to patient medical records. The behavioral health team, consulting psychiatrist, and primary care providers work together to provide care and monitor patient health. However, the primary care provider maintains decision-making authority.
Integrated care has resulted in increased access to behavioral health services, more engaged patients, more screening for depression, more documentation of behavioral goals, fewer referrals, and less medication use. AHRQ lists the evidence rating as moderate based on “pre- and post-implementation comparisons of various measures of primary care clinician involvement in behavioral health treatment” and “post-implementation trends in the number of primary care patients accessing behavioral health services in the primary care clinics.”
New Research Opportunity
Take a look at the following funding opportunity:
Department of Health and Human Services Health Resources and Services Administration (HRSA)
Rural Health Care Coordination Network Partnership Program
HRSA announced a grant opportunity, Rural Health Care Coordination Network Partnership, “to support the development of formal, mature rural health networks that focus on care coordination activities for the following chronic diseases: diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary diseases (COPD).” The aim of this program is to provide accessible and coordinated quality health care for people with chronic conditions in rural areas. The Request for Application (RFA) cites the importance of caring for the whole person and the importance of integrating behavioral health in primary care.
“There are often psychosocial (psychological and social) issues related to chronic diseases…In addition, more mental health problems are seen in the primary care setting than other health care settings; thus, integrating behavioral health care into primary care helps address both the physical and psychosocial aspects of health and wellness. Reviews and reports from the Agency for Healthcare Quality and Research (AHRQ) have shown a positive impact from integrating a team approach to care for a variety of disease conditions.  Health care coordination for people living with chronic conditions is vital to providing high quality care, especially in rural areas where access to health care is an issue.”
 Jortberg BT, Miller BF, Gabbay RA, et al. Patient-centered medical home: how it affects pyschosocial outcomes for diabetes. Curr Diab Rep. 2012;12:721-728. PMID: 22961115.
For more information about the funding opportunity see: http://www.grants.gov/view-opportunity.html?oppId=273226
Posted March 2015
The National Action Alliance for Suicide Prevention’s Research Prioritization Task Force (RPTF) published a Prioritized Research Agenda for Suicide Prevention: An Action Plan to Save Lives in February 2014. The Plan seeks to reduce rates of suicide attempts and deaths in the next 5-10 years. The Research Agenda focuses on six different questions, which will be addressed in a series of webinars sponsored by the National Council for Behavioral Health with the Action Alliance, and the National Institute of Mental Health. The topics and dates for the 2015 webinar series are listed below:
January 29 — Why do people become suicidal? View past recording.
February 24 — How can we better detect/predict suicide risk? View past recording.
April 2 — What interventions prevent suicidal behavior? Register.
April 29 — What are the most effective services to treat and prevent suicidal behavior?
May 27 — What suicide interventions outside of health care settings reduce risk?
June 24 — What research infrastructure do we need to reduce suicidal behavior?
Additional information about the webinar series will be posted on the Academy event calendar as it becomes available.
For more information, see:
Posted March 2015
There is growing consensus that there is an increasing need for enhanced teamwork if primary care practices are to be efficient and effective. This study, Electronic health records and support for primary care teamwork, examines how electronic health records (EHRs) facilitate teamwork, as well as what challenges they pose, and what practices do to overcome those.
This qualitative study was done in a selected subset of practices that were recognized as patient centered medical homes using the National Committee for Quality Assurance 2011 assessment tool. The study found that EHRs facilitate communication and task delegation through
- instant messaging,
- task management software, and
- the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses.
Respondents felt that areas in which EHR functionalities were weakest and posed challenges to teamwork included
- the lack of integrated care manager software and care plans in EHRs,
- poor practice registry functionality and interoperability, and
- inadequate ease of tracking patient data in the EHR over time.
While practices developed solutions for some of the challenges they encountered, they expressed a need for “more permanent vendor and policy solutions for other challenges.”
The authors state the following conclusions:
“EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time.”
The full study is available at: http://jamia.oxfordjournals.org/content/jaminfo/early/2015/01/26/jamia.ocu029.full.pdf
Posted March 2015
Promising findings from two large-scale tests of advanced primary care: the Comprehensive Primary Care (CPC) initiative and the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration were just announced by Dr. Patrick Conway, the Centers for Medicare & Medicaid Services (CMS) Deputy Administrator for Innovation and Quality and Chief Medical Officer.
Some of the grantees in both the CPC initiative and the MAPCP demonstration are primary care practices that are integrating behavioral health.
The reported first-year results illustrate the potential for steady improvements in the participating practices’ advanced primary care capabilities. The CMS anticipates continued improvements as the participating practices deepen and refine their methods of delivering advanced primary care so that patients can continue to receive improved quality and coordination of care.
The full report is available at: http://innovation.cms.gov/Files/reports/CPCI-EvalRpt1.pdf
Descriptions of the practices involved in these efforts can be found at http://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/ and http://innovation.cms.gov/initiatives/Multi-payer-Advanced-Primary-Care-Practice/index.html
There has been little research in the literature in the last few years on treating substance use disorders (SUD) in an integrated behavioral health and primary care setting. A good deal more research is available on treating mental health disorders in the integrated care setting. Most of the more current publications have been summarized on the Academy Portal, and may be found by using the general search function.
With regard to policy and financing related literature, we would refer you to the following publications:
The cost effectiveness and sustainability of treating SUDs in the Integrated medical and behavioral health setting is addressed in: Manderscheid R, Kathol R. Fostering sustainable, integrated medical and behavioral health services in medical settings. Ann Intern Med. 2014 Jan;160:61-65. PMID:24573665, which is found at: http://annals.org/article.aspx?articleid=1811029
There are significant barriers to integrating SUD with primary care. A recent study indicates many of these “arise at the policy level and are addressable.” For more information, see: Urada D, Teruya C, Gelberg L, et al. Integration of substance use disorder services with primary care: health center surveys and qualitative interviews. Subst Abuse Treat Prev Policy. 2014 March; 9:15. PMID: 24679108., which may be found at: http://www.substanceabusepolicy.com/content/pdf/1747-597X-9-15.pdf
Take a look at the following funding opportunities:
Robert Wood Johnson Foundation (RWJF)
RWJF has issued a request for proposals from organizations and government entities for projects relating to health care policy, financing, and organization issues. Examples of supported projects include “examining significant issues and issues related to health care financing and organization” and “exploring or testing major new ways to finance and organize health care.” HCFO grants are awarded for projects requiring less than $100,000 that will be completed in less than 12 months. For projects requiring more than $100,000 and lasting longer than twelve months, visit: Changes in Health Care Financing and Organization.
Take a look at the following funding opportunities:
Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA has issued a request for applications from community-based projects that provide integrated medical and behavioral services to adults with serious mental illness (SMI), who may have co-occurring substance use disorders or be at risk for co-morbid primary care conditions and chronic diseases. The program is intended to “improve the health of individuals with SMI, enhance the consumer experience of care, and reduce the per capita cost of care.”
For more information about PBHCI and SAMHSA see: http://www.integration.samhsa.gov/about-us/pbhci
The (AHRQ) Health IT Portfolio has a public Web (http://healthit.ahrq.gov/) that offers more than 10,000 documents, presentations, articles, and tools to health information technology (IT) researchers, implementers, and policymakers. The National Resource Center of Health IT (NRC) Web site offers over 20 tools and resources to support health IT research and evaluation. The Health IT Literacy Guide has been available through the NRC since 2007.
More recently, AHRQ contracted with the Research Triangle Institute (RTI International) to evaluate this report. The report notes:
- health literacy remains a significant challenge;
- health information is increasingly accessed through health IT; and
- an important aim is usable health IT for individuals with limited literacy.
The evaluation report summarized findings and presents recommendations based on an environmental scan, expert interviews, and focus groups conducted with the intended developers and purchasers of health IT, who are the intended audience of the Health IT Literacy Guide.
The four chapters of the report include:
- Chapter 1: Background, context, and identification of the research questions;
- Chapter 2: Summary of approach used in the evaluation;
- Chapter 3: Summary of findings; and
- Chapter 4: Recommendations based on research findings.
Key findings of the evaluation are:
- developers and purchasers were largely unaware of the Guide;
- developers and purchasers had limited agreement on definitions of health literacy or the role of health IT in supporting individuals with low literacy;
- information in the Guide appeared to be outdated;
- experts and focus group participants were highly interested in the “checklist intended to help purchasers and developers identify best practices when purchasing or designing systems that support patients”; and
- the Guide could be useful during system development or product evaluation if it was used at appropriate points during product testing or system selection.
See the evaluation report in its entirety at: http://www.ahrq.gov/research/findings/final-reports/healthitresources/index.html .