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National Institutes of Health (NIH)
Providers are beginning to use automated, real time alerts to keep them informed of important patient updates at the Maimonides Medical Center in Brooklyn, New York. Given their known higher health care needs and prevalence within the Brooklyn area, patients with bipolar and schizophrenia were first chosen to pilot this secure email alert system. Alerted health care events such as inpatient admissions/discharges, emergency department admissions/discharges, psychiatric admissions/discharges, or death were included and prompted providers to coordinate care quickly.
“Beyond the benefits of coordinating care between disparate systems and providers, as an individual physician,
I now have a greater sense of where my patients are. Having that information is incredibly powerful.”
Kishor Malavade, M.D.
Since its inception, the system has enrolled more than 5,000 patients and has prompted more than 10,000 alert messages. Maimonides’ psychiatrist Kishor Malavade, M.D. expressed the benefits of this tool and stated:
“Just because I get a text message alert on my phone doesn’t replace the fact that I need to
communicate with my colleagues and the patient. These alerts are great, but they’ll never
be as robust as in-person conversation.”
Plans to expand the program include provider alerts for patients with other chronic illnesses and within home health organizations to improve care coordination.
Funding for the Brooklyn Health Information Exchange (BHIX) program was provided by a 2009 New York State Health Care Efficiency and Affordability Law (HEAL) grant with the intent of improving care coordination within the patient-centered medical home and home health services. More generally, health information exchange (HIE) includes the electronic exchange of health care information to improve communication and care while reducing cost.
Read the related article: http://www.healthit.gov/buzz-blog/state-hie/hie-bright-spots-supporting-mental-health-care-coordination-part-3/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+healthitbuzzblog+%28Health+IT+Buzz+Blog%29
A Utah clinic has recently begun integrating family medicine and mental health. When patients at Intermountain Healthcare’s Salt Lake Clinic exhibit symptoms of depression, their primary care physician will now work with a psychiatrist, Dr. Karen Christian, M.D., to provide them with care.
Patients can now immediately speak with Dr. Christian and even schedule a follow-up appointment, lessening the burden on patients to access resources themselves. “That is the beauty of mental health integration,” explains Dr. Christian. “Because often times what happens is the primary care doctor will say ‘I would like you to see a psychiatrist’ and people freak out and they think ‘I’m not crazy. That is not me.’ And when they have to go to a building that they have never been, find their way, there are just too many barriers and often times people don’t make it.”
View the original announcement here: http://www.kutv.com/health/features/check-health/stories/vid_323.shtml
Five nonprofit organizations throughout Maine will be receiving $25,000 each in grants for connecting primary care providers with patients receiving mental health services and substance abuse treatment, according to an announcement from the Maine Health Access Foundation (MeHAF).
The grants, approved by MeHAF’s Board of Trustees, are aimed at improving primary care service coordination with medical specialty care, behavioral health services, and oral health care. MeHAF President and CEO, Dr. Wendy Wolf, M.D., M.P.H., states " These grants will allow mental health providers to develop a framework for integrating primary care services within their community mental health centers so the centers can serve as a comprehensive 'health home' for their patients. This new approach will ensure that people with serious mental illness receive higher quality care in a more cost-effective and timely way. Primary care will be coordinated by the mental health providers these patients already trust." Dr. Becky Hayes Boober, Ph.D., MeHAF Senior Program Officer overseeing the grants, adds, "These grants will help community mental health organizations become what the MaineCare and federal Affordable Care Act (ACA) call 'Behavioral Health Homes.' A 'Behavioral Health Home' is not a place but a new way of coordinating patient care and community services.”
The following organizations are recipients of the Behavioral Health Homes (BHH) grants:
- Aroostook Mental Health Services, Inc. for its project developing BHH services in outpatient clinic sites.
- The Charlotte White Center for its project designing a rural BHH for adults with serious mental illness in Piscataquis County.
- HealthReach Network Mental Health & Substance Abuse Services for its project establishing a collaborative with several community behavioral health organizations with integrated care to explore best practices for creating BHHs in two counties.
- The Opportunity Alliance for its project creating a BHH in Portland to meet the primary care, behavioral health, and community living needs of individuals living with severe and persistent mental illness and other chronic health conditions.
Tri-County Mental Health Services for incorporating the services of a nurse practitioner into a Community Mental Health Center and integrating care with area primary care providers for people with severe and persistent mental illness.
View the funding announcement here: http://www.mehaf.org/news/2013/03/27/health-foundation-announces-grants-improve-care-five-community-mental-health-centers/
Demonstrated workforce competencies are essential to successfully meet both patient and provider needs and cost constraints in integrated primary care settings. Since 2007, approximately 1,500 health care professionals have received this specialized training through The Certificate Program in Primary Care Behavioral Health at the University of Massachusetts’ Center for Integrated Primary Care. Program Director and NIAC member Alexander Blount, EdD explains that a key approach in assessing any program’s success is to implement valid and reliable self-evaluation measures which capture pre- and post-participant self-reports of taught core competencies. Retrospective pretest assessment not only asks participants for pre-training evaluations but retrospective assessment of their core skills at post-training, thus reducing self-report bias. Using this method, the program demonstrated improvements in all core competency domains such as working with physicians, evidence-based therapies and substance abuse in primary care, and behavioral medicine interventions.
Read the related article: http://www.umassmed.edu/workforceevaluation.aspx
Historically, psychiatric records have been kept separate from a patient’s medical records and as more organizations transition to electronic health records (EHRs), these records continue to remain separated despite recommendations that they should be shared. A recent study by a group of researchers including Adam Kaplin, MD, PhD, Assistant Professor of Psychiatry and Behavioral Sciences and Assistant Professor of Neurology at the Johns Hopkins University School of Medicine in Baltimore, found that very few hospitals in the United States even store psychiatric records electronically and even fewer share the records with nonpsychiatric physicians.
“The psychiatric illnesses these patients have play a huge bearing on their medical illnesses,” Dr. Kaplin said. “As an example, whether or not you have depression following a heart attack is as big as or bigger than any other risk factor as to whether you are going to die in the year following that heart attack.”
This is a huge issue according to Dr. Kaplin, one that prevents physicians from giving patients the complete care that that they deserve. Kait B. Roe, a patient advocate and patient engagement consultant in Washington, says:
“It is the health of the whole person that matters, and until we can get past all of this stuff that is attached to mental illness, we will never have parity in how we treat patients.”
There are many barriers to sharing records including patient concerns about privacy, separate patient consent models for physical and mental health care and technical and logistical difficulties within the EHR.
“We are a long way from discussing the nitty-gritty of what should be shared,” Dr. Kaplin said. “But at the very minimum, other physicians should know the name of a patient's treating psychiatrist, the diagnosis, the medications he or she takes, and whether he or she is suicidal,” he said.
Read the full article at: http://www.amednews.com/article/20130211/profession/130219979/4/?goback=%2Egde_4254769_member_218819122
The authors of a recent article in The American Journal of Managed Care discuss the benefits and importance of integrating mental health care into Accountable Care Organizations (ACOs). ACOs are patient-centered coordinated systems of care created through the Patient Protection and Affordable Care Act (PPACA) (also referred to as "Affordable Care Act" or ACA). They have specific quality and performance standards they must meet in order to receive payments under the Medicare Shared Savings Program (MSSP). ACOs are incentivized to improve patient outcomes to benefit from shared savings; however, they are not directly incentivized to improve mental healthcare which the authors say is “missed opportunity to champion integrated mental healthcare.” The authors argue that “in order for ACOs and the medical home to achieve the “triple aim” of improved care for patients and populations at a lower cost, mental health care must be integrated within PCMHs.” Financial and organizational models for integrating mental health into primary care are suggested in the article. The authors specifically discuss the Chronic Care Model (CCM) and encourage ACOs to increase focus on mental health care to reap the full benefits of the MSSP and meet the goals of improving health care outcomes while reducing costs.
On January 24, 2013, NIAC member Michael Hogan, PhD testified before the Senate Committee on Health, Education, Labor and Pensions, which convened to assess the state of America’s mental health system. In his testimony, Dr. Hogan reminded the Committee that previous evidence supports the inclusion of mental health care in health care. He alluded to a recent study outlined in Richard Frank and Sherry Glied’s Better But Not Well: Mental Health Policy in the United States since 1950 that suggests that improved well-being for people with mental illness is not due to improvements in mental health care but rather, due to increased access to mainstream services like health care. Additionally, the Mental Health Parity and Addictions Equity Act (MHPAEA) calls for including mental illness care in health care and furthermore, indicates that a separate and unequal mental health system is not a solution. Finally, the Affordable Care Act (ACA) includes mental health changes within it changes to health care. Dr. Hogan then described that integrating basic mental health care into primary care is therefore the first major challenge for the next decade. However, it will call for major structural changes and utmost attention from the Committee and federal agencies.
Read a transcript of Dr. Hogan’s testimony: http://www.help.senate.gov/imo/media/doc/Hogan.pdf
Also watch the full committee hearing: http://www.help.senate.gov/hearings/hearing/?id=b2048a10-5056-a032-529c-340d7ae5f237
In her blog post from just before this year’s State of the Union, NIAC member Kavita Patel, MD, MSHS talks about the importance of addressing mental health in the national discussion. She declares that due to laws that require mental health professionals to report to authorities the names of those who could harm themselves or others, recent efforts to expand access to mental health facilities and raise standards of mental health services should be approached with caution. These laws may only increase stigma and barriers to seeking mental health treatment. Dr. Patel asserts that truly integrating behavioral and mental health services in other aspects of care such as primary care will be more effective. Thus, the president will have to balance the need for immediate action with the need for effective evidence-based mental health models that can transform care. Discussions of mental health should therefore be approached with a critical eye and influenced by perspectives from public health and other social determinants of health and primary care.
Read Dr. Patel’s blog post: http://www.brookings.edu/blogs/up-front/posts/2013/02/08-discuss-mental-health-sotu-patel
Learning Community on Integrated Health Care
In efforts to promote integrated health care in Texas, the Hogg Foundation for Mental Health funded the Texas Learning Community (TLC) on Integrated Health Care in 2009-2011. The TLC convened primary care and mental health provider organizations from throughout the state to disseminate and learn strategies for implementing integration in their communities. Read the full summary report to find out more about efforts and outcomes of the TLC: http://www.hogg.utexas.edu/uploads/documents/TLC%20Summary%20Report_final1.pdf
The Affordable Care Act Takes Hold in VA
HealthWorks For Northern Virginia, a Loudon County Community Health Center, recently transformed itself into a modern model of the “health home,” an aim of the Affordable Care Act. It provides fully integrated services–medical, dental, optometry, pharmacy, and behavioral health– all under one roof and uses an electronic health records system. Read more about the HRSA-funded project that transformed HealthWorks: http://www.hrsa.gov/about/enews.html#virginia