News Archives

Organizations Supporting Integration

This month the AHRQ Academy has updated the Organizations page on the Resources tab to include a more comprehensive list of organizations and guilds that are engaged in behavioral health integration in some way. Many of these have also developed publications and resource materials that are available on their websites. The list provides links to the organization’s home-page. Organization sites may be searched to locate information, resources, and opportunities specific to behavioral health integration.

AMA Telemedicine Policy

In June 2014, the American Medical Association (AMA) voted to issue a list of guidelines for guaranteeing adequate coverage and financing of telemedicine services. The AMA feels “that the appropriate use of telemedicine to deliver care to patients could greatly improve access and quality of care, while maintaining patient safety”. The guiding principles originate from a previous policy report by AMA’s Council on Medical Service that offered a discussion of coverage and payment for telemedicine (including current rules), background information on the delivery of telemedicine, a summary of respective practice guidelines and position statements, and case studies. The report also mentioned that the American Telemedicine Association—an organization that has led efforts to develop guidance for telemedicine—issued practice guidelines for video-based online mental health services with feedback from the American Psychiatric Association. In 2009, most of the telemedicine services provided to Medicare beneficiaries were mental health services provided by mostly psychologists, psychiatrists, and clinical social workers, which accounted for 49% of total practitioners who offered telemedicine services. Family and internal medicine physicians accounted for 7%.

The AMA goal of the guidelines is to help promote innovative use of telemedicine, protect the relationship between patients and physicians, and improve care coordination and communication in medical homes. AMA President, Robert M. Wah, M.D., says, “This new policy establishes a foundation for physicians to utilize telemedicine to help maintain an ongoing relationship with their patients, and as a means to enhance follow-up care, better coordinate care and manage chronic conditions." The guiding principles address AMA’s strategic focus areas, which include “improving health outcomes, enhancing patient satisfaction and practice sustainability and accelerating change in medical education.” Ultimately, telemedicine can improve the patient-physician relationship, increase access to remote medically appropriate services for patients including those with chronic conditions, and reduce health care costs.

Read the related press release and obtain the policy report: http://www.ama-assn.org/ama/pub/news/news/2014/2014-06-11-policy-coverage-reimbursement-for-telemedicine.page

Get Your Latest News Via the Academy

Stay current with the latest news! Access timely topical news that’s relevant to the integration of behavioral health and primary care. You can access the Latest News stories through the portal topical pages or under News Archives.

Click on the topical pages below where you can see recently posted Latest News items:

Clinical & Community

  • PCMH Saves Costs in the VHA

Health IT

  • AHRQ Health IT Portfolio

Education & Workforce

  • Proximity of Behavioral Health and Primary Care Providers

PCMH Saves Costs in the VHA

Date: 
Mon, 07/21/14

In 2010, the Veterans Health Administration (VHA) began the Patient Aligned Care Teams (PACT), a nationwide initiative “that reorganized care at all [their] primary care clinics in accordance with the patient-centered medical home [PCMH] model.” The goal of PACT is to provide comprehensive, longitudinal, patient-centered primary care by establishing team-based care, increasing access to same-day care, improving care management and coordination, and increasing focus on patient-centeredness. It also builds on efforts to integrate behavioral health and primary care that were started in 2007. A recent study of 11 million primary care patients analyzed PACT data from fiscal years 2003-2012 to monitor changes in health care utilization and cost after implementation. Results show that after 2-1/2 years, PACT caused a slight decrease in hospitalizations for ambulatory care-sensitive conditions and specialty mental health visits, and a slight increase in outpatient primary care visits for patients 65 years and older. These effects avoided $596 billion in costs where $774 billion was initially invested in the initiative. Although there was no positive return on investment and a net loss of $178 million, PACT is still evolving and these trends in utilization and cost avoidance are favorable. Thus, the PCMH model does not pose a huge financial risk for the VHA.

The costs PACT avoided were largely due to the decline in specialty mental health care visits. This reduction may have been enabled by the integration of primary care and mental health. Because mental health care was more accessible in primary care, PACT teams perhaps had less need to refer patients to specialty mental health services. In turn, the increase in primary care visits might have also contributed to these cost savings. Due to counseling of patients with complex chronic conditions by PACT nurse care managers, patients might have been encouraged to shift more of their care from Medicare to the VHA. Although, this trend may have increased visits within the VHA, it nullified costs associated with obtaining care elsewhere. Over time, these factors’ impacts on cost savings will become clearer. Still, savings are expected to remain if other components of PACT become well integrated into primary care. Nonetheless, the VHA’s adoption of the PCMH model has certainly improved the quality of and satisfaction with care.

Read the related article: http://www.ncbi.nlm.nih.gov/pubmed/?term=Patient-Centered+Medical+Home+Initiative+Produced+Modest+Economic+Results+For+Veterans+Health+Administration%2C+2010%E2%80%9312

Proximity of Behavioral Health and Primary Care Providers

Date: 
Mon, 07/21/14

Despite increasing awareness of integrated behavioral health and primary care, little is known about the distribution of integration across the United States. Currently, there is a lack of information at the state and national levels about:

  • Number and location of primary care practices with integrated behavioral health;
  • Where the potential for collaboration exists through provider proximity; and
  • Where integration cannot occur due to the absence of either a primary care or a behavioral health provider.

This article, written by Academy Principal Investigator, Benjamin Miller, PsyD, and colleagues, is featured in the recent special issue: American Psychologist. The article aims to use data from the Centers for Medicare and Medicaid Services’ National Plan and Provider Enumeration System (NPPES) Downloadable File to examine and assess where [geographic] colocation exists for primary care providers and any behavioral health provider (psychiatrists, psychologists, social workers, marriage and family therapists, and mental health counselors) and more specifically, primary care providers and psychologists. The article findings indicate, “Approximately 29% of primary care physicians are [geographically] collocated with psychologists and 43% are [geographically] collocated with any behavioral health provider.” When researchers compared the most urban areas to the most rural areas, “the percentage of primary care physicians colocated declines from 31.3 to 6.3 per 100,000 persons.”

The authors of this article suggest policy recommendations that could increase the spread of behavioral health integration. The authors go on to further explain their policy recommendations in the following fields: training, education, and workforce; payment reform; and research. 

The NPPES database only identifies if providers are [geographically] collocated. Proximity of providers does not indicate if providers are collaborating or integrated. Currently, there is not enough data to support a true count of integrated practices; however, opportunities exist to further expand this research.

Behavioral health [geographic] colocation is a prerequisite for integration of behavior health and primary care. Although this is not currently feasible everywhere, in places where [geographic] colocation exists, integration of behavioral health and primary care could quickly be enabled. The authors summarize the potential of NPPES and conclude by stating,

“The NPPES database provides an opportunity to simultaneously analyze the distributions of behavioral health and primary care clinicians and, for the first time, show where in the United States behavioral health and primary care are actually collocated.”

The article may be accessed at: http://psycnet.apa.org/journals/amp/69/4/443/

AHRQ Health IT Portfolio

Date: 
Mon, 07/21/14

Use of health information technology (IT) is central to the success of integrated behavioral health and primary care. Availability of secure and private electronic health records to all those who need it when they need it can improve on the quality and cost of care. The Agency for Healthcare Research and Quality (AHRQ) offers the HealthIT Portfolio, which produces and shares information and evidence-based tools “about the impact of health IT on health care quality.” To do so, it predicts future needs of the health care system and supports the development of health IT solutions; finds and fills present gaps in knowledge about health IT; and “leverages the capability of health IT to improve the quality, safety, efficiency and effectiveness of health care.” AHRQ has already encouraged more than 150 communities, hospitals, providers, and health care systems in 48 states to adopt and promote access to health IT. On the AHRQ HealthIT website is information about AHRQ-funded projects, tools and resources, relevant events, key topic areas, funding opportunities, and ways to stay informed. The site also features a video and a related report on how health IT enhances care coordination, particularly with regard to communication among providers, a key feature of Integration. A recent webinar discusses how to successfully implement health IT while ongoing changes occur in the way people and organizations work. Visit the AHRQ Health IT Portfolio today to access these resources and learn how health IT can advance integration and produce better health outcomes.

AHRQ Health IT Portfolio: http://healthit.ahrq.gov/

Integrating Behavioral Health Within Medicaid ACOs

The Commonwealth Foundation released a brief that outlines considerations for state Medicaid agencies to use in successfully integrating behavioral health services within accountable care organizations (ACOs). Medicaid ACOs have the potential to improve the quality of health care and reduce rising costs. This is particularly true for high-need beneficiaries with co-occurring disorders. Since behavioral health conditions are prevalent, as are their cost implications, among Medicaid patients, the coordination of behavioral health services within Medicaid ACOs may help states significantly improve quality of care and gain notable cost savings by reducing avoidable inpatient care and emergency department use.

Minnesota, Maine, and Vermont are among the states that already have ACOs that target their Medicaid populations. In defining program requirements for their Medicaid ACOs to encourage integrated delivery of and payment for physical and behavioral health services, these three states identified five focus areas as keys to success:

  • Financial incentives and sustainability;
  • Confidentiality of data sharing and provider supports for health information exchange;
  • Quality measurement;
  • Alignment with existing behavioral health initiatives; and
  • Potential regulatory and policy levers to overcome barriers to integration.

The Commonwealth Foundation brief thoroughly explores each of the five focus areas by identifying key opportunities states can use to capitalize on existing building blocks for integration. It also provides considerations to guide states in supporting the integration of services in Medicaid ACOs. The concluding paragraph of the brief reads as follows:

“By linking payments to improvements in quality of behavioral health services and improved integration with medical services, ACOs encourage historically siloed providers to share timely information and coordinate patient care more effectively. State efforts to promote provider relationship building, support capacity building activities, implement payment reforms, and enable new billing practices will help further existing service integration efforts and pave the way for ACOs to become totally accountable for all facets of patient care.”

View the entire brief at: http://www.chcs.org/media/ACO-LC-BH-Integration-Paper-070914.pdf

Primary Care and Psychology – American Psychologist Special Issue May/June 2014

The current issue of American Psychologist is a special issue featuring Primary Care and Psychology.The scholarly lead article, “An Introduction to Primary Care and Psychology,” is written by Susan H. McDaniel and Frank V. deGruy, III. The abstract states that “This article introduces psychologists to the fundamental changes taking place in primary care and to the various roles that psychologists can play in the new health care system.” Following the introductions are groups of articles addressing Clinical Primary Care Across the Lifecycle; Special Populations;  and Education, Research and Evaluation, and Policy. Among the authors are deGruy and C.J. Peek, who serve on the National Integration Academy Council (NIAC), and Benjamin F. Miller and Deborah J. Cohen of the Academy Team.

These articles provide an excellent overview of the integration of behavioral health in primary care (BHPC) and discuss the possibilities of various types of collaboration. The application of this approach is discussed as it relates to children with special needs, persons with serious mental illness, refugees, and deaf people. The experience of the U.S. Departments of Defense and Veterans Affairs, with the BHPC model is also discussed. Workforce issues are addressed in terms of competencies for psychologists in primary care practices, and the colocation of providers. The importance of research and evaluation are discussed as they apply to the transformation of primary care. One of the resources for this lies in accessing the knowledge and skills of psychologists to understand what works best in practicing psychology in the primary care setting.

A feed with abstracts of the articles is available at: http://content.apa.org/journals/amp.rss

Links to the full documents are at: http://psycnet.apa.org/journals/amp/69/4/

 

Get Your Latest News Via the Academy

Stay current with the latest news! Access timely topical news that’s relevant to the integration of behavioral health and primary care. You can access the Latest News stories through the portal topical pages or under News Archives.

Click on the topical pages below where you can see recently posted Latest News items:

Policy & Financing

  • The Paradox of Parity

Clinical & Community

  • Commentaries on the "Joint Principles: Integrating Behavioral Health Care into the Patient-Centered Medical Home"

 

 

Commentaries on the "Joint Principles: Integrating Behavioral Health Care into the Patient-Centered Medical Home"

Date: 
Wed, 07/02/14

In the June 2014 issue of Families, Systems, & Health, the Journal of Collaborative Family Healthcare Association, there is a special Commentaries section on the "Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home." This is follow-up toThe Development of Joint Principles: Integrating Behavioral Health Care into the Patient-Centered Medical Home,” which was written by the Working Party Group and published in the Annals of Family Medicine in its March/April 2014 issue. These joint principles are based on the premise that the patient-centered medical home (PCMH) cannot attend to all of a person’s health care needs without addressing the behavioral aspects of health. Integrated behavioral health is a core principle of the PCMH and thus, indispensable to its success. These principles supplement the original Joint Principles of the Patient Centered Medical Home (PCMH) from 2007 that called for “personal, coordinated, continuous and comprehensive” care that “should address most or all of a person’s health care needs” within the primary health care setting.

The Commentary authors represent the following professional organizations:

American Association for Marriage and Family Therapy (AAMFT)

American Association of Nurse Practitioners (AANP)

American College of Physicians (ACP)

American Psychiatric Association (APA) [Workgroup on Integrated Care]

American Psychological Association (APA)

Collaborative Family Healthcare Association (CFHA)

National Association of Social Workers (NASW)

Patient-Centered Primary Care Collaborative (PCPCC)

Among the authors are NIAC member Parinda Khatri, PhD, who is President of the Collaborative Family Healthcare Association. Each of these commentaries provides useful comments representing the perspective(s) of the organization represented. We encourage you to read this section in its entirety.

For abstracts of the Commentaries and other articles in this issue of Families, Systems, & Health, see:

http://content.apa.org/journals/fsh.rss

For an earlier overview of the “The Development of Joint Principles: Integrating Behavioral Health Care into the Patient-Centered Medical Home,” which appeared in the Annals of Family Medicine, please see:

http://integrationacademy.ahrq.gov/node/5889 .

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