News Archives

Psychologists in Primary Care—Experiences at DoD

Date: 
Tue, 06/10/14

The U.S. Department of Defense (DoD) was a pioneer in the integration of behavioral health and primary care and is widely acknowledged as an exemplar. This article by Christopher Hunter, et al. reviews the development of integrated behavioral health care in the DoD primary care clinics. The authors explain the crucial role of psychologists in this process. In addition to successfully promoting integrated care as a core component of the DoD patient-center medical home (PCMH), psychologists played key roles in policy development, the development and implementation of training programs, clinical care, and program evaluation.

The article goes into detail, providing information on the different approaches taken across service branches, the structural and funding issues across the DoD, a description of the shifts made in a clinic implementing the behavioral health in primary care, and the primary care physician perspective. The authors end by saying that, while psychologists played a significant role in the development and implementation of integrated care programs in DoD clinics, there is still a lot to be done and psychologists will continue to have a significant role as the process moves forward in the DoD clinics.

Based on their experience, the authors provide 9 recommendations for psychologists to consider, depending upon the role they play in integrated care. They conclude by stating: 

“As the nation faces significant changes in its health care system, the diverse contributions of psychologists in the DoD, from direct clinical care to policy development, suggest that psychologists are critical for implementing integrated care in systems throughout the United States.”

 

Hunter CL, Goodie JL, Dobmeyer AC, et al. Tipping points in the Department of Defense’s experience with psychologists in primary care. American Psychologist 2014 May-Jun; 69(4): 388-398. doi: 10.1037/a0035806

 

NOTE: This article is one of 11 in American Psychologist - Journal of the American Psychological Association, Special Issue: Primary Care and Psychology

The article may be accessed at: http://psycnet.apa.org/journals/amp/69/4/388/

The abstract and related citations may be found at: http://www.ncbi.nlm.nih.gov/pubmed/?term=Tipping+points+in+the+Department+of+Defense%E2%80%99s+experience+with+psychologists+in+primary+care.

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Clinical & Community

  • An Introduction to Primary Care and Psychology
  • Psychologists in Primary Care - Experiences at DOD

An Introduction to Primary Care and Psychology

Date: 
Tue, 06/10/14

This article by Susan H. McDaniel, PhD, and Frank V. deGruy III, MD, MSFM, serves as the introduction to the recent special issue of American Psychologist , the journal of the American Psychological Association (APA).  The authors point out that

“The value of primary care turns on its comprehensiveness, which means that behavioral health care-health behavior change, mental health care, management of psychological symptoms and psychosocial distress, and attention to substance abuse-must be woven into the fabric of primary care practice. This integration is beginning to happen as psychologists and other behavioral health clinicians are incorporated as essential team members in the patient-centered medical home and other emerging models of primary care.”

The article introduces psychologists to the changes evolving in primary care and the variety of roles for psychologists as the new health care system emerges in the U.S. The authors go on to explain the many aspects of primary care transformation, such as policy, research and education, and the roles psychologist play in each facet. Each of these facets is further explicated in the subsequent articles in this special issue of the APA journal.

To view the abstract, go to:  http://www.ncbi.nlm.nih.gov/pubmed/24820682

The full article may be obtained at:  http://psycnet.apa.org/journals/amp/69/4/325/

American Psychologist – BH Integration Featured in Special Issue

American Psychologist Features Integration in Special Issue

The American Psychological Association (APA) featured behavioral health integration in a Special Issue: Primary Care and Psychology, published in May-June 2014.

The articles were developed through collaborations between psychologist and primary care physician authors. Susan H. McDaniel, PhD, and Frank V. deGruy, III, MD, MSFM, provided the lead article, An Introduction to Primary Care and Psychology.

Many of the 11 articles in this special issue will be featured on the Academy Portal in this and upcoming updates.

Public Knowledge about Mental Health Parity

A recent survey, commissioned by the American Psychological Association (APA) as part of their mental health parity awareness initiative, indicates that only 4% of Americans know that health insurance is mandated to cover mental health, behavioral health, and substance abuse disorders as it does physical health. Despite the increase of national discussions about mental health services, people are no more of aware of the Mental Health Parity and Addictions Equity Act (MHPAEA) than they were in 2010. Moreover, 90% of the American public has never heard of “parity” according to Katherine Nordal, executive director for professional practice at APA. In the six years since MHPAEA was passed, she would have thought that the average consumer knew more. Nordal calls for “public education to let [consumers] know how their insurance benefit is changing and allow them to seek treatment,” especially now when mental health and substance use treatment is an essential health benefit under the Affordable Care Act. Thirty million people are expected to receive health coverage through Medicaid and the insurances exchange, which includes mental health care. Under MHPAEA, insurance companies are required to provide behavioral health coverage benefits equal to or better than coverage for physical health benefits. There can be no annual limits, and copays and deductibles must be equal to or less than those for medical benefits.

Nevertheless, “cost and whether or not providers [will] accept insurance” is one of the major barriers for consumers with regards to accessing services. “Financial concerns outweigh stigma,” Nordal says. She adds that many people do not read over their health insurance policy unless they have to. According to the survey, 29% of Americans said that their insurance has different co-pays or limits on mental health care, 24% said they aren’t sure if their insurance provides the same coverage for mental and physical health, and just 56% of people said that their insurance covers seeing a psychologist or other mental health professionals. Furthermore, “when asked what information they would need before being treated by a psychologist or mental health professional,” 75% of consumers said they would have to know if they accepted insurance. These findings suggest that consumers ultimately need to know that their mental health co-pays will be low since they compare to co-pays for medical benefits. Still, psychologists are hopeful that with vanishing economic barriers, more patients will get the evidence-based psychological help they need.

Read the related press release: https://www.apa.org/news/press/releases/2014/05/mental-health-coverage.aspx

Access resources on the mental health parity law: http://www.apa.org/helpcenter/parity-law-resources.aspx

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Clinical & Community>Patients> Population Groups> Age

  • Collaborative Care Improves Outcomes for Dementia Patients

 

How to Build Effective Integrated Teams

“Q: How do you know if you have an effective team in place? A: When your clients stop asking why their medical and mental health providers don’t talk with each other.”

Jürgen Unützer, MD, MA, MPH, a University of Washington-based psychiatrist, leader of integrated primary care efforts, and NIAC member, describes the core elements required to build an effective integrated team in this Substance Abuse and Mental Health Services Administration online feature. Dr. Unützer observes:

“A high functioning care team is essential to delivering effective integrated primary and behavioral healthcare and achieving the ‘triple aim’ of better care, improved outcomes, and lower costs. But building a team is easier said than done. Team members are often asked to work in unfamiliar ways, and the very act of functioning collaboratively can be an unknown or unused skill.”

Defining the integrated team is complex due to the shifting members that are needed to attend to various patients at different times. As further defined by the Lexicon for Behavioral Health and Primary Care Integration, Dr. Unützer points out that members may work at different locations. For example, Dr. Unützer describes the Jefferson Center for Mental Health’s structure, a community mental health center in the Denver, CO metro area, which defines team members as “a care coordinator to an administrative assistant, addictions specialist, nurse practitioners, psychiatrist, peer health coach, medical assistants, and senior leadership.”

There are many components and skill sets that comprise a collaborative integrated team. Key elements include strong organizational and leadership commitment; creating a shared vision; establishing clear roles and functions of each member; developing shared goals when discussing the patients’ treatment plan; fostering effective communication; continual nurturing; and expressing clear and consistent expectations and goals for team members. If you are seeking guidance on building your integrated team, more educational tools can be found at Dr. Unützer’s Center for Advancing Integrated Mental Health Solutions.

To read the report, please visit: http://www.integration.samhsa.gov/about-us/esolutions-newsletter/e-solutions-april-2014#Feature%20Article

 

4 out of 10 Hospital Readmissions Due to Behavioral Health Conditions

Mood disorders, schizophrenia, substance and alcohol abuse, and other psychotic disorders are among the top 10 reasons patients were readmitted to the hospital in 2011. In this

Agency for Healthcare Research and Quality Statistical Brief, the Healthcare Cost and Utilization Project outlines the causes of readmissions in U.S. community hospitals. Results are reported by payment type (i.e., Medicare, Medicaid, private insurance and uninsured), which further highlights the leading causes within these populations.

Among a total of 3.3 million 2011 readmissions nationwide, report findings suggest that mood disorders were most consistently one of the leading causes. In fact, mood disorders were the primary cause in the Medicaid and uninsured populations. An approximate 19.8 Medicaid recipients were hospitalized per 100 admissions, contributing to 6.2% of all Medicaid readmissions. However, schizophrenia and other psychotic disorders contributed to the highest costs within Medicaid at $302 million. Combined Medicaid costs totaled $832 million across schizophrenia, mood, other psychotic disorders, and substance and alcohol abuse disorders. The uninsured had similar utilization rates and $165 million in annual behavioral health-related readmission costs.

Findings draw attention to our system’s continuing need to better address behavioral health. Integrating behavioral health care within primary care settings not only improves access to the patients who need these services (Medicaid and uninsured in particular), but also reduces hospital readmission costs.

To read the report, please visit: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf

 

 

 

 

Collaborative Care Improves Outcomes for Dementia Patients

Date: 
Thu, 05/22/14

According to a recent Health Affairs article, Health Aging Brain Center Improved Care Coordination and Produced Net Savings, more than 4.7 million Medicare recipients have dementia which often co-occurs with depression. Together, dementia and depression costs Medicare $30 billion in annual spending. Most Medicare beneficiaries with these conditions are seen in primary care which is often not well equipped to provide appropriate care. Inadequate care for dementia and depression can result in morbidity and additional health care costs. Fortunately, over the past 20 years, the collaborative care model in primary care has been “effective in improving care quality, efficiency, and outcomes for older adults suffering from dementia and depression.” It has also historically “been shown to improve care and coordination and to reduce utilization.”

The Healthy Aging Brain Center (HABC), a memory clinic at Eskenazi Health in Indianapolis, Indiana, has leveraged the collaborative model to provide better, more efficient care. Eskenazi Health provides “urban public safety-net health care [to] a racially and ethnically diverse population” and sees more than 10,000 patients ages 65 and older for almost 90,000 visits annually. HABC provides care to referred patients and offers “assessment and management of their cognitive, behavioral, and psychological symptoms,” as well as caregiver support 5 days a week. It does not take on care of patients but, rather, collaborates with their primary care physicians. Its collaborative care components include “a trained care coordinator who works with the patient, family, and primary care provider”; individual care plans that incorporate the 10 main components of the collaborative care model; self-management education; resources and counseling for caregivers; and monitoring of patients’ “biopsychosocial needs” and progress. Full staff is comprised of a memory care physician (e.g., geriatrician, behavioral neurologist); two care coordinators (a social worker and registered nurse); a medical assistant; and a technician to administer neuropsychological tests.

The HABC produces a net cost saving of $2,856 per patient annually and could help save billions of dollars nationwide. Moreover, it “reduces patients’ behavioral and psychological symptoms,” reduces caregiver burden and depression, and improves upon quality of care. With robust workforce training and initial funding for new business models (e.g., bundled payments), the collaborative care model could become the standard of care and continue to produce positive health outcomes exhibited by the HABC.

Access the Health Affairs article: http://content.healthaffairs.org/content/33/4/613.abstract

IOM Report: Social and Behavioral Data in the EHR

Date: 
Wed, 04/30/14

The social and behavioral determinants of health such as smoking status and depression are significant factors attributed to risk and functional outcomes for patients with chronic disease. Despite this importance, most electronic health records (EHRs) do not capture this patient information. An EHR that captures this data would be a great asset to integrated behavioral health care.

A select committee of leading researchers and population health experts, funded by the Institute of Medicine (IOM), was tasked to identify these core domains to facilitate future use of EHR data for improved care delivery and research alike. In the first stage of this report, Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1, six criteria were chosen to more clearly identify domains with high priority for inclusion in EHRs. These include: “1) strength of the evidence of the association of the domain with health; (2) usefulness of the domain, as measured for the individual, population, and research; (3) avail­ability and standard representation of a reliable and valid measure(s) of the domain; (4) feasibility for the patient and clinician and in terms of administrative time and cost of interfaces and storage; (5) sensitivity, such as for revealing personal information; and (6) accessibility of data from another source.”

Using the first two criteria, the committee has currently established 17 pertinent domains including sociodemographic, psychological and behavioral factors, sexual orientation, education, stress, and dietary and physical activity patterns. The Phase 2 report plans to use all six criteria to establish a more targeted set of domains. Inclusion of social and behavioral determinants in EHRs will provide useful information to providers and patients, and lead to improved assessment and treatment approaches for American patients.

A summary of the report may be found at:

http://iom.edu/~/media/Files/Report%20Files/2014/EHR-Phase-1/EHRdomains.pdf

To read the report, please visit: http://iom.edu/Reports/2014/Capturing-Social-and-Behavioral-Domains-in-Electronic-Health-Records-Phase-1.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=04.08.14+New+Report+-+EHR+1&utm_content=&utm_term=

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