San Mateo County’s public health system is now equipped to better treat substance abuse in all patients seen, thanks to Medical Director of Behavioral Health and Recovery Services Robert Paul Cabaj, M.D. “It was astonishing—the number of people in the public-health system with substance abuse issues,” Dr. Cabaj reported. “The vast majority of them were in primary care, and it was very clear that if physicians had some...
Tracking measurable outcomes within integrated primary care is essential to develop effective systems. However, health care organizations are slow to establish these new procedures and systems given a lack of existing evidence-based measures. In a 2012 white paper, the Institute for Healthcare Improvement (IHI) proposed a menu of measures, their targeted outcomes within health care settings, and the health care organizations that use these...
A recent study reports one in five Michigan residents have been diagnosed at some time in their lives with depression: a higher rate than the national average (18%). “Economic stress, poor access to health care, unemployment, are all risk factors (for depression) and Michigan unfortunately is saddled with those burdens more than other states, so I wouldn’t be surprised that it’s...
The United States healthcare system is in need of significant redesign and revitalizing primary care is among one of the top priorities of the Patient-Centered Primary Care Collaborative (PCPCC).This has been partially motivated by the rising healthcare costs that burden American employers. These employers have become “increasingly frustrated and tired of buying high-cost, frequently low-quality health care that is poorly coordinated.” The PCPCC,...
Since the 1990s, the Veteran’s Health Administration (VHA) has used telehealth to deliver consistent, organized and holistic primary and specialty care. Today, it is the biggest consumer of home telehealth technology in the world. Telehealth in the VHA “involves use of information and communications technologies to deliver medical care remotely by connecting multiple users in separate locations.” It incorporates “health informatics, disease management, and telehealth...
The number of elderly persons with severe mental illness (i.e., schizophrenia, major recurrent depression, bipolar disorder) is increasing, thereby creating a need to better understand the health care needs of this group of patients. Dr. Hendrie from the Indiana University Center for Aging Research and his colleagues recently published research examining health care utilization, health outcomes, and cost of care among the elderly patients with severe mental illnesses. Their findings indicate...
Over 70 randomized, controlled studies suggest collaborative care—the collaboration among primary care providers, primary care-based behavioral health providers, case managers, and psychiatrists to better target and deliver mental health treatment—improves outcomes and service cost-effectiveness. The passing of the Affordable Care Act is thought to quicken its adoption to meet the increasing population need. The Accreditation...
In a mid-January 2014 blog post, NIAC member, Kavita Patel, MD, MSHS and colleague Jeffery Nadel indicated that current efforts to improve the cost and quality of health care are aptly focused on primary care. According to the 2010 National Ambulatory Medical Care Survey, 560 million or 55.5% of the almost 1.1 billion physician office visits every year are to a primary care...
Although “integrating primary and behavioral health has been recognized as having significant potential to prevent behavioral health issues from becoming severe,” it is often difficult to achieve in rural areas where behavioral health providers are scarce. Fortunately, telehealth (or telemedicine)—described as “the use of medical information exchanged from one site to another via electronic communications to improve patients' health status”—can address...
Over 20 years of research suggests integrating behavioral health and primary care services improves mental health outcomes. With the implementation of the Affordable Care Act, states are now opportunely positioned to implement integrated care, particularly to address the needs of the underserved. Wayne Katon, MD and...

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