Literature Collection

981

Payment strategies for behavioral health integration in hospital-affiliated and non-hospital-affiliated primary care practices

Type: Journal Article

Authors: Kris Pui Kwan Ma, Brenda L. Mollis, Jennifer Rolfes, Margaret Au, Abigail Crocker, Sarah H. Scholle, Rodger Kessler, Laura-Mae Baldwin, Kari A. Stephens

Year: 2022

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982

Payment Structures That Support Social Care Integration With Clinical Care: Social Deprivation Indices and Novel Payment Models

Type: Journal Article

Authors: Alison N. M.D. Huffstetler, Robert L. M.D. Phillips

Year: 2019

Publication Place: New York

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983

PBRN Impact Profile Series

Type: Web Resource

Authors: Agency for Healthcare Research and Quality

Year: 2025

Publication Place: Rockville, MD

Topic(s):

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Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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984

Pediatric integrated behavioral health service delivery models: Using a federal framework to assess levels of integration

Type: Journal Article

Authors: Sean Lynch, Catherine Greeno, Judith L. Teich, Janet Heekin

Year: 2019

Publication Place: Oxfordshire

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985

Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency

Type: Journal Article

Authors: A. R. Riley, A. Grennan, K. Menousek, K. W. Hoffses

Year: 2018

Publication Place: United States

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986

Peer recovery coaches in general medical settings: Changes in utilization, treatment engagement, and opioid use

Type: Journal Article

Authors: J. F. Magidson, S. Regan, E. Powell, H. E. Jack, G. E. Herman, C. Zaro, M. T. Kane, S. E. Wakeman

Year: 2021

Publication Place: United States

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987

Peer support to reduce readmission in Medicaid-enrolled adults with substance use disorder

Type: Journal Article

Authors: S. L. Hutchison, K. L. MacDonald-Wilson, I. Karpov, A. D. Herschell, T. Carney

Year: 2023

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988

Pennsylvania's Medical Home Initiative: Reductions in Healthcare Utilization and Cost Among Medicaid Patients with Medicaland Psychiatric Comorbidities

Type: Journal Article

Authors: K. V. Rhodes, S. Basseyn, R. Gallop, E. Noll, A. Rothbard, P. Crits-Christoph

Year: 2016

Publication Place: United States

Abstract: BACKGROUND: The Chronic Care Initiative (CCI) was a large state-wide patient-centered medical home (PCMH) initiative in Pennsylvania in place from 2008-2011. OBJECTIVE: Determine whether the CCI impacted the utilization and costs for Medicaid patients with chronic medical conditions and comorbid psychiatric or substance use disorders. DESIGN: Analysis of Medicaid claims using difference-in-difference regression analyses to compare changes in utilization and costs for patients treated at CCI practices to propensity score-matched patients treated at comparison non-CCI practices. SETTING: Ninety-six CCI practices in Pennsylvania and 60 non-CCI practices during the same time period. PARTICIPANTS: A total of 11,105 comorbid Medicaid patients treated in CCI practices and an equal number of propensity-matched comparison patients treated in non-CCI practices. MEASUREMENTS: Changes in total per-patient costs from 1 year prior to 1 year following an index episode period. Secondary outcomes included utilization and costs for emergency department (ED), inpatient, and outpatient services. RESULTS: The CCI group experienced an average adjusted total cost savings of $4145.28 per patient per year (P = 0.023) for the CCI relative to the non-CCI group. This was largely driven by a $3521.15 savings (P = 0.046) in inpatient medical costs, in addition to relative savings in outpatient psychiatric ($21.54, P < 0.001) and substance abuse service costs ($16.42, P = 0.013), compared to the non-CCI group. The CCI group, related to the non-CCI group, had decreases in expected mean counts of ED visits (for those who had any) and psychiatric hospitalizations of 15.6 (95 % CI: -21, -9) and 40.7 (95 % CI: -57, -18) percentage points respectively. LIMITATIONS: We do not measure quality of care and cannot make conclusions about the overall cost-effectiveness or long-term effects of the CCI. CONCLUSIONS: The CCI was associated with substantial cost savings, attributable primarily to reduced inpatient costs, among a high-risk group of Medicaid patients, who may disproportionally benefit from care management in patient-centered medical homes.

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989

Persons with chronic conditions. Their prevalence and costs

Type: Journal Article

Authors: C. Hoffman, D. Rice, H . Y. Sung

Year: 1996

Publication Place: UNITED STATES

Abstract: OBJECTIVES: To determine (1) the number and proportion of Americans living with chronic conditions, and (2) the magnitude of their costs, including direct costs (annual personal health expenditures) and indirect costs to society (lost productivity due to chronic conditions and premature death). DESIGN: Analysis of the 1987 National Medical Expenditure Survey for prevalence and direct health care costs; indirect costs based on the 1990 National Health Interview Survey and Vital Statistics of the United States. SETTING: US population. PARTICIPANTS: For the estimate of prevalence and direct costs, the National Medical Expenditure Survey sample of persons who reported health conditions associated with (1) use of health services or supplies or (2) periods of disability. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The number of persons with chronic conditions, their annual direct health care costs, and indirect costs from lost productivity and premature deaths. RESULTS: In 1987, 90 million Americans were living with chronic conditions, 39 million of whom were living with more than 1 chronic condition. Over 45% of noninstitutionalized Americans have 1 or more chronic conditions and their direct health care costs account for three fourths of US health care expenditures. Total costs projected to 1990 for people with chronic conditions amounted to $659 billion--$425 billion for direct health care costs and $234 billion in indirect costs. CONCLUSIONS: The prevalence and costs of chronic conditions as a whole have rarely been estimated. Because the number of persons with limitations due to chronic conditions is more regularly reported in the literature, the total prevalence of chronic conditions has perhaps been minimized. The majority of persons with chronic conditions are not disabled, nor are they elderly. Chronic conditions affect all ages. Because persons with chronic conditions have greater health needs at any age, their costs are disproportionately high.

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990

Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms

Type: Journal Article

Authors: P. C. Treitler, C. F. Bowden, J. Lloyd, M. Enich, A. N. Nyaku, S. Crystal

Year: 2021

Publication Place: United States

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991

Perspectives on the roles and value of social work practice in neighborhood health centers and implications for the reimbursement of services

Type: Journal Article

Authors: Terry Mizrahi, Victoria M. Rizzo

Year: 2008

Publication Place: United States

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992

Pharmacy-based statewide naloxone distribution: A novel "top-down, bottom-up" approach

Type: Journal Article

Authors: Kate J. Morton, Brianna Harrand, Carly Cloud Floyd, Craig Schaefer, Julie Acosta, Bridget Claire Logan, Karen Clark

Year: 2017

Publication Place: United States

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993

Physical health outcomes and implementation of behavioural health homes: a comprehensive review

Type: Journal Article

Authors: K. A. Murphy, G. L. Daumit, E. Stone, E. E. McGinty

Year: 2018

Publication Place: England

Abstract: People with serious mental illness (SMI) have mortality rates 2-3-times higher than the general population, mostly driven by physical health conditions. Behavioural health homes (BHHs) integrate primary care into specialty mental healthcare settings with the goal of improving management of physical health conditions among people with SMI. Implementation and evaluation of BHH models is increasing in the US. This comprehensive review summarized the available evidence on the effects of BHHs on physical healthcare delivery and outcomes and identified perceived barriers and facilitators that have arisen during implementation to-date. This review found 11 studies reporting outcomes data on utilization, screening/monitoring, health promotion, patient-reported outcomes, physical health and/or costs of BHHs. The results of the review suggest that BHHs have resulted in improved primary care access and screening and monitoring for cardiovascular-related conditions among consumers with SMI. No significant effect of BHHs was reported for outcomes on diabetes control, weight management, or smoking cessation. Overall, the physical health outcomes data is limited and mixed, and implementation of BHHs is variable.

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994

Physical, Mental Health and Developmental Conditions, and Sociodemographic Characteristics Associated With Adverse Childhood Experiences Among Young Children in Pediatric Primary Care

Type: Journal Article

Authors: Stacy Sterling, Felicia Chi, Judy Lin, Padmaja Padalkar, Uma Vinayagasundaram, Esti Iturralde, Kelly Young-Wolff, Verena E. Metz, Arnd Herz, Rahel Negusse, Melanie Jackson-Morris, Paul Espinas

Year: 2021

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995

Physician "Costs" in Providing Behavioral Health in Primary Care

Type: Journal Article

Authors: Tawnya Meadows, Rachel Valleley, Mary Kelly Haack, Ryan Thorson, Joseph Evans

Year: 2011

Abstract: OBJECTIVE: To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. METHODS: Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22% of patient visits, was =90%. RESULTS: Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. CONCLUSION: Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement.

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996

Physician and enrollee knowledge of Medicaid coverage for tobacco dependence treatments

Type: Journal Article

Authors: S. B. McMenamin, H. A. Halpin, J. K. Ibrahim, C. T. Orleans

Year: 2004

Publication Place: Netherlands

Abstract: BACKGROUND: The 2000 Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, recommends health insurance coverage for tobacco-dependence treatments proven effective in helping smokers to quit. Two states with comprehensive coverage for tobacco-dependence treatments in their Medicaid programs were selected to document awareness of coverage for tobacco-dependence treatments among primary care physicians who treat Medicaid enrollees and Medicaid-enrolled smokers. METHODS: In 2000, surveys were conducted among Medicaid smokers (n =400) and physicians (n =160) to document knowledge of covered tobacco-dependence treatments under state Medicaid programs in two states with comprehensive coverage. RESULTS: Only 36% of Medicaid-enrolled smokers and 60% of Medicaid physicians knew that their state Medicaid program offered any coverage for tobacco-dependence treatments. Physicians were more than twice as likely to know that pharmacotherapies were covered compared to counseling. CONCLUSIONS: Greater effort is needed to make Medicaid smokers and physicians aware that effective pharmacotherapies and counseling services are available to assist in treating tobacco dependence. Additionally, future research should explore the methods that are most effective in informing patients and providers regarding covered benefits.

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997

Physician coding for mental illness reimbursement and the need for mental health parity

Type: Web Resource

Authors: V. Nicholson

Year: 2007

Publication Place: United States -- Texas

Abstract: Many patients with anxiety and depression initially seek treatment from their primary care physicians. Changes in insurance coverage and current mental parity laws, make reimbursement for services a problem. This has led to a coding dilemma for physicians seeking payment for their services. This study seeks to determine first the frequency at which primary care physicians use alternative coding, and secondly, if physicians would change their coding practices, provided reimbursement was assured through changes in mental parity laws. A mail survey was sent to 260 randomly selected primary care physicians, who are family practice, internal medicine, and general practice physicians, and members of the Harris County Medical Society. The survey evaluated the physicians' demographics, the number of patients with psychiatric disorders seen by primary care physicians, the frequency with which physicians used alternative coding, and if mental parity laws changed, the rate at which physicians would use a psychiatric illness diagnosis as the primary diagnostic code. The overall response rate was 23%. Only 47 of the 59 physicians, who responded, qualified for the study and of those 45% used a psychiatric disorder to diagnose patients with a primary psychiatric disorder, 47% used a somatic/symptom disorder, and 8% used a medical diagnosis. From the physicians who would not use a psychiatric diagnosis as a primary ICD-9 code, 88% were afraid of not being reimbursed and 12% were worried about stigma or jeopardizing insurability. If payment were assured using a psychiatric diagnostic code, 81% physicians would use a psychiatric diagnosis as the primary diagnostic code. However, 19% would use an alternative diagnostic code in fear of stigmatizing and/or jeopardizing patients' insurability. Although the sample size of the study design was adequate, our survey did not have an ideal response rate, and no significant correlation was observed. However, it is evident that reimbursement for mental illness continues to be a problem for primary care physicians. The reformation of mental parity laws is necessary to ensure that patients receive mental health services and that primary care physicians are reimbursed. Despite the possibility of improved mental parity legislation, some physicians are still hesitant to assign patients with a mental illness diagnosis, due to the associated stigma, which still plays a role in today's society.

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Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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998

Physician Perspectives on Telemedicine at an Integrated Health System During the COVID-19 Pandemic

Type: Journal Article

Authors: A. M. Luciani, M. Parry, I. F. Udoeyo, M. Suk, J. J. Mercuri, E. M. DelSole

Year: 2023

Abstract:

Introduction: The use of telemedicine (TM) for patient care greatly increased during the COVID pandemic. This study presents data from a single health system regarding physician's perspectives on TM, which could ultimately determine how it is used in the future. Methods: A questionnaire was distributed to physicians throughout the health system. Physicians were divided based on the standard level of patient interaction in each specialty, as well as practice locations and years in practice. Physician perspectives were categorized by their opinions on different aspects of telehealth visits. Results: Of 1,794 physicians, 379 (20.7%) responded to the survey. Psychiatrists used TM significantly more than other groups and project the most future use. Surgeons were least likely to incorporate TM in the future. Ability to perform a physical examination via TM differed significantly by specialty and practice environment, but not by years in practice. Frequency of being able to complete a treatment plan via TM differed significantly by specialty, but not by years in practice or practice environment. Overall, 76.3% of physicians reported feeling "satisfied" with performing TM visits. Satisfaction with TM varied significantly by specialty and practice environment, but not by years in practice. There were no significant differences regarding physician expectations on reimbursement or billing for TM visits based on specialty, age, or practice environment. Conclusions: Discrepancies exist among physicians with respect to their satisfaction and expected future use of TM. Consensus may be difficult to reach regarding reimbursement for these visits, and further work is needed to clarify the optimal practice setting for TM.

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999

Physician practice participation in accountable care organizations: the emergence of the unicorn

Type: Journal Article

Authors: S. M. Shortell, S. R. McClellan, P. P. Ramsay, L. P. Casalino, A. M. Ryan, K. R. Copeland

Year: 2014

Publication Place: United States

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1000

Pilot testing a tool to determine the costs and time associated with community pharmacy-based administration of injectable naltrexone

Type: Journal Article

Authors: J. H. Ford II, A. M. Gilson, G. M. Bryan, R. E. Gicquelais, M. Gassman, D. A. Mott

Year: 2021

Publication Place: United States

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