Literature Collection

1121

The effects of the Maryland Medicaid Health Home Waiver on Emergency Department and inpatient utilization among individuals with serious mental illness

Type: Journal Article

Authors: S. N. Bandara, A. Kennedy-Hendricks, E. A. Stuart, C. L. Barry, M. T. Abrams, G. L. Daumit, E. E. McGinty

Year: 2019

Publication Place: United States

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1122

The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial

Type: Journal Article

Authors: Lauren K. Whiteside, Ly Huynh, Sophie Morse, Jane Hall, William Meurer, Caleb J. Banta-Green, Hannah Scheuer, Rebecca Cunningham, Mark McGovern, Douglas F. Zatzick

Year: 2022

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1123

The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial

Type: Journal Article

Authors: L. K. Whiteside, L. Huynh, S. Morse, J. Hall, W. Meurer, C. J. Banta-Green, H. Scheuer, R. Cunningham, M. McGovern, D. F. Zatzick

Year: 2022

Publication Place: United States

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1124

The Essential Aspects of Parity: A Training Tool for Policymakers

Type: Web Resource

Authors: Substance Abuse and Mental Health Services Administration

Year: 2022

Publication Place: Rockville, MD

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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 Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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1125

The evolution of a department of internal medicine under an integrated clinical enterprise model: The University of Kentucky experience

Type: Journal Article

Authors: Robert T. Means, David J. Moliterno, Roxanne Allison, Jay A. Perman, Richard P. Lofgren, Michael Karpf, Frederick C. deBeer

Year: 2010

Publication Place: US: Lippincott Williams & Wilkins

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1126

The Evolving Role of Subspecialties in Population Health Management and New Healthcare Delivery Models; The Impact of a Co-Located, Integrated Primary Care Service in a Mental Health Clinic on People with Serious Mental Illness

Type: Journal Article

Authors: Dhruv Khullar, Sandhya K. Rao, Sreekanth K. Chaguturu, Rahul Rajkumar, Melinda Haas

Year: 2016

Publication Place: Plainsboro, New Jersey; Baltimore, Maryland

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1127

The experience of implementing a low-threshold buprenorphine treatment program in a non-urban medical practice

Type: Journal Article

Authors: Shashi N. Kapadia, Judith L. Griffin, Justine Waldman, Nicolas R. Ziebarth, Bruce R. Schackman, Czarina N. Behrends

Year: 2021

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1128

The faces of Medicaid III: Refining the portrait of people with multiple chronic conditions

Type: Report

Authors: Richard G. Kronick, Melanie Bella, Todd P. Gilmer

Year: 2009

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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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1129

The financial dimension of integrated behavioral/primary care

Type: Journal Article

Authors: N. A. Cummings, W. T. O'Donohue, J. L. Cummings

Year: 2009

Publication Place: United States

Abstract: There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.

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1130

The future of pediatrics: Mental health competencies for pediatric primary care

Type: Journal Article

Authors: Committee on Psychosocial Aspects of Child and Family Health and Task Force on Mental Health

Year: 2009

Publication Place: United States

Abstract: Pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home. In this report, the American Academy of Pediatrics proposes competencies requisite for providing mental health and substance abuse services in pediatric primary care settings and recommends steps toward achieving them. Achievement of the competencies proposed in this statement is a goal, not a current expectation. It will require innovations in residency training and continuing medical education, as well as a commitment by the individual clinician to pursue, over time, educational strategies suited to his or her learning style and skill level. System enhancements, such as collaborative relationships with mental health specialists and changes in the financing of mental health care, must precede enhancements in clinical practice. For this reason, the proposed competencies begin with knowledge and skills for systems-based practice. The proposed competencies overlap those of mental health specialists in some areas; for example, they include the knowledge and skills to care for children with attention-deficit/hyperactivity disorder, anxiety, depression, and substance abuse and to recognize psychiatric and social emergencies. In other areas, the competencies reflect the uniqueness of the primary care clinician's role: building resilience in all children; promoting healthy lifestyles; preventing or mitigating mental health and substance abuse problems; identifying risk factors and emerging mental health problems in children and their families; and partnering with families, schools, agencies, and mental health specialists to plan assessment and care. Proposed interpersonal and communication skills reflect the primary care clinician's critical role in overcoming barriers (perceived and/or experienced by children and families) to seeking help for mental health and substance abuse concerns.

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1131

The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study

Type: Journal Article

Authors: D. Naqvi, A. Malik, M. Al-Zubaidy, F. Naqvi, A. Tahir, A. Tarfiee, S. Vara, E. Meyer

Year: 2019

Publication Place: England

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1132

The group health medical home at year two: Cost savings, higher patient satisfaction, and less burnout for providers

Type: Journal Article

Authors: R. J. Reid, K. Coleman, E. A. Johnson, P. A. Fishman, C. Hsu, M. P. Soman, C. E. Trescott, M. Erikson, E. B. Larson

Year: 2010

Publication Place: United States

Abstract: As the patient-centered medical home model emerges as a key vehicle to improve the quality of health care and to control costs, the experience of Seattle-based Group Health Cooperative with its medical home pilot takes on added importance. This paper examines the effects of the medical home prototype on patients' experiences, quality, burnout of clinicians, and total costs at twenty-one to twenty-four months after implementation. The results show improvements in patients' experiences, quality, and clinician burnout through two years. Compared to other Group Health clinics, patients in the medical home experienced 29 percent fewer emergency visits and 6 percent fewer hospitalizations. We estimate total savings of $10.3 per patient per month twenty-one months into the pilot. We offer an operational blueprint and policy recommendations for adoption in other health care settings.

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1133

The holy grail of health and social care integration

Type: Journal Article

Authors: J. Glasby

Year: 2017

Publication Place: England

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1134

The impact of a primary care psychology training program on medical utilization in a community sample [Thesis]

Type: Web Resource

Authors: Autumn Marie Lanoye

Year: 2014

Abstract: Mental illness and psychological distress is associated with higher rates of medical service usage and treatment of these issues results in more appropriate medical utilization rates. Little research has been conducted in an integrated care clinic, wherein health psychologists or behavioral health specialists work together with physicians to provide patient care. The current study examines the effects of brief behavioral and mental health interventions on patient medical utilization in this setting with care delivered by medical residents and doctoral psychology trainees. Access to the health system's electronic billing records allowed for objective measures of annual healthcare utilization in terms of inpatient, outpatient, and emergency department use. A quasi-control group was constructed using propensity score matching in order to compare patients who had received a primary care psychology intervention to those who had not. Rates of inpatient utilization decreased significantly among treated patients overall as well as among treated patients identified as frequent attenders; there was no change in inpatient utilization among patients in the control group overall nor among frequent attenders in the control group, indicating that there is likely an effect of behavioral and mental health treatment on rates of inpatient visits. Rates of emergency department use and specialty outpatient visits were comparable between treated and control group patients, suggesting the lack of a treatment effect in these areas. Strengths, limitations, possible mechanisms, and implications for future research are discussed.

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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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1135

The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home

Type: Journal Article

Authors: C. A Salzberg, A. Bitton, S. R. Lipsitz, C. Franz, S. Shaykevich, L. P. Newmark, J. Kwatra, D. W. Bates

Year: 2017

Publication Place: United States

Abstract: BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change. RESULTS: Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (P<0.0001), 2.42 (P<0.0001), 3.98 (P<0.0001), and 3.61 (P<0.0001) per 1000 per month. Modest increases in inpatient admission were seen among these patients in PCMH either with or without payment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization. CONCLUSIONS: We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions.

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1136

The impact of Assertive Community Treatment on utilization of primary care and other outpatient health services: the North Carolina experience

Type: Journal Article

Authors: E. Wiley-Exley, M. E. Domino, T. C. Ricketts, G. Cuddeback, B. J. Burns, J. Morrissey

Year: 2013

Publication Place: United States

Abstract: BACKGROUND: A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. OBJECTIVE: To analyze whether investments in ACT yield savings in primary care and other outpatient health services. DESIGN: Patterns of medical and mental health service use and costs were examined using Medicaid claims files from 2000 to 2002 in North Carolina. Two-part models and negative binomial models compared individuals on ACT (n = 1,065 distinct individuals) with two control groups of Medicaid enrollees with severe mental illness not receiving ACT services (n = 1,426 and n = 41,717 distinct individuals). RESULTS: We found no evidence that ACT affected utilization of other outpatient health services or primary care; however, ACT was associated with a decrease in other outpatient health expenditures (excluding ACT) through a reduction in the intensity with which these services were used. Consistent with prior literature, ACT also decreased the likelihood of emergency room visits and inpatient psychiatric stays. CONCLUSIONS: Given the increasing emphasis and efforts toward integrating physical health and behavioral health care, it is likely that ACT will continue to be challenged to meet the physical health needs of its consumers. To improve primary care receipt, this may mean a departure from traditional staffing patterns (e.g., the addition of a primary care doctor and nurse) and expansion of the direct services ACT provides to incorporate physical health treatments.

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1137

The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

Type: Journal Article

Authors: K. Alexander, M. Pogorzelska-Maziarz, A. Gerolamo, N. Hassen, E. L. Kelly, K. L. Rising

Year: 2021

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1138

The impact of COVID-19 on opioid treatment programs in the United States

Type: Journal Article

Authors: L. A. Goldsamt, A. Rosenblum, P. Appel, P. Paris, N. Nazia

Year: 2021

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1139

The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization

Type: Journal Article

Authors: A. Lanoye, K. E. Stewart, B. D. Rybarczyk, S. M. Auerbach, E. Sadock, A. Aggarwal, R. Waller, S. Wolver, K. Austin

Year: 2017

Publication Place: United States

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1140

The impact of integrating mental and general health services on mental health's share of total health care spending in Alberta

Type: Journal Article

Authors: R. Block, M. Slomp, S. Patterson, P. Jacobs, A. E. Ohinmaa, R. Yim, C. S. Dewa

Year: 2008

Publication Place: United States

Abstract: OBJECTIVE: In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. METHODS: The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. RESULTS: The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). CONCLUSIONS: Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

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