Literature Collection

1241

Using Team Training to Transform Practice within a Geriatrics‐Focused Patient‐Centered Medical Home

Type: Journal Article

Authors: Elizabeth N. Harlow, Karina I. Bishop, John D. Crowe, Jane F. Potter, Katherine J. Jones

Year: 2019

Publication Place: New York

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1242

Utilization and cost impact of integrating substance abuse treatment and primary care

Type: Journal Article

Authors: S. Parthasarathy, J. Mertens, C. Moore, C. Weisner

Year: 2003

Publication Place: United States

Abstract: OBJECTIVE: To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. RESEARCH DESIGN: Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO's primary care clinics independently from substance abuse treatment. SUBJECTS: Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. MEASURES: Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. RESULTS: For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from 431.12 US dollars to 200.03 US dollars (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. CONCLUSIONS: (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.

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1243

Utilization and cost of behavioral health services: Employee characteristics and workplace health promotion

Type: Journal Article

Authors: J. V. Trudeau, D. K. Deitz, R. F. Cook

Year: 2002

Publication Place: United States

Abstract: The study sought to (1) model demographic and employment-related influences on behavioral health care utilization and cost; (2) model behavioral health care utilization and cost influences on general health care cost, job performance, and earnings; and (3) assess workplace-based health promotion's impact on these factors. Behavioral health care utilization was more common in employees who were female, over age 30, with below-median earnings, or with above-median general (non-behavioral) health care costs. Among employees utilizing behavioral health care, related costs were higher for employees with below-median earnings. Employees utilizing behavioral health care had higher general health care costs and received lower performance ratings than other employees. Health promotion participants were compared with a nonparticipant random sample matched on gender, age, and pre-intervention behavioral health care utilization. Among employees without pre-intervention behavioral health care, participants and nonparticipants did not differ in post-intervention utilization. Among employees utilizing behavioral health care adjusting for pre-intervention costs, participants had higher short-term post-intervention behavioral health care costs than nonparticipants.

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1244

Utilization and emergency department diversion as a result of pediatric psychology trainees integrated in pediatric primary and specialty clinics

Type: Journal Article

Authors: Lila M. Pereira, Jenna Wallace, Whitney Brown, Terry Stancin

Year: 2020

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1245

Utilization and intensity of integrated behavioral health services within a primary care setting

Type: Web Resource

Authors: Joseph A. Shafer

Year: 2017

Topic(s):

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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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1246

Utilization and perceptions of primary health care services in Australian adults with mental illness

Type: Journal Article

Authors: D. Scott, B. Happell

Year: 2013

Publication Place: United States

Abstract: Persons accessing inpatient mental health services generally experience reduced access to and quality of primary health care. The objective of this study was to compare health service utilization and perceptions, and receipt of specified health services, in Australian adults with and without a previous mental illness diagnosis. A cross-sectional survey was administered by computer-assisted telephone interviewing in 2011; the main outcome measures were receipt of services in the previous 12 months, satisfaction with health care services, and concerns regarding health care affordability. Participants included 1275 adults residing in Queensland, Australia; 292 (23%) participants reported a diagnosis of mental illness, largely depression and/or anxiety (87%). The mental illness group had higher scores for concerns regarding health care affordability (mean ranks 778 vs. 706, respectively; z=-2.90, P=0.004) and lower scores for perceptions of health care service quality and accessibility (mean ranks 631 vs. 701, respectively; z=-2.90, P=0.004). After adjustment for increased utilization of services, the mental illness group had an increased likelihood of having received only 5 of 19 services in the past 12 months (odds ratios: 1.54-1.71). Compared to those with no mental illness, Australians with a mental illness report increased dissatisfaction with health care affordability, accessibility, and quality, and generally have similar odds of primary care services per health care utilization despite being at significantly greater risk of chronic disease.

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1247

Utilization of Integrated and Colocated Behavioral Health Models in Pediatric Primary Care

Type: Journal Article

Authors: A. Hoff, C. Hughes-Reid, E. Sood, M. Lines

Year: 2020

Publication Place: United States

Abstract:

Integrating behavioral health services within pediatric primary care may help address barriers to these services for youth, especially the underserved. Models of primary care behavioral health include coordinated, colocated, integrated, and collaborative care. This study began exploring the comparative utility of these models by investigating differences in the demographics and diagnoses of patients seen for a behavioral health warm handoff (integrated model) and a scheduled behavioral health visit (colocated model) across 3 pediatric primary care sites. The 3 sites differed in their rates of warm handoff usage, and there were differences in certain diagnoses given at warm handoffs versus scheduled visits. Depression diagnoses were more likely to be given in warm handoffs, and disruptive behavior, trauma/adjustment, and attention-deficit/hyperactivity disorder-related diagnoses were more likely to be given in scheduled visits. These results have implications for the influence of office structure and standardized procedures on behavioral health models used in pediatric primary care.

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1248

Utilization of Medications for Opioid Use Disorder Across US States: Relationship to Treatment Availability and Overdose Mortality

Type: Journal Article

Authors: N. Krawczyk, V. Jent, S. E. Hadland, M. Cerda

Year: 2022

Publication Place: United States

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1249

Utilization of outpatient medical care and substance use among rural stimulant users: Do the number of visits matter?

Type: Journal Article

Authors: Michael A. Cucciare, Kristina M. Kennedy, Xiaotong Han, Christine Timko, Nickolas Zaller, Brenda M. Booth

Year: 2018

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1250

Utilization of primary care among college students with mental health disorders

Type: Journal Article

Authors: J. C. Turner, A. Keller, H. Wu, M. Zimmerman, J. Zhang, L. E. Barnes

Year: 2018

Publication Place: United States

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1251

Utilization of treatment by Medicaid enrollees with opioid use disorder and co-occurring substance use disorders

Type: Journal Article

Authors: P. O'Brien, R. M. Henke, M. B. Schaefer, J. Lin, T. B. Creedon

Year: 2020

Publication Place: Ireland

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1252

Utilization, cost, and medication management outcomes of an integrated care intervention for depression

Type: Web Resource

Authors: Robert William Bremer

Year: 2004

Publication Place: US

Abstract: Integrated Care (IC) has been proposed as a treatment model to improve the recognition and treatment of depression in primary care. The primary objectives of this thesis were to evaluate (1) changes in the rates of primary care, mental health department, and medical sub-specialty services, (2) the total cost of health services between groups, and (3) the relationship among adherence to antidepressants and depression outcomes as a result of an IC intervention. The IC model in this study was implemented in a Family Medicine clinic and consisted of a full-time psychologist based in the clinic to provide direct care and consultation to primary care physicians. The study population was 86 patients in the IC group from the Family Medicine clinic and 81 patients in a Screening Only group from the Internal Medicine clinic. Evaluation of the rates of primary care, mental health department, and medical sub-specialties showed no differences between groups at any of the four post-intervention time points. Health services costs included in the analysis showed that there was a significant decrease in costs between groups at three of the four time points, but comparison of costs for all time points from baseline was not significant. Analysis of antidepressant medication management showed no differences between groups in the improvement of adequate antidepressant management. There were also no differences in the improvement of depression severity scores between patients who did received adequate antidepressant management and those patients who did not. There was however, significant improvement in depression severity scores in the IC group, among a subset of patients who received adequate antidepressant management. These findings support the conclusion that costs for the IC intervention were statistically equivalent to a group of patients who only received screening, and that the benefit of the IC intervention involve some other important factor other than improving adequate antidepressant medication management. The specific processes that led to improvements in QPD scores among the group that had adequate antidepressant medication management needs to be explored further. Further study from other similar intervention is needed to more strongly support these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

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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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1253

Value and Performance of Accountable Care Organizations: a Cost-Minimization Analysis

Type: Journal Article

Authors: S. Parasrampuria, A. H. Oakes, S. S. Wu, M. A. Parikh, W. V. Padula

Year: 2018

Publication Place: England

Abstract: OBJECTIVES: Determine the relationship between quality of an accountable care organization (ACO) and its long-term reduction in healthcare costs. METHODS: We conducted a cost minimization analysis. Using Centers for Medicare and Medicaid cost and quality data, we calculated weighted composite quality scores for each ACO and organization-level cost savings. We used Markov modeling to compute the probability that an ACO transitioned between different quality levels in successive years. Considering a health-systems perspective with costs discounted at 3 percent, we conducted 10,000 Monte Carlo simulations to project long-term cost savings by quality level over a 10-year period. We compared the change in per-member expenditures of Pioneer (early-adopters) ACOs versus Medicare Shared Savings Program (MSSP) ACOs to assess the impact of coordination of care, the main mechanism for cost savings. RESULTS: Overall, Pioneer ACOs saved USD 641.24 per beneficiary and MSSP ACOs saved USD 535.59 per beneficiary. By quality level: (a) high quality organizations saved the most money (Pioneer: USD 459; MSSP: USD 816); (b) medium quality saved some money (Pioneer: USD 222; MSSP: USD 105); and (c) low quality suffered financial losses (Pioneer: USD -40; MSSP: USD -386). CONCLUSIONS: Within the existing fee-for-service healthcare model, ACOs are a mechanism for decreasing costs by improving quality of care. Higher quality organizations incorporate greater levels of coordination of care, which is associated with greater cost savings. Pioneer ACOs have the highest level of integration of services; hence, they save the most money.

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1254

Value and Performance of Accountable Care Organizations: a Cost-Minimization Analysis

Type: Journal Article

Authors: S. Parasrampuria, A. H. Oakes, S. S. Wu, M. A. Parikh, W. V. Padula

Year: 2018

Publication Place: England

Abstract: OBJECTIVES: Determine the relationship between quality of an accountable care organization (ACO) and its long-term reduction in healthcare costs. METHODS: We conducted a cost minimization analysis. Using Centers for Medicare and Medicaid cost and quality data, we calculated weighted composite quality scores for each ACO and organization-level cost savings. We used Markov modeling to compute the probability that an ACO transitioned between different quality levels in successive years. Considering a health-systems perspective with costs discounted at 3 percent, we conducted 10,000 Monte Carlo simulations to project long-term cost savings by quality level over a 10-year period. We compared the change in per-member expenditures of Pioneer (early-adopters) ACOs versus Medicare Shared Savings Program (MSSP) ACOs to assess the impact of coordination of care, the main mechanism for cost savings. RESULTS: Overall, Pioneer ACOs saved USD 641.24 per beneficiary and MSSP ACOs saved USD 535.59 per beneficiary. By quality level: (a) high quality organizations saved the most money (Pioneer: USD 459; MSSP: USD 816); (b) medium quality saved some money (Pioneer: USD 222; MSSP: USD 105); and (c) low quality suffered financial losses (Pioneer: USD -40; MSSP: USD -386). CONCLUSIONS: Within the existing fee-for-service healthcare model, ACOs are a mechanism for decreasing costs by improving quality of care. Higher quality organizations incorporate greater levels of coordination of care, which is associated with greater cost savings. Pioneer ACOs have the highest level of integration of services; hence, they save the most money.

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1255

Value-Based Care Alone Won't Reduce Health Spending and Improve Patient Outcomes

Type: Report

Authors: David Bailey

Year: 2017

Publication Place: Boston, MA

Topic(s):

,

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1256

Value-based financially sustainable behavioral health components in patient-centered medical homes

Type: Journal Article

Authors: R. G. Kathol, F. DeGruy, B. L. Rollman

Year: 2014

Publication Place: United States

Abstract: Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today's health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value-added integrated behavioral health care in the PCMH. These components are to: (1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral "teams;" (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services.

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1257

Value-based payment in implementing evidence-based care: the Mental Health Integration Program in Washington state

Type: Journal Article

Authors: Y. Bao, T. G. McGuire, Y. F. Chan, A. A. Eggman, A. M. Ryan, M. L. Bruce, H. A. Pincus, E. Hafer, J. Unutzer

Year: 2017

Publication Place: United States

Abstract: OBJECTIVES: To assess the role of value-based payment (VBP) in improving fidelity and patient outcomes in community implementation of an evidence-based mental health intervention, the Collaborative Care Model (CCM). STUDY DESIGN: Retrospective study based on a natural experiment. METHODS: We used the clinical tracking data of 1806 adult patients enrolled in a large implementation of the CCM in community health clinics in Washington state. VBP was initiated in year 2 of the program, creating a natural experiment. We compared implementation fidelity (measured by 3 process-of-care elements of the CCM) between patient-months exposed to VBP and patient-months not exposed to VBP. A series of regressions were estimated to check robustness of findings. We estimated a Cox proportional hazard model to assess the effect of VBP on time to achieving clinically significant improvement in depression (measured based on changes in depression symptom scores over time). RESULTS: Estimated marginal effects of VBP on fidelity ranged from 9% to 30% of the level of fidelity had there been no exposure to VBP (P <.05 for every fidelity measure). Improvement in fidelity in response to VBP was greater among providers with a larger patient panel and among providers with a lower level of fidelity at baseline. Exposure to VBP was associated with an adjusted hazard ratio of 1.45 (95% confidence interval, 1.04-2.03) for achieving clinically significant improvement in depression. CONCLUSIONS: VBP improved fidelity to key elements of the CCM, both directly incentivized and not explicitly incentivized by the VBP, and improved patient depression outcomes.

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1258

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

Type: Journal Article

Authors: J. R. Morgan, E. K. Quinn, C. E. Chaisson, E. Ciemins, N. Stempniewicz, L. F. White, B. P. Linas, A . Y. Walley, M. R. Larochelle

Year: 2022

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1259

Variation in use and costs of primary health and social services in mental health or drinking problems

Type: Journal Article

Authors: L. Forma, T. Jarvala, J. Ahonen, K. Vitikainen, P. Rissanen

Year: 2009

Publication Place: Italy

Abstract: BACKGROUND: Psychiatric inpatient hospital care was cut dramatically in Finland in recent last decades, and patients were assigned to care in the community. Consequently, the burden of care shifted from hospital districts to municipalities, which have considerable autonomy in organizing health and social services. These changes probably created locally differing service patterns in mental health care. AIMS OF THE STUDY: We assessed the use of primary social and health care due to mental health and drinking problems and the resulting costs. We also examined differences between municipalities, and analysed factors which may be associated with the variation in use and costs of these services. METHODS: Data were collected in five municipalities in Pirkanmaa Hospital District, Finland, using a short questionnaire containing questions on e.g. the reason for the visit, time spent during the visit, and of the client's psychosocial functioning (Global Assessment of Function Scale, GAF). The questionnaire was completed at all individual clients' visits to these services during a two-week period in December 2003, by professionals (MD's, nurses, social workers etc.) who worked in either local health or social services. Descriptive statistics and several regression techniques were used to describe and analyse factors associated with the use and costs of services. RESULTS: During the study period, altogether 25,738 visits took place, the total number of visitors being 10,265. Of these visitors, 1,360 had mental health or drinking problems totalling to 4,471 visits. Most of these visits took place to mental health clinics or were visits made as home care. The average cost of mental health work in primary care per client was 29.8 in two weeks, ranging between municipalities from 29 to 52 . Client's poor GAF and being a recipient of home care were associated with higher costs of services. Even after controlling for visitor-related factors, use and costs of services were associated with the local service patterns. DISCUSSION: The response rate could not be calculated for each service producer; however, we estimated that this varied between 50% and 100%. Therefore our results represent this visitor population. However, our limited data did not allow any analysis of municipality-related factors which might explain the role of service patterns in costs and use of services. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: A considerable proportion of total use and costs of local welfare services are due to mental health problems. The differences between municipal service patterns cause variation in total costs of care of mental disorders. IMPLICATIONS FOR HEALTH POLICIES: Some capacity in local primary services is allocated to mental health problems, thus enabling a shift from institutional care toward community care. However, varying local patterns may cause a risk to unequal access to mental health services. IMPLICATIONS FOR FURTHER RESEARCH: In future studies it is important to analyse the properties of local service patterns which influence appropriate use and optimal costs of care.

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1260

Variations in prescription drug monitoring program use by prescriber specialty

Type: Journal Article

Authors: Benjamin C. Sun, Nicoleta Lupulescu-Mann, Christina J. Charlesworth, Hyunjee Kim, Daniel M. Hartung, Richard A. Deyo, K. J. McConnell

Year: 2018

Publication Place: Elmsford

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