Literature Collection

Background/Objectives: People with a severe mental illness die much earlier than the rest of the population from a preventable physical illness. Annual health checks are a way of assessing the person to then offer the appropriate interventions. Integrated Care Northampton, England used the long-term plan baseline funding allocated to them from the government department that commissions primary care services, to implement a local enhanced service. Their aim was to provide a person-centred physical health check that people with severe mental illness feel comfortable, confident, and able to engage with. Methods: Wellbeing Organisation Research Training Hub Northampton were commissioned by Integrated Care Northampton to provide training, support, and evaluate the locally enhanced service. Training was provided by training trainers who then offered one-to-one support to those delivering health checks in practice. Providers of the health checks could also access individual support from Wellbeing Organisation Research Training Hub staff. Patient data were collected via a template that is part of usual practice. Questionnaires were used to evaluate the education of staff, the delivery of health checks, and the impact on people with severe mental illness. Results: Training was well received but most of the trainers did not continue in their role. The project was successful in highlighting the physical health needs of people with severe mental illness and monitoring in primary care increased. Though methods were put in place to evaluate the delivery of health checks and their impact on people with severe mental illness, these were not utilised by the service. Conclusions: This paper emphasises how difficult it is to implement a new service and evaluate it successfully. Future projects should prioritise measuring the quality of the service.

BACKGROUND: Numerous US patients seek the hospital emergency department (ED) for behavioral health care. Community Health Centers (CHCs) offer a potential channel for redirecting many to a more patient-centered, lower cost setting. OBJECTIVE: The aim of this study was to identify unique market areas serviced by CHCs and to examine whether CHCs are effective in offsetting behavioral health ED visits. RESEARCH DESIGN: We identified CHC-year specific service areas using patient origin zip codes. We then estimated random effects models applied to 42 federally qualified CHCs operating in New York State during 2013-2020. The dependent variables were numbers of ED mental health (substance use disorder) visits per capita in a CHC's service area, drawn from HCUP State Emergency Department Databases. Key explanatory variables measured CHC number of mental health (substance use disorder) visits, number of unique mental health (substance use disorder) patients, and mental health (substance use disorder) intensity, obtained from the HRSA Uniform Data System. RESULTS: Controlling for population, we observed small negative effects of CHC behavioral health integration in explaining ED behavioral health utilization. Measures of mental health utilization in CHCs were associated with 1.3%-9.3% fewer mental health emergency department visits per capita in Community Health Centers' service areas. Measures of substance use disorder utilization in Community Health Centers were associated with 1.3%-3.0% fewer emergency department visits per capita. CONCLUSION: Results suggest that behavioral health integration in CHCs may reduce reliance on hospital EDs, but that policymakers explore more avenues for regional coordination strategies that align services between CHCs and local hospitals.

OBJECTIVE: The authors sought to describe the early use of collaborative care model (CoCM) and general behavioral health integration (BHI) billing codes among clinicians. METHODS: Counts and payments were calculated for accepted and denied claims for CoCM and general BHI services delivered to Medicare beneficiaries nationwide in 2017-2018. Payment and utilization data were stratified by clinical specialty and site of service. RESULTS: Overall, 10,294 CoCM and general BHI services were delivered in 2017, totaling $626,292 in payments, and 81,433 CoCM and general BHI services were delivered in 2018, totaling $7,442,985 in payments. Medicare denied 5% of services in 2017 and 32% in 2018. Most CoCM and general BHI services were delivered by primary care physicians in office-based settings. CONCLUSIONS: This study of codes designed to promote BHI revealed an eightfold increase in CoCM and general BHI use between 2017 and 2018. However, denied services represent a barrier, and use among eligible beneficiaries remains low.