INTEGRATED CARE: WHAT IT MEANS TO YOU
INTEGRATED CARE: WHAT IT MEANS TO YOU
Federal Confidentiality Rule Updated Regarding Substance Use Treatment: The U.S. Department of Health and Human Services (HHS) finalized changes to Confidentiality of Alcohol and Drug Abuse Patient Records regulations, (42 CFR Part 2) to facilitate health integration and information exchange within new health care models while continuing to protect the privacy and confidentiality of patients seeking treatment for substance use disorders. The new rule was published in the January 18 Federal Register. Following the release of the final rule, President Donald Trump issued a freeze on January 20 that requires federal agencies not to issue any new regulations or guidance documents, pull back any regulations or guidance under review by the Office of the Federal Register, and temporarily postpone regulations and guidance that have been published but have yet to take effect.
APA is seeking information to understand the impact of the freeze on 42 CFR Part 2. APA staff is also analyzing the final rule, and will include an analysis in a future issue of Psychiatric News.
Study (January 17)
Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness: In this randomized controlled trial comparing usual care (N=33) to the presence of a peer navigator, 34 homeless African Americans with serious mental illness fared better in a complex health care system when paired for one year with a "peer navigator" living successfully with mental illness within the community for one year. The navigators offered practical and logistic guidance on doctor's orders, medications, and therapy options in the real medical setting during real time. They also provided empathy and reflective listening when components of care become overwhelming. Overall health and quality of life, including homelessness, improved for intervention recipients.
Low Rates of HIV Testing Among Adults With Severe Mental Illness Receiving Care in Community Mental Health Settings: Among Medicaid enrollees with severe mental illness in California's public mental health system, only 6.7% received HIV testing in a one-year period. The authors encourage public mental health administrators to expand efforts to integrate care beyond cardiovascular risk reduction to develop multilevel interventions to improve HIV testing.
Review Identifies Mental Health Screening Tools Validated For Spanish And Use In People With Limited English Proficiency: A recent literature review identified several mental health screening tools validated for Spanish and use in individuals with limited English proficiency." To evaluate "Spanish-language validity and implementation of Bright Futures pre-visit mental health screening tools and models of care for Latino children, researchers reviewed studies published between 2005 and 2015 that reported screening results for Latino or Spanish-speaking population." After their assessment, the study authors recommended use of the Pediatric Symptom Checklist, including pictorial versions (PSC-35), and the Strengths and Difficulties Questionnaire (SDQ) "as they are validated in Spanish and freely accessible." The review'sfindings were published online Nov. 23 in Clinical Pediatrics.
First Psychiatrist Joins Federal Panel on Women's Preventive Health Services:The Women's Preventive Services Initiative (WPSI) announced its final clinical guidelines in December for preventive health care services for women.
The initiative is an update of a 2011 report from the Institute of Medicine (now the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine) that listed eight preventive health care services for women.For the first time, the WPSI steering committee included an APA representative, Maureen Van Niel, M.D., a private practitioner in Cambridge, Mass., and president of APA's Women's Caucus. The presence of a psychiatrist on the panel opened a door to consider the mental health implications of preventive services on an equal basis with other medical issues, said Van Niel.
Study Highlights Ways Clinicians Can Help Families Overcome Burden of Pediatric OCD:The challenges faced by children with obsessive-compulsive disorder (OCD) can ripple outward to negatively impact family function in myriad ways, concluded astudypublished online this week in the Journal of the American Academy of Child and Adolescent Psychiatry. The findings of the study point to several ways that clinicians can work with families to overcome the burden that pediatric OCD may place on them.
Confirmation Hearing for HHS Secretary-Nominee Rep. Tom Price (R-GA)Hearing (January 25): The Senate Finance Committee held its confirmation hearingfor Rep. Tom Price (R-GA) on Tuesday. Price deferred to Congress on Medicaid funding decisions and expressed support for some voluntary CMS innovation demonstrations.
Democratic senators raised concerns with Price's previous support for Medicaid block grants - a policy now backed by the Trump administration - and the financial pressure that could put on states. Senator Warner Warner (D-VA) also asked whether Price would support bundled pay, which he said can help move the health care system toward quality.Price said that "for certain patient populations, bundled payments make a lot of sense." Finance Chair Orrin Hatch (R-UT) said the committee will vote on Price's nomination "promptly" but did not say when that would take place.
Executive Order Minimizing the Economic Burden of the ACA Pending RepealExecutive Order (January 20):On his first day in office, President Donald Trump signed an Executive Order with the intent to minimize the economic burden of the Patient Protection and Affordable Care Act, pending its repeal.
Under the Executive Order, "the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications."
It also states, "the Secretary and the heads of all other executive departments and agencies with authorities and responsibilities under the Act, shall exercise all authority and discretion available to them to provide greater flexibility to States and cooperate with them in implementing healthcare programs."
It is unclear how the administration plans to carry out the Executive Order.
The Office of the National Coordinator for Health Information Technology (ONC)Article (January 19)ONC and OCR Clarify HIPAA's Effect on PHI Exchange for Health Oversight Activities:A new HealthIT Buzz Blog Post looking at howHIPAA Supports Electronic Exchange of Health Information at the Federal, State, and Local Levelwas recently posted. ONC's Chief Privacy Officer, Lucia Savage, writes on how health oversight agencies request patient information from covered entities to conduct evaluations. To learn more about the ways HIPAA supports the sharing of information, view theHealthIT.gov HIPAA Permitted Uses Blog Posts and Fact Sheets Series.
The Office of the National Coordinator for Health Information Technology (ONC) Article (January 19)Health IT-Enabled Quality Measurement Strategic Implementation Guide:ONC's State Innovation Model (SIM) Health IT Resource Center released theHealth IT-Enabled Quality Measurement Strategic Implementation Guideto serve as a framework to help states implement policy strategies and data infrastructure supporting alternative payment models (APMs). This guide identifies 10 essential activities for building a quality measurement strategy supporting APMs across national, state, and private endeavors. You can learn more about APMs from theCenters for Medicare & Medicaid Services.
U.S. Department of Health and Human Services (HHS)Press Release(December 21)HHS selects eight states for new demonstration program to improve access to high quality behavioral health services:The U.S. Department of Health and Human Services today announced the selection of eight states for participation in a two-year Certified Community Behavioral Health Clinic (CCBHC) demonstration program designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders.
Centers for Medicare & Medicaid Services (CMS)Annual Report (December 22)
Evaluation of the Comprehensive Primary Care (CPC) Initiative - Third Annual Report: On December 20, 2016, the Centers for Medicare & Medicaid Services (CMS) released the third annual evaluation report for the Comprehensive Primary Care (CPC) Initiative. This third annual report focuses on CPC's third program year (January through December 2015), examining how practices implemented CPC and altered health care delivery during that year, and estimating the impacts on patient experience, cost, service use, and quality-of-care outcomes for attributed Medicare fee-for-service (FFS) beneficiaries over the first 36 months of CPC (October 2012 through September 2015), using the most recent data available.
Obama Signs 21st Century Cures Act: President Obama signed the 21st Century Cures Act, a bill to spur innovation and research, on Tuesday, December 13. The bill, which was approved with overwhelming bipartisan support in both the House and Senate, includes significant components to improve the nation's mental health system.
Among the bill's many provisions, the law will increase coordination among federal agencies responsible for treating mental illness by establishing medical leadership in the Substance Abuse and Mental Health Services Administration, improve how the federal government finances and manages evidence-based mental health services, promote workforce development, strengthen the enforcement of parity, and reauthorize grants to support integrated care models for primary care and behavioral healthcare services. The legislation also broadens the definition of integrated care to incorporate the collaborative care model
CMS Announces Medicare-Medicaid ACO Model: The Centers for Medicare and Medicaid Services (CMS) announced a new initiative that aims to improve the quality of care while lower costs for patients who are enrolled in both Medicare and Medicaid. The new model, known as the Medicare - Medicaid ACO Model, will allow Medicare Shared Savings Program ACOs to take accountability for the quality of care and cost for enrollees in Medicare - Medicaid. The new intiative is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid. CMS is accepting letters of intent from states who hope to work with CMS to design specific elements of this new model. Following evaluation of the letters of intent, CMS will enter into a participation agreement with up to six states with preference given to those states with low Medicare ACO saturation.
The new initiative is an opportunity for clinicians to participate in the Advanced Alternative Payment Model under MACRA.
President Signs Telemedicine Bill: On December 15, the President signed into law the Expanding Capacity for Health Outcomes (ECHO) Act, a bipartisan bill introduced by U.S. Senators Brian Schatz (D-Hawaii) and Orrin Hatch (R-Utah). The goal of the law is to increase access to high-quality health care in hard-to-reach regions using the ECHO model, a continuing medical education program that uses interactive videoconferencing to link specialist teams with primary care providers in rural and underserved areas. Together, they participate in weekly tele-clinics that combine teaching with mentoring and case-based learning.
Under the law, the Department of Health and Human Services (DHHS) is required to develop a study on the use of telemedicine and distance-learning models to provide health care, particularly in rural and underserved areas. The study must include the model's impact on mental and substance use disorders, among a list of other chronic conditions.
CMS Releases its Person and Family Engagement Strategy: The CMS Person and Family Engagement Strategy will serve as a guide for the implementation of person and family engagement principles and strategies throughout CMS programs. This strategy will expand the awareness and practice of person and family engagement by providing the following goals and objectives:
- Goal 1: Actively encourage person and family engagement along the continuum of care within the broader context of health and well-being in the communities in which people live.
- Goal 2: Promote tools and strategies that reflect person and/or family values and preferences and enable them to actively engage in directing and self-managing their care.
- Goal 3: Create an environment where persons and their families work in partnership with their health care providers to develop their health and wellness goals informed by sound evidence and aligned with their values and preferences.
- Goal 4: Develop meaningful measures and tools aimed at improving the experience and outcomes of care for persons, caregivers, and families. Also, identify person and family engagement best practices and techniques in the field that are ready for widespread scaling and national integration.
New Survey Points to Health System Failures in Care for Those with Complex Needs: The Commonwealth Fund survey of 3,009 adults (1,805 of whom are high-need) was released in conjunction with the launch of a new online resource, The Playbook of Best Practices, to help health system leaders and insures improved care for patients with complex medical and social needs. The Playbook offers insights about patients with complex needs, examples of successful approaches to care, guidance on making the business case for these models, and opportunities for policy and payment reform.
Five national health care foundations: the John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, the SCAN Foundation, and the Commonwealth Fund, together have partnered with the Institute for Healthcare Improvement to develop this online resource.
The Integration Edge: The Integration Edge is a new resource from the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) that outlines practical tips and examples from organizations that have been working to integrate primary and behavioral health care.
Surgeon General Issues Landmark Report on Alcohol, Drugs and Health: A new Surgeon General's report finds alcohol and drug misuse and severe substance use disorders, commonly called addiction, to be one of America's most pressing public health concerns. Nearly 21 million Americans - more than the number of people who have all cancers combined - suffer from substance use disorders.
The report identifies substance use disorders as a public health problem that requires a public health solution. It recommends taking action by eradicating negative attitudes and changing the way people think about substance use disorders; recognizing substance misuse and intervening early; and expanding access to treatment. Check out the key findings of the report and download supplementary materials.
Collaborative Care for Patients with Cognitive Disorders: Neurocognitive disorders, broadly dichotomized into major neurocognitive disorder (dementia) and mild neurocognitive disorder (also known as mild cognitive impairment), rise steeply with age. The boundary between mild and major neurocognitive disorders is somewhat fluid, as the distinction rests on the judgment of family members, friends, or clinicians to what extent cognitive limitations interfere with everyday life. Whether due to ageism bias or generosity of spirit, less is often expected of the elderly, so dementia is frequently underdiagnosed.
Attempts to increase specialty care for dementia to match the rising need may not only be futile, but also ill advised. Frail older patients tend to accumulate a diverse cast of specialty providers, which can result in poor care coordination, dangerous polypharmacy, increased cost, and burden of travel to the patient. A collaborative care dementia program based in a primary care clinic can help answer the complex biopsychosocial needs of older patients with comorbid medical, neurologic, and psychiatric problems.
Can Collaborative Care Really Help Patients With Depression and Diabetes or Heart Disease: Studies suggest that collaborative care can benefit patients with comorbid physical and mental health conditions. In a recent Psychiatric News column, David Katzelnick, M.D., of the Mayo College of Medicine; Rebecca Rossom, M.D., M.S., of the University of Minnesota; and Leif Solberg, M.D., of the HealthPartners Institute describe of the results of COMPASS, a large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease.
Psychiatry Online Study (December 15)
Carrots and Sticks on Opposite Sides of the Atlantic: Integration Incentives for People With Serious Mental Illness in England: This article compares the ways in which integrated care is incentivized in the United States - with a carrot - and the United Kingdom - with a stick. Even though the two countries have different payer systems, each can learn from the other's experience.
Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis: In Mexico City, the World Health Organization's goal of integrating mental health and primary care as a way to close treatment gaps will be difficult to achieve. Interviews with staff of 19 community-based primary care clinics revealed widespread shortages of resources and other barriers that limit the delivery of adequate primary care, let alone mental health treatment.
Patients With Acute Coronary Syndrome Or Unstable Angina May Be At A 15% Higher Risk For Suicide Than Healthy Adults, Researchers Say: Patients with certain heart problems may be at an increased risk for suicide, according to a study published December 7 online in the Journal of the American Heart Association. The high prevalence of acute coronary syndrome (ACS) represents a significant burden on healthcare resources. A robust association exists between depression and increased morbidity and mortality after ACS. This study examined the relationship between suicide and ACS after adjusting for depression and other comorbidities.
Collaborative Care for Youth: Statewide Success Stories
The need for consultative services like the ones described by this month’s author, Bob Hilt, M.D., reflects the workforce shortages in psychiatry; in some communities the wait to see a child psychiatrist can be as long as nine to 12 months, if one is available at all. This often leaves primary care providers as the sole mental health prescriber for a child and the need for those of us in the mental health field to help them with that task. Read more.
Collaborative Care Found to Reduce Postpartum Depression Risk Among Socioeconomically Disadvantaged Women
Depressed women who experience an adverse birth event, such as preterm delivery, are at risk of even more severe postpartum depression. In this study of Medicaid-enrolled women, a collaborative care intervention called MOMCare mitigated this risk and reduced postpartum symptoms. In MOMCare, a depression care specialist on the obstetric team provides brief interpersonal psychotherapy, pharmacotherapy, or both, along with help resolving practical, psychological, and cultural barriers to care. Read more.