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.