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Cornell University Health Services Offers Integrated Medical and Behavioral Health Services
In a white paper on integration in college health centers, an American College Health Association (ACHA) task force concluded that, “An integrated approach between counseling and health services may allow for an alignment of support services and systems,” and “may provide the best foundation for providing holistic care to students[1].”
The approach taken at Cornell University Health Services (CUHS, also known as “Gannett Health Services”), located in Ithaca, New York, includes colocation of services; multidisciplinary clinical teams; behavioral health screening (e.g., depression, anxiety, alcohol use) during primary care visits; cohesive communication strategies; innovative outreach programs; and a comprehensive electronic health record shared by all providers. According to Dr. Janet Corson-Rikert, Associate Vice President for Campus Health, integration of medical and behavioral health services is a growing focus in college health, and is essential to providing high-quality care for students while containing cost. Recent H1N1 and suicide crises underscored both the central role that the model plays in emergency preparedness and campus public health, as well as the value of extending that model to incorporate community resources and stakeholders.
Cornell’s values and sense of shared responsibility for student health are evident, from presidential statements to strategic planning (“Educational Excellence,” #5), and from a comprehensive mental health framework that reflects best practices represented by the Model for Comprehensive Suicide Prevention and Mental Health Promotion.
Proud of all they’ve accomplished, Dr. Corson-Rikert looks forward to what the future holds. “We are engaged with an evolving effort in our local community focused on coordination of care among providers. We’re also exploring pioneering programs like Cherokee Health Systems in Tennessee (including a consultation with Dr. Parinda Khatri), the Institute for Family Health in New York, and the Military Health System, and are excited about incorporating some of their best practices for integration into our own.”
For more information about Cornell’s program, visit their website or email CUHS.
[1] American College Health Association Considerations for Integration of Counseling and Health Services on College and University Campuses (2010). Linthicum, MD: American College Health Association. Page 1.
Primary Care/ Behavioral Health Integration Efforts in North Carolina
To add to the previous work of the ICARE (Integrated, Collaborative, Accessible, Respectful, Evidence-Based) Partnership in 2006, the North Carolina Center for Excellence in Integrated Care (the Center), Community Care of North Carolina (CCNC) and the North Carolina Division of Medical Assistance (DMA) are working together to promote integrated care in North Carolina.
Read more about how this partnership’s accomplishments within the past 5 years has made North Carolina a leader in the field of integrated primary and behavioral health care and their plans for the future: http://www.ncmedicaljournal.com/wp-content/uploads/2012/05/NCMJ_73311_FINAL.pdf
Arizona Department of Health Services’ Partners in Integrated Health
The Arizona Department of Health Services (ADHS) has developed a strategic plan based on the position that in order to be healthy, we need to take care of both our physical and behavioral health needs. The body and mind are not separate and thus, neither should the health care delivery system, especially for those with serious mental illness. People with serious mental illness die more than 25 years before the general population mostly from modifiable risk factors like smoking, obesity, substance abuse, and no access to primary and acute medical care. In response to this health disparity, ADHS created a strategic plan that includes integrating behavioral and acute health care. ADHS put out a Request for Proposals (RFP) for the delivery of behavioral health services in Maricopa County and received bids from Magellan Complete Care of Arizona, Inc.; Cenpatico of Arizona, LLC; Arizona Physicians IPA, Inc. (APIPA); United Healthcare Whole Health; Mercy Maricopa Integrated Care; and Partners in Integrated Health, LLC. ADHS evaluators will soon begin analyzing these bidders to determine which one will win the contract to deliver preventative, acute and primary care with recovery-based behavioral health to Maricopa County’s public behavioral health system beginning on October 1, 2013.
Read the related ADHS blog post and access their blog roll: http://directorsblog.health.azdhs.gov/?tag=partners-in-integrated-health
Disparities in Unmet Need for Mental Health Services
A National Center for Health Statistics (NCHS) study indicates that population access to mental health services has declined in the past decade, partly due to limited health insurance coverage and the rising number of uninsured Americans. Study results show that the unmet need for health services increased from 4.3 million in 1997 to 7.2 million in 2011, the bulk of which is concentrated in the working age population (18-64). Rates of unmet need for mental health services were almost 5 times higher for the uninsured than for the privately insured. In addition, unmet need for both mental health services and primary care is not only higher for uninsured working-age adults but also for adults with a psychiatric diagnosis and multiple functional impairments, women, unmarried individuals, and those with low incomes. It is anticipated that the Affordable Care Act (ACA) of 2010 and the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 will reduce the number of uninsured persons and improve access to mental health services in years to come. However, additional research is needed to examine how these policy initiatives will affect local access issues, particularly in rural areas where there are shortages in mental health providers. Moreover, provider capacity to meet the expected increase in people seeking mental health services or substance abuse treatment is also an urgent concern (Roll et al., 2013).
See the related journal article: http://ps.psychiatryonline.org/data/Journals/PSS/926133/80.pdf
AHRQ Innovations – Integrated Health Care Clinics
Individuals that lack adequate health insurance, are low-income, or reside in rural areas often cannot access preventive and primary care services and do not have a regular source of care. As a result, health problems may go undiagnosed and/or untreated, increasing the long-term risk of serious illness and death among the medically underserved. One of AHRQ’s featured innovations to combat this issue involves Integrated Health Care clinics. These clinics are academic nurse-managed primary care centers operated by the University of Illinois at Chicago College of Nursing and embedded in and coordinated with Thresholds Psychiatric Rehabilitation Centers. The program provides ongoing primary and preventive care delivered by advanced practice nurses1 to individuals with serious mental illness. The program’s aim is to increase access to quality health care and improve health outcomes for this underserved population. Under this program, health care indicators have improved and participants’ satisfaction with the quality of services has reached higher levels. To read the innovation in its entirety, follow this link: http://www.innovations.ahrq.gov/content.aspx?id=1878
Innovative Initiatives to Improve Patient Involvement
Health care systems and providers have been vigorously pursuing the creation of programs that involve and empower patients to be actively involved in their personal health care. The Agency for Healthcare Research and Quality’s Health Care Innovations Exchange discusses three innovative initiatives in their October 10th issue which highlight different techniques for patient involvement (SelfTest, OpenNotes, and Group Health Cooperative). Implemented in 2005 by Sentara Healthcare, SelfTest makes it possible for patients to receive up to 20 routine blood tests without physician instruction, allowing them the ability to pursue essential health testing between doctor’s visits. OpenNotes is a secure portal that allows patients to electronically access the notes taken during their medical visits in order to better self-manage their illnesses and treatment regimens. Similar to the OpenNotes system, the Group Health Cooperative is an online resource that facilitates patient-provider communication and provides an array of interactive services through a secure patient portal. This system is meant to help patients share the responsibility of their health care by allowing them to access relevant educational resources, obtain test results, and schedule appointments. These creative approaches to enhancing patient engagement serve to empower patients to enjoy a better quality of life by taking control of their health care.
Read more description about these innovative programs here: http://www.innovations.ahrq.gov/issue.aspx?id=140
Integrated Care for Dual Eligibles
Providing coordinated care for people enrolled in both Medicare and Medicaid, or dual-eligible beneficiaries, has been challenging. Commonwealth Care Alliance, a non-profit and fully integrated pre-paid care system, has demonstrated how to use cost effective and care-focused principles to successfully transform the delivery system of care for dual eligibles. As a result, the organization has lowered hospital readmission rates and slowed increasing medical expense rates for nursing home certifiable (3.3%) and ambulatory enrollees (2.8%) both of which are lower than in the Medicare trend. With an understanding of the financial burden and unmet healthcare needs of dual eligibles, other organizations have also used this demonstration’s models of integrated care which are similar to the health home provisions in the Affordable Care Act (ACA).
The Commonwealth Care Alliance demonstration programs have prompted the standardization of its provisions in Massachusetts. The state will be the first to demonstrate this effective care delivery transformation with effective safeguards. Furthermore, disability consumers and advocates have informed these procurements and have worked with the Centers for Medicare and Medicaid Services (CMS) to promote certain protections. If adopted, these models of integrated care will transform care for and protect dual eligibles.
Read more about integrated care for dual eligibles: http://healthaffairs.org/blog/2012/10/22/realizing-the-promise-of-integrated-care-for-the-dual-eligibles/
New Research Opportunities for the Field of Integration from NIMH
The National Institute of Mental Health (NIMH) seeks to leverage existing natural experiments by building research capacity for subsequent rigorous testing of services interventions already implemented at state and local levels for adults, youth, or children. This Funding Opportunity Announcement (FOA)(RFA-MH-13-140) will support 1-year R24 grants for research planning activities to develop the infrastructure needed to enable subsequent testing of existing innovative services interventions that aim to reduce the prevalence and magnitude of common modifiable health risk factors related to shortened lifespan in people with severe mental illness (SMI).
Improving Health and Reducing Premature Mortality in People with Severe Mental Illness (R01)
The NIMH intends to promote a new initiative by publishing an FOA (NOT-MH-13-010) to request applications for rigorous effectiveness testing of innovative services interventions designed to reduce the prevalence and magnitude of common modifiable health risk factors related to shortened lifespan in adults with sSMI, as well as in children and youth with serious emotional disturbances (SED).
Sharing Sensitive Health Information Securely
Technological advances have helped make vast improvements in the medical world. To that end, the move toward sharing health information electronically has patients concerned about privacy issues. The Department of Health and Human Services (HHS) and the Department of Veterans Affairs (VA) were able to successfully demonstrate the sharing of a “mock patient’s substance abuse treatment records tagged with privacy metadata from one electronic health record system to another after consent from the mock patient,” (HHS, 2012). The privacy metadata tag lets the provider receiving the sensitive health information know that he or she must have patient consent before disclosing it to others. This mock scenario proves that gaining the cooperation of patients is doable. However, retaining the patient’s trust requires that providers remain vigilant about complying with privacy laws when using electronic health records and health information exchanges.
Read more on this privacy metadata tag in the HHS press release: http://www.hhs.gov/news/press/2012pres/09/20120917b.html
Practice-Based Interventions Addressing Concomitant Depression and Chronic Medical Conditions in the Primary Care Setting
Of all mental health conditions, depression produces the greatest societal burdens in terms of social and economic costs and can be accompanied by chronic medical conditions which affect more than half of all Americans. The World Health Organization identifies “the integration of mental health into primary care as the most salient means of addressing the burden of mental health conditions” (World Health Organization, 2008). This AHRQ August 2012 report discusses adult primary care patients with depression and chronic medical condition diagnoses. The report reveals how collaborative care, a major characteristic of integrated mental health and primary care services, has effectively addressed the needs of some of these patients.
Read more about practice-based interventions to address depression and chronic disease in primary care: http://www.effectivehealthcare.ahrq.gov/ehc/products/297/1219/CER75_Conc...
