Primary Care Integration Paper

Medicaid care plans struggle to provide mental health services and with the expansion of Medicaid under the Affordable Care Act many individuals will gain access to healthcare and also to behavioral health coverage. Though the Affordable Care Act outlined changes to make access to mental health service easy, it is still a struggle to make this happen. It is upto the plan, states and other stake holders to ensure there is access to

Please be reminded that OMH and DOHMH will host a meeting with the NYC Health Homes Serving Children “HH” and Legacy Care Management Agency “CMA” providers. The meeting will be held on Tuesday, March 21, from 11:00am until 2:00pm at the Office of Mental Health located at 330 5th Avenue, NY, NY. This meeting will serve as a forum for Health Homes and Care Management providers to gain greater familiarity with each other and with the established health home network represented within NYC. This meeting will also provide an opportunity for the group to discuss relevant health home implementation practice issues. If there are specific topics you would like addressed, please contact your assigned Program

The National Survey on Drug Use and Health (NSDUH) reported in 2008 that 13.4% of adults in the U.S. received treatment for a mental health issue (i.e. emotional or mental problems) using services such as inpatient, outpatient, and prescription treatments (Use of Mental Health Services, n.d.). Over half of the adults- 58.7% - that identify with a serious mental illness (SMI) accessed some form of service to seek treatment for their specified disorder (Use of Mental Health Services, n.d.). In 2011, NSDUH documented a .2% increase - 13.6% of adults utilized services for a mental health issue (Substance Abuse and Mental Health Services Administration, n.d.). Even with an increase, there is a lack of access to these services. One main reason is due to geographical barriers. An estimated 77% of counties in the United States have a severe shortage of mental health providers. A majority of these provider-deprived counties are located in rural areas where most accessible providers are located in metropolitan areas (Thomas, Konrad, Holzen, & Morrissey, 2009).

Not only will this understanding provide the most effective policies, funding, research, and a decrease in barriers within society, but will also provide the most appropriate treatment and services for these individuals. By examining the different facets of public health that are impacted by these disorders, the most appropriate structure within our delivery system can be achieved. This includes the most recent and accurate data backing up the programmatic structure of the delivery of services as well as treatment protocols and policies for treatment and quality assurance to be implemented at a federal level. Individuals with co-occurring disorders present unique needs and challenges to receiving treatment. For this reason, the way in which public health is impacted is also unique and presents challenges. Understanding the dynamics of different facets of public health and how co-occurring disorders affect these brings society closer to maximizing the amount of individuals who can access and successfully receive treatment that is appropriate and standard throughout our

Mental health issues continue to be a growing concern sweeping across many nations globally and domestically. Findings from the National Institutes of Mental Health (2013) illustrated that in 2013, in the United States, 43.8 million adults suffered from a mental illness. According to the World Health Organization (WHO) (2006) mental illness and substance use disorders are the leading causes of disability worldwide. As mental health issues continue to endure and implicate the lives of many, the need for competent, qualified clinicians emergent from a field that implements efficacious treatments for such conditions

The PCMH model is relatively new and is part of the efforts to reform healthcare. The efforts to integrate primary care with behavioral health using the primary care model continues to evolve and requires continued research and evaluation on its effectiveness, both the quality of care and the value provided to its community. National core measures for the PCMH, monitor only depression statistics. With nearly 50% of patient with chronic health conditions having one or more mental health conditions (Katon, W.J. & Unutzer, 2013; Manderscheid & Kathol, 2014) this evaluation hopes to demonstration, a) an insight into common mental health issues seen in the PCMH model, b) the potential prevalence of common mental health diagnosis in the patient

Furthermore, improving the quality of the care that is received will be cost-effective in the long-term. Primary care physicians and educators can be further trained to recognize depression as well as any other mental health disorder. With early identification and referral for diagnosis, much of the later treatment can be avoided. Intervention for behavioral health occurs in four stages – detection, medication, counseling, and continuity of care. Currently, all four areas have a deficit. Detection should be increased with primary care physicians. Medications should be more accessible. Counseling should be available and affordable. Continuity of care is only possible when patients can access regular follow-up care with a physician, preferably a psychiatrist. If detection is improved, there needs to be availability of resources for referral. Smit et al. (2006) found that minimal contact cognitive behavioral therapy had a 70% chance of being more cost-effective than primary care alone for subthreshold depression, showing that intervention even before diagnosis can prevent cost of hospital admissions and decreased productivity in the future1. While this study only focused on depression, the same is true for many behavioral health pathologies because they are often progressive in nature.

Building a behavioral health practice management system with a value-based focus allows specialty practices to successfully improve patient outcomes and achieve the financial goals of the organization. Unlike other types of medical organizations, mental health practices must proactively overcome barriers such as the public stigma associated with seeking

The educational medical center, University Hospital for Bronx College of Medicine in New York, will be putting this model into practice to progress care for both youth and adult patients with a diversity of mental health disorders through accomplishment of the integration model in a primary care setting. Bronx College Hospital is dedicated to treating a wide sort of behavioral health conditions throughout the lifespan cycle including depression and anxiety, which may include, post traumatic, and alcohol use disorders. It will also improve health of patients and the characteristic of their care, the study aims to support continuing program sustainability through a case-based expense model that compensation professionals to provide a range of assistances and supports the necessities of the behavioral team . To apply the imbursement model, Bronx College Hospital will work in partnership with health plans that will reduce the cost of receiving services. It will be the leading study on which integration care has been established at the medical center assisting a safety-net population . The first visit with a Patient Educator is about 20 minutes long where it consists of a screening interview and assessment concentrating on the patients existing mental health concerns. Based on this interview, the social worker will commence a functional evaluation with patient’s objectives and an understanding

Behavioral health disorders cripple America’s workforce as the leading cause of disability. Nearly 9 million have a mental illness that greatly affects their day-to-day living, and 10.8 million full-time adult workers have an addiction.

Plus, out of these 800,000 individuals over 50% presented with at least one behavioral health complaint and diagnosis (Smith, et all 2013). This presents a problem to individuals, micro level, and to the larger system, macro level. At the micro level, individuals experience a lower level of functioning as they are constantly seeking for the relief to their symptoms. At a government level, they add up to numbers like those above. In collaborative health care, Medicaid found great relief, an evidence based model that, can improve the overall quality outcomes for its participants and at the same time lower costs

There are a numerous of benefits in integrating behavioral health services. By working closely with mental health professionals, I can help patients return to work and even save lives. According to the British Medical Journal, "when primary care practices used a care manager to help them treat older adults with depression, the patients are 24 percent less likely to die compared with those in usual care" (Olse, 2014).

The estimated impact from the ACA is to “reduce the fiscal and psychological barriers to mental healthcare services” (SAMHSA, 2015). The ACA offers additional reimbursement policies to expand utilization and added protection for individuals with mental illness. The ACA also created integrated care models to help PCP offices and psychiatrist offices manage patients, with their illnesses and chronic diseases (SAMHSA, 2015). Prior to the ACA, 54% of people were estimated to be left untreated and yet the costs of mental health have risen.

The improvements of the current systems of behavioral healthcare according to “3 Ways Hospitals Are Improving Behavioral Health Care” (2017), here are three key factors to making a system better than what some may believe to be a Grade-A system. c. More clients getting the service will benefit because all will be treated. No client should slip through the cracks of the system because of lack of staff members at any facility. Many primary care physicians seek assistance when treating clients with behavioral health issues which sparked an enterprise in 2014 that began to embed social workers and psychiatrists in each of its 23 primary care sites. Social workers are hopefully placed

The development of collaborative care models between psychiatry and primary care departments has recently received increased attention in the United States. Historically, primary