EXPERTS

5/12/2020

• “A Broken System When It’s Needed Most” – as NHMH has advocated since its creation 13 years ago, it is an urgent need in our country to make effective mental health care available where the majority of behavioral health patients go, i.e. medical settings such as primary care. COVID-19’s after-math is highly likely to make this reality widely understood. The solution: The federal and state governments (through Medicare and Medicaid), and private insurance companies, must pay for and reward clinicians who integrate evidence-based behavioral health services into their primary care practices. Rather than costing our healthcare system more, it will mean substantial cost savings, given fact it will lower medical expenditure costs. This is the future — behavioral health services integrated into medical settings — that NHMH has long recognized and worked for and the C-19 pandemic has shown is critically needed.
• https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/

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4/16/2020

• On April 13, 2020 NHMH posted public comments on the proposed National Quality Forum (NQF) Behavioral Health quality measure 3538 regarding emergency department use rate as a BH quality measure for Medicaid patients with SMI and/or co-occurring medical-behavioral health conditions. NQF is a nonpartisan organization that sets standards and recommends measures for use in provider payment and accountability programs that lead to enhanced healthcare value and improved health outcomes.
• NQF4EDVisits

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3/10/2020

• NHMH and other Behavioral Health Organizations Meet with U.S. House of Representatives’ Speaker’s Office urging legislation providing further incentives and supports to physicians seeking to integrate evidence-based behavioral health services into their practices.
• U.S.HouseRepresMtg6March2020

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2/10/2020

• Clinical Trial, on Rural Integrated Care Via Tele-Psychiatry, in which NHMH is a Participant, Publishes a Design-Protocol Paper in Contemporary Clinical Trials Journal.
• SPIRIT_Protocol_Paper_CCT_2020

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11/25/2019

• Brigham & Young’s Dr. Stuart Pollack says the key to improved quality primary care, is the trusting patient-centered relationship between PCP and patient. Healthcare system reform needs to focus on valuing that trusting PCP-patient relationship.
• Pay for Relationship: A Novel Solution to the Primary Care Crisis

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10/30/2019

• New Development To Help Capture Behavioral Health Issues during the Patient’s Primary Care Visit.
• Personal Life Events—A Promising Dimension for Psychiatry in Electronic Health Records

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9/13/2019

• Which Health Policies Actually Work? We Rarely Find Out.
  Dr. Austin Frakt describes how rigorous evaluations of whether health policy changes actually work need to be done, and how a new law passed in 2019 (The Foundations for Evidence-Based Policy-making Act) could address this issue by improving data collection on government health programs, and the ability to access that data, and requiring government agencies to develop ways to evaluate their health programs.
• Which-policies-actually-work

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9/13/2019

• Rhode Island Integrates Behavioral Health into Primary Care and Becomes Most Improved State Health System per Sept 11, 2019 Commonwealth Fund Study.
  Rhode Island made two health delivery changes in past five years: health coverage expansion and integration of behavioral health into primary care. And as a result, among the 50 states, R.I. improved on the most health system performance indicators. This Commonwealth Fund study found that R.I. “prioritized integrating behavioral health into the primary care setting as a cost-effective way of increasing access to such (behavioral health) services. Studies have shown that integrated care improves depression and anxiety outcomes, along with quality of life, while reducing the total cost of care.” (p. 3). And cited the 2018 Milliman study posted elsewhere on NHMH website.
• Rhode Island: A Most-Improved State in Health Performance

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July 2nd, 2019

• Minnesota A Long-Time Leader in Behavioral Integration into Primary Care Has Issued a Call to Action. Citing lack of progress in behavioral care integration in primary care over the past 10 years in their state, and nationally, the Minnesota Health Collaborative partners have endorsed a new framework for clinicians to implement integration, and for designing changes to care delivery models. The Call To Action encourages practices to aim for full integration as their ultimate goal, since it is the optimal form of care. They conclude that the co-location approach may also improve access and quality of care, provided care is taken by practices to plan for fuller integration over time.
• IBH Call to Action

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April 30, 2019

• The Federal Government Revealed Today A New Initiative in Effort to Transform how Primary Care is Delivered in U.S.  The federal Centers for Medicare and Medicaid (CMS), part of HHS, described new Medicare doctor payment categories that aim to reward primary care physicians for delivering value care that saves health system money in the long run, e.g. reduced hospital admissions.  This voluntary CMS care delivery/payment initiative will allow PCPs to take varying levels of financial responsibility for improving care services and lowering costs.  Broadly this new effort called “CMS Primary Cares” hopes to reward PCPs for improving the management of care for patients with chronic conditions such as diabetes, heart disease, COPD, etc.  This development has real relevance for NHMH as our work is focused on integrating behavioral health services INTO primary care, and depression is one of the co-existing chronic conditions this initiative is aimed at.  Depression often accompanies chronic medical conditions such as cancer, diabetes, cardiovascular disease, etc.  NHMH appreciates the priority attention the federal government is giving primary care and patients with co-existing medical-behavioral care which urgently needs to be improved.
• US Health Officials Initiative to Overhaul Primary Care

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March 26, 2019

• The 2016-2019 New York State Pilot Project Helping Small Medical Practices Integrate Behavioral Health Services Releases Its Final Report.  NHMH is proud to have been a member of the Stakeholder Advisory Group of this NYS pilot which has revealed important takeaways regarding how small/medium practices (<10 clinicians) can start providing patients with mental health services.  Key findings include need for step-by-step progression along a framework laying out a continuum of advancements, and tailored to individual practice's resources, goals, etc.  Also, the medical-behavioral professional(s) working relationship, whether both on-site or one offsite, is crucial for collaboration and coordination of patient integrated care.  From patient perspective, patients revealed they like being shown their PHQ-9 depression symptom scores on trend-line graphs; it helps them see concrete progress, and is motivating.  Patients also like having same-day, even same-time, "integrated visits" where medical and behavioral providers in same room, or seen immediately afterwards.
• NYS Behavioral Health Integration Final Report, Feb 2019

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• We Will Not Have Large-Scale Uptake of Integrated Care Models Until Integrated Care Quality Measures are In Place. Dr. Harold Pincus (Columbia University) writes that a set of robust quality indicators must be developed and adopted by CMS and health plans as a priority. Those quality measures can be used to evaluate practices’ integration performance for quality, and hence be the basis for payment to the practices, since only quality integrated care will be reimbursed.
• Prioritizing quality measure concepts at the interface of behavioral and physical healthcare

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• NHMH Sends Recommendations to the U.S. Senate HELP (Health, Education Labor & Pensions) Committee in response to its request for feedback on how to help address America’s rising healthcare costs. NHMH stresses that treating now-untreated behavioral health conditions in primary care patients, will improve health outcomes and drive down healthcare costs significantly.
• NHMH Response to U.S. Senate Health Committee
• Senate HELP Committee originating letter

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• On December 10, 2018 NHMH submitted comments to Center for Medicare/Medicaid Innovation (CMMI) regarding their 7-year innovation model called the “Integrated Care for Kids (InCK)” project. The InCK Model requires integrated care delivery, care coordination, and case management of clinical care with 7 other cross-sector child health services for children under 21 yrs of age covered by Medicaid or CHIP. The InCK Model which CMMI is testing is designed improve outcomes on priority measures of child health, reduce avoidable stays and out-of-home placements, and develop alternative payment models. NHMH lauded CMMI for its truly whole-system approach to child health, including varied systems such as medical, behavioral health, school, child protection, housing, etc. NHMH urged CMMI to provide a role for nonprofit patient advocacy organizations in the InCK study, and also to ensure that the InCK Model encompasses PARENT health/behavioral health, i..e. that the InCK Model have a family wellness focus, not just a child wellness focus.
• Integrated Care for Kids (InCK) Model

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• Milliman Reports, the independent national actuarial firm, estimating the high cost savings opportunity when behavioral care integrated into primary care across the public health plans Medicaid and Medicare, and across commercial health insurance plans.
• 2014 Milliman Report
• 2018 Milliman Report

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• Bipartisan Congressional district visits to New York State primary care practices integrating care

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• Update on PCORI clinical trial (the independent Patient-Centered Outcomes Research Institute) in which NHMH participates, integrating psychiatric treatment for PTSD and bipolar disorder into rural primary care clinics, through two tele-psychiatry approaches, tele-psychiatry collaborative care and tele-psychiatry enhanced referral, and comparing both approaches for benefits and costs, occurring across three states, Arkansas, Michigan and Washington.
• S​tudy to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT)