My apologies for posting this late. In our February subcommittee meetings, the Integration of Health and Behavioral Health Workgroup reviewed a number of possible solutions to problems in each of our areas: policy (my subcommittee), service delivery, and training and service delivery. The solutions were derived from a review of the literature on programs providing integrated care throughout the United States.
Key points and issues were summarized in documents circulated to members of the workgroup and each subcommittee used and “Joint Document” to consider these areas in our meetings and in e-mail requests for comments after the meetings. In the background section, it was noted that the majority of behavioral health conditions are treated by primary care physicians, many medical disorders coexist with mental disorders, diagnoses of severe and persistent mental disorders are associated with dying 25 years earlier than the general population (29 years earlier in Texas); and that behavioral health screening in primary care can catch and treat conditions before they become more severe in persons who will not go to behavioral health settings.
Best practice models of integrated care were presented. These included the Four Quadrant Model, the Systems of Care Model, the Patient-Centered Medical Home (or Person-Centered Healthcare Home) Model, the Care Model, Embedded Programs, Unified Programs, Collaborative Programs, the Collaborative Care Model, and the Primary Care Behavioral Model.
In the Joint Document, key points and issues were summarized along with barriers and possible solutions for Texas, and these were discussed in each subcommittee. The key points highlighted were, Increased Cooperation and Collaboration, Exchange of Client Information, Reimbursement of Services, Public and Provider Education, and Referral System.
In terms of barriers, the following areas were highlighted: clinical barriers (providers and their treating entities are in silos with little sharing or knowledge of the others – physical health, behavioral health & substance abuse), organizational barriers (the length of time for appointments in primary care, the lack of psychiatric services in primary care, the lack of physical health services in behavioral health care, use of psychotropic medications for children), consumer barriers (those without insurance have barriers in getting behavioral health services, higher co-pays for behavioral health services, transportation, stigma, and getting to know a new system), policy barriers (privacy laws vary among settings, electronic record sharing, publicly funded centers may be restricted in use of funds, and agencies may be limited in the populations they can serve), and financial barriers (misalignment of health care funding incentives provided through public and private third party payors, and billing and reimbursement practices).
Numerous possible solutions were suggested and discussed. For Increased Cooperation and Collaboration, these included having local networks and advisory groups, developing interagency contracts and agreements, increased use of tele-health resources, building upon the existing responsibilities of certain behavioral healthcare providers (such as psychologists, social workers, and advanced practice nurses), and increasing peer support programs. In the Exchange of Client Information area, some possible solutions included were developing HIPAA compliant release forms and ensuring that new laws for Health Information Technology (HIT) were consistent with integrated care. In terms of reimbursement, some suggestions were to review existing procedure codes to see how they might best be used in integrated care and development of new codes for this purpose and putting an end to denials of same day billing for physical and behavioral health services. On the Provider Training front, solutions suggested included making integrated health a part of training for all providers. Referral System solutions focused on examining transportation and reimbursement for consumers, use of tele-consultation, evaluating the feasibility of requiring primary care providers to refer patients with chronic health conditions to behavioral health professionals, and evaluation of ways to cover the uninsured and underinsured.
The full workgroup will meet next week on Wednesday, March 10, to hear presentations from public and private entities from across the state that have been working on integration of health and behavioral health in their organizations. There are 8 different programs presenting in two panels, one in the morning and one in the afternoon.
If you have ideas that you want to share with me, please e-mail me at OllieSeayPhD@austin.rr.com or reply to my posting.
