The Integration of Health and Behavioral Health Workgroup had its final meeting on Thursday, May 27. We took only 4 hours of our scheduled all day meeting to review and give input into the 12 recommendations that were provided to us in draft form by our work group leaders (Tom Valentine and Ricky Garcia from the Texas Health and Human Services Commission [HHSC], the agency charged with providing recommendations to the legislature by August 1). We were told that we could share background and the recommendations documents, but comments are due back by June 15. Sherry Reisman has graciously posted these documents for your review on the TPA website at:
http://www.texaspsyc.org/associations/246/files/Integration%201.pdf
http://www.texaspsyc.org/associations/246/files/Integration%202.pdf
If you have any comments to share about them, please send those to me before June 15 at OllieSeayPhD@austin.rr.com
Briefly, the recommendations and some of the comments shared in our meeting are as follows:
Establish local healthcare integration planning – We suggested that be changed to “Include integrated healthcare in local planning.” It was felt that some of this could occur through already established Provider Network Advising Councils (PNACs) through community mental health centers, Regional Health Districts through DSHS, and hospital districts. Inclusion of public and private sector providers was seen as crucial.
Eliminate systemic barriers to healthcare integration – While this recommendation primarily focused on making the Department of State Health Services (DSHS) contracts with local mental health centers more flexible, we suggested that evidence based approaches should be used to do this and that consumer access to services issues should be included here as well as the need to be able to bill for and have behavioral health services paid for in physical health settings.
Create a State Healthcare Integration Leadership Council – We thought the membership should be made up of the same types of members as the Integration of Health and Behavioral Health Workgroup. (Note: the recommendations refer to the Health and Human Services Enterprise meaning all the agencies under HHSC, but we recommended that HHSC be used since that is a more familiar term).
Create and support a focus on healthcare integration in Texas – Basically, this is for reference materials and technical assistance for organizations looking to provide integrated care. We felt that, since the Hogg Foundation had already provided some funds in the past for public health clinics to demonstrate integration, it might be a good idea to look at a pilot project with a private organization that operates health clinics such as Austin Regional Clinic or some similar organization.
Encourage adoption of confidential health information technology and information sharing – We felt that we needed to consider ways to establish and share electronic records among health and behavioral health providers and that perhaps a special group composed of representatives of these entities and vendors of electronic records systems could come together to discuss ways to make this happen. It was also noted the The Centers for Medicare and Medicaid (CMS) had been providing resources and funding for physical health providers to develop such records, but behavioral health had not been at the table. Model consent forms were also addressed here.
Develop systems for meaningful and functional outcome measurement and tracking – We discussed having the state collaborate with academia to develop process and outcome measures for integration of health and behavioral health in state programs and through voluntary participation by organizations inthe private sector. More work with the Texas department of Insurance was encouraged so that private sector insurance issues could be addressed.
Integration efforts should be implemented as part of federal health requirements – This was meant to address issues of parity in insurance coverage for health and behavioral health issues as well as the yet to be developed regulation for healthcare reform.
Routine health and behavioral health screening should be universally provided to Texans during patient assessments, no matter where those assessments are provided – Here we felt we should add more about the “health home” concept and that any assessments should be evidence-based. It was further noted that, if assessments were going to be done, there needed to be resources for addressing any problems identified. It was further noted that there should be some type of coding system for these assessments so data could be used for future planning. Finally, other non-medical settings, such as public schools, should be included as locations for such screenings.
Training related to integration of services for Texas physicians and allied health professionals should be early in their professional education and continue through their course of study – This recommendation was written just after they leaders talked the with Texas Medical Association, and the language is reflective of that organization’s way of referring to their members and to trainees. We suggested the targeted group should just be called “health professionals’ and that undergraduate and graduate programs should include such information. We also discussed the need for competency-based education, not just exposure to concepts.
The tenets of integration should be incorporated into continuing education requirements for physicians, allied health professionals, and other related professionals – Again, we felt the targeted group should simply be called “health professionals” and that continuing education credits in the ethics area covering these issues should be encouraged for all health professionals.
Creative solutions should be developed through workforce utilization – Here we discussed not just looking at co-housing of health and behavioral health providers, but sharing best practices of various models. We also felt that some recent efforts of peer-to-peer services were left out and that barriers to the use of telecommunication should be addressed to help maximize the use of this resource. Billing codes need to be developed and used for these types of services. Further, we felt that professionals, other than physicians, should be able to use and bill for telehealth services.
Address reimbursement barriers to healthcare integration – This recommendation was aimed at reducing barriers to payment for behavioral health services that are provided in health settings and vice versa. Also, this is a problem for all types of providers not just primary care physicians. Another issues that was suggested for a discussion with “the right people” was why there are different rates of reimbursement for different types of providers for the same service (e.g., physicians get one rate, psychologists another, and social workers yet another for individual psychotherapy codes). This comes down from CMS, so the idea was to get the reasoning behind the differential pay. We also felt that we could learn from some of the providers who presented their models to the workgroup in the April meeting that have found ways to get paid for providing integrated care.
Did we leave some things out? Yes, and some of these we noted in our meeting and are to be addressed in the final document to include veteran’s issues, assertive case management for integration of health and behavioral health for persons with severe mental illness who have great difficulty connecting to services, cultural competency issues, substance abuse inclusion, not just addressing severe mental illness when we use the term behavioral health, considering other mental disorder diagnoses besides those currently identified as severe, patient education about integration of healthcare, and public awareness about the process.
Personally, I found this to be a very productive group. There were representatives of state and private entities, consumer groups and professional associations. I think we did a good job of integrating all the input we got and provided ourselves. No one faction was allowed to dominate the entire group, though this may have led us to be more general, rather than specific, with some recommendations. There was a decision by the leaders to not get into any scope of practice issues which was probably a wise decision on their part. I was glad to have been a part of this effort and to have been representing the psychologists of Texas.
If you have other points you think should be included, be sure to get those to me before June 15 at the e-mail address above.
I will post or get links to the final document that will be sent to the legislature.
Ollie
