Technology for advancing behavioral health integration: implications for behavioral health practice and policy.

Behavioral health integration (BHI) encompasses the integration of general health, mental health, and substance use care. BHI has promise for healthcare improvement, yet several challenges limit its uptake and successful implementation. Translational Behavioral Medicine published the Continuum-Based Framework by Goldman et al.

Providing Behavioral Health Care in PACE - A Review of Federal and State Manual Regulations.

Objectives: Present analysis of the federal and state regulations that guide The Program of All-Inclusive Care for the Elderly (PACE) operations and core clinical features for direction on behavioral health (BH).

Design: Review and synthesize the federal (Centers for Medicare and Medicaid Services [CMS]) and all publicly available state manuals according to the BH-Serious Illness Care (SIC) model domains.

Setting And Participants: The 155 PACE organizations operating in 32 states and the District of Columbia.

Behavioral health integration in the Program of All-Inclusive Care for the Elderly (PACE): A scoping review.

Background: The Program of All-inclusive Care for the Elderly (PACE) is a community-based care model that delivers collaborative care via an interdisciplinary team to meet the medical and social needs of older adults eligible for nursing home placement. Fifty-nine percent of PACE participants are reported to have at least one psychiatric disorder. PACE organizations (POs) function through an interdisciplinary model of care, but a behavioral health (BH) provider is not a mandated role on the interdisciplinary team.

Integrating Behavioral Health and Serious Illness Care in a Post-COVID-19 Environment.

Individuals with serious medical illnesses experience high rates of comorbid behavioral health conditions. Behavioral health comorbidity affects outcomes in serious illness care. Despite this consequence, behavioral health remains siloed from serious illness care.

Bridging the Behavioral Health Gap in Serious Illness Care: Challenges and Strategies for Workforce Development.

Comorbidity with behavioral health conditions is highly prevalent among those experiencing serious medical illnesses and is associated with poor outcomes. Siloed provision of behavioral and physical healthcare has contributed to a workforce ill-equipped to address the often complex needs of these clinical populations. Trained specialist behavioral health providers are scarce and there are gaps in core behavioral health competencies among serious illness care providers.

A Model to Improve Behavioral Health Integration into Serious Illness Care.

Behavioral health problems are highly prevalent among people with serious medical illness. Individuals living with these comorbidities have complex clinical and social needs yet face siloed care, high health care costs, and poor outcomes. Interacting factors contribute to these inequalities including historical separation of behavioral and physical health provision.

Evolving Models of Integrated Behavioral Health and Primary Care.

Purpose Of Review: Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption.

Recent Findings: Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders.

Measuring Efficiency at the Interface of Behavioral and Physical Health Care.

Background: Measures of efficiency in healthcare delivery, particularly between different parts of the healthcare system could potentially improve health resource utilization. We use a typology adapted from the Agency for Healthcare Research and Quality to characterize current measures described in the literature by stakeholder perspective (payer, provider, patient, policy-maker), type of output (reduced utilization or improved outcomes) and input (physical, financial or both).

Aims Of The Study: To systematically describe measures of healthcare efficiency at the interface of behavioral and physical healthcare and identify gaps in the literature base that could form the basis for further measure development.

Health and Aging Policy Fellows: Dementia and Mental Health Policy to Improve Lives of Older Adults.

The Health and Aging Policy Fellows (HAPF) Program has, since its inception in 2008, provided health policy training and mentorship for 113 gerontological professionals across a wide range of disciplines and stages of careers. The fellows' shared passion is the effective engagement of policy levers to improve the lives of older adults. This article briefly describes the HAPF Program and provides a sample of policies with which fellows have been engaged related to dementia and late-life mental health.

The Case for Severe Mental Illness as a Disparities Category.

Extensive evidence documents that people with severe mental illness have higher rates of morbidity and mortality compared with the general population and receive lower-quality and higher-cost health care. These trends, at least in part, stem from discrimination, exclusion, widespread stigma, and criminalization of individuals with mental illness. As such, severe mental illness should receive formal, national recognition as a disparities category.

Measuring and improving the quality of mental health care: a global perspective.

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments.

Health and Aging Policy Fellows Program: Shaping a Healthy Future for Older Americans.

As the size of the elderly population increases, so do the challenges of and barriers to high-quality, affordable health care. The Health and Aging Policy Fellows (HAPF) Program is designed to provide health and aging professionals with the skills and experience to help lead the effort in reducing these barriers and shaping a healthy and productive future for older Americans. Since its inception in 2008, the program has affected not only the fellows who participate, but also the field of health and aging policy.

Bringing Recovery and Consumers' Views Into the Mainstream of Mental Health Quality Measurement.

Health policies in the United States and elsewhere are moving to increase accountability of health care systems and providers for providing high-quality, efficient care and driving application of evidence-based improvement strategies. To support these efforts, a "quality measurement industrial complex" has been created to develop, endorse, and apply quality measures that incentivize these behaviors. Parallel to this development in mental health care is an emerging commitment to include recovery orientation approaches in treating serious mental illness.

Prioritizing quality measure concepts at the interface of behavioral and physical healthcare.

Objective: Integrated healthcare models can increase access to care, improve healthcare quality, and reduce cost for individuals with behavioral and general medical healthcare needs, yet there are few instruments for measuring the quality of integrated care. In this study, we identified and prioritized concepts that can represent the quality of integrated behavioral health and general medical care.

Design: We conducted a literature review to identify candidate measure concepts.

Carrots and Sticks on Opposite Sides of the Atlantic: Integration Incentives for People With Serious Mental Illness in England.

Integrating care pathways between primary and specialist mental health care is seen as integral to improving the health of people with mental illness. Multiple integration initiatives have been implemented, but few have tried to integrate care for people with serious mental illness. This column describes two such initiatives in the United States and in England.

A review of mental health recovery programs in selected industrialized countries.

The concept of recovery has gained increasing attention and many mental health systems have taken steps to move towards more recovery oriented practice and service structures. This article represents a description of current recovery-oriented programs in participating countries including recovery measurement tools. Although there is growing acceptance that recovery needs to be one of the key domains of quality in mental health care, the implementation and delivery of recovery oriented services and corresponding evaluation strategies as an integral part of mental health care have been lacking.

Challenges in the Operationalization of Mental Health Quality Measures: An Assessment of Alternatives.

Interest in measuring the quality of mental health services has increased, but challenges remain in moving from general standards of quality and best practices to specific, implementable quality measures. The International Initiative for Mental Health Leadership identified 656 mental health quality measures and then applied a modified Delphi approach to assess various available alternative quality measures. Panel members considered issues of data source, segmentation, and thresholds.

Quality Measures For Mental Health And Substance Use: Gaps, Opportunities, And Challenges.

Following up on its Crossing the Quality Chasm report, in 2006 the Institute of Medicine issued a report that included sweeping recommendations to improve the quality of behavioral health care in the United States. To date, few of those recommendations have been implemented, and there is little evidence that behavioral health care quality has improved significantly over the past ten years. However, the advent of health care reform, parity of insurance coverage, and growing recognition of the impact of behavioral health disorders on population health and health care costs have created new demands and opportunities for expanded and innovative strategies to assess the quality of care for this patient population.

Quality Measures at the Interface of Behavioral Health and Primary Care.

The development of quality measures has gained increasing attention as health care reimbursements transition from fee-for-service to value-based payment models. As behavioral health care moves towards integration of services with primary care, specific measures and payment incentives will be needed to successfully expand access. This study uses a keyword search to identify 730 quality indicators that are relevant to behavioral health and general medical health.

Measuring the quality of mental health care: consensus perspectives from selected industrialized countries.

This international initiative sought to develop a consensus framework of mental health quality measures. The 656 quality measures identified via literature review were narrowed to 36 measurement concepts. A modified Delphi process was used to rate these for validity, importance, and feasibility.

ICD-11 for quality and safety: overview of the WHO Quality and Safety Topic Advisory Group.

This paper outlines the approach that the WHO's Family of International Classifications (WHO-FIC) network is undertaking to create ICD-11. We also outline the more focused work of the Quality and Safety Topic Advisory Group, whose activities include the following: (i) cataloguing existing ICD-9 and ICD-10 quality and safety indicators; (ii) reviewing ICD morbidity coding rules for main condition, diagnosis timing, numbers of diagnosis fields and diagnosis clustering; (iii) substantial restructuring of the health-care related injury concepts coded in the ICD-10 chapters 19/20, (iv) mapping of ICD-11 quality and safety concepts to the information model of the WHO's International Classification for Patient Safety and the AHRQ Common Formats; (v) the review of vertical chapter content in all chapters of the ICD-11 beta version and (vi) downstream field testing of ICD-11 prior to its official 2015 release. The transition from ICD-10 to ICD-11 promises to produce an enhanced classification that will have better potential to capture important concepts relevant to measuring health system safety and quality-an important use case for the classification.