Integrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit.

Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration.

Value-Based Integrated Case Management at Payor Level: Implementation and Impact.

Purpose Of Study: Case management is an ideal service for patients with health complexity. However, most case management models do not integrate medical and behavioral health training and interventions, and there are little data evaluating these models in privately insured populations. The purpose of this study was to evaluate impact of an integrated case management (ICM) service at the payor level.

Specialty Psychiatric Services in US Emergency Departments and General Hospitals: Results From a Nationwide Survey.

Objective: To explore the handling of psychiatric patients in medical hospitals and emergency departments (EDs) as well as hospital characteristics associated with the availability of psychiatric services in these settings.

Methods: From October 1, 2017, to April 1, 2018, a telephone survey regarding the presence and nature of psychiatric services was attempted among all US registered Medicare hospitals.

Results: Of the included 4812 US hospitals, 2394 (50%) were surveyed.

Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial.

Background: Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding.

Impact of Behavioral Health Comorbidities on Health Care Costs Among Japanese Patients With Cancer.

Background: Little is known about how behavioral health (BH) conditions affect health care costs of patients with cancer in Japan.

Objective: The purpose of this study is to evaluate the magnitude of general medical claims expenditures for individuals with cancer who use or do not use BH services in Japan.

Methods: The study used a health insurance claims database for more than 3 million enrollees in Japan.

General medical claims for behavioral health patients in Japan.

Objectives: To evaluate the magnitude of general medical claims expenditures (ie, medical service use) for individuals who use and do not use behavioral health (BH) services in the Japanese free-access medical insurance system to determine if BH patients use substantially more health services, as has consistently been reported in the United States.

Study Design: Retrospective comparison of Japanese occupation-based total health services use for enrollees with and without comorbid BH conditions.

Methods: The study used a health insurance claims database for more than 3 million enrollees in Japan.

Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care.

The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet.

The role of behavioral health services in accountable care organizations.

Nationally, care delivery organizations are developing accountable care organizations (ACOs), but few have an appreciation of the importance of behavioral health services or knowledge about how to include them in an ACO since their funding and delivery are currently segregated from other medical services. This commentary reviews data on the impact of patients with concurrent medical and behavioral health conditions. They indicate that three-fourths of patients with behavioral health disorders are seen in the medical setting, but are largely untreated because few medical patients choose to access the behavioral health sector, which is where behavioral health providers are paid to work.

Using the INTERMED complexity instrument for a retrospective analysis of patients presenting with medical illness, substance use disorder, and other psychiatric illnesses.

Background: The financial and treatment challenges of complex patients must be addressed with adequate assessment and evaluation. The INTERMED complexity instrument (INTERMED) has been developed for this purpose, but to date has not been used retrospectively. The current study represents a retrospective validity investigation of INTERMED with patients with substance use disorder comorbid with other psychiatric and medical conditions (triple diagnoses).

What is integrated care?

Increasing awareness of mental illness's impact on medical and psychiatric health has accelerated global efforts to integrate medical and behavioural health services. As the field of integration has advanced, numerous integrated programmes have been implemented. In examining the impact of these programmes, it is important to maintain a standardized vocabulary to describe the various components of their integration.

Value-based financially sustainable behavioral health components in patient-centered medical homes.

Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today's health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value-added integrated behavioral health care in the PCMH.

Fostering sustainable, integrated medical and behavioral health services in medical settings.

The integration of behavioral health (BH) and primary care services has been the subject of considerable attention for almost a decade. Such work has been motivated by the prevalence of chronic health problems in persons with BH conditions and correspondingly high rates of early death. Service integration efforts typically included cross-referral or bidirectional efforts to add some features of primary care to specialty BH settings or the reverse.

Creating clinical and economic "wins" through integrated case management: lessons for physicians and health system administrators.

Objective: This article describes an innovative integrated approach to case management using a standardized complexity assessment grid and communication tool, which is designed to identify barriers to improvement in 4 domains: biological, psychological, social, and health system; to create and implement holistic care plans based on "anchored barriers; and to document ongoing targeted outcomes.

Practice Settings: Adult and pediatric case and disease managers working for hospitals or clinics, health care delivery systems, general medical health plans, care management vendors, government agencies, and employers can effectively employ integrated case management procedures.

Integrated Case Management: Integrated case management augments traditional care coordination by allowing trained medical or mental health managers to assist with cross-disciplinary barriers without handoffs; to connect multidomain barriers to mutually agreed-upon care plan goals and activities; and to measure clinical, functional, fiscal, quality of life, and satisfaction outcomes as a part of the management process, especially in high-cost, complex patients.

Reprint of: Psychosomatic medicine and consultation-liaison psychiatry: scope of practice, processes, and competencies for psychiatrists working in the field of CL psychiatry or psychosomatics. A consensus statement of the European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) and the Academy of Psychosomatic Medicine (APM).

Objective: In 2008, the Board of the European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) and the Academy of Psychosomatic Medicine (APM) Council commissioned the creation of a task force to study consensus-based summaries of core roles, scope of clinical practice, and basic competencies for psychiatrists working in the field of Psychosomatic Medicine (PM) and/or Consultation-Liaison Psychiatry (CLP).

Method: The task force used existing statements of competencies and feedback from EACLPP and APM symposia and workshops to develop a draft document. After review by the EACLPP and APM committees, and the EACLPP Board and APM Council, a period of comment from the field preceded a final draft resubmitted for consideration of the EACLPP Board and APM Council in February 2010.

Creating clinical and economic "wins" through integrated case management: lessons for physicians and health system administrators.

The 5% of patients using 50% of health resources commonly have interacting and persistent multimorbid illnesses; concurrent mental health problems; impaired social networks; and/or difficulties in accessing care through the health system. To improve outcomes in these patients, it is necessary to overcome clinical and nonclinical barriers that lead to poor health, treatment resistance, high health care cost, and disability. This article describes an innovative complexity-based and outcome-oriented approach using integrated case management.

Does integrated care improve treatment for depression? A systematic review.

Care management-based interventions promoting integrated care by combining primary care with mental health services in a coordinated and colocated manner are increasingly popular; yet, the benefits of specific approaches are not well established. We conducted a systematic review of integrated care trials in US primary care settings to assess whether the level of integration of provider roles or care process affects clinical outcomes. Although most trials showed positive effects, the degree of integration was not significantly related to depression outcomes.

Psychosomatic medicine and consultation-liaison psychiatry: scope of practice, processes, and competencies for psychiatrists working in the field of CL psychiatry or psychosomatics. [corrected] A consensus statement of the European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) and [corrected] the Academy of Psychosomatic Medicine (APM). [corrected].

Objective: In 2008, the Board of the European Association of Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) [corrected] and the Academy of Psychosomatic Medicine (APM) Council commissioned the creation of a task force to study consensus-based summaries of core roles, scope of clinical practice, and basic competencies for psychiatrists working in the field of Psychosomatic Medicine (PM) and/or Consultation-Liaison Psychiatry (CLP).

Method: The task force used existing statements of competencies and feedback from EACLPP and APM symposia and workshops to develop a draft document. After review by the EACLPP and APM committees, and the EACLPP Board and APM Council, a period of comment from the field preceded a final draft resubmitted for consideration of the EACLPP Board and APM Council in February 2010.

Physician staffing for the practice of psychosomatic medicine in general hospitals: a pilot study.

Background: The treatment of psychiatric illnesses, prevalent in the general hospital, requires broadly trained providers with expertise at the interface of psychiatry and medicine. Since each hospital operates under different economic constraints, it is difficult to establish an appropriate ratio of such providers to patients.

Objective: The authors sought to determine the current staffing patterns and ratios of Psychosomatic Medicine practitioners in general hospitals, to better align manpower with clinical service and educational requirements on consultation-liaison psychiatry services.

Barriers to physical and mental condition integrated service delivery.

Objective: To assess pragmatic challenges faced when implementing, delivering, and sustaining models of integrated mental health intervention in primary care settings. Thirty percent of primary care patients with chronic medical conditions and up to 80% of those with health complexity have mental health comorbidity, yet primary care clinics rarely include onsite mental health professionals and only one in eight patients receive evidence-based mental health treatment. Integrating specialty mental health into primary care improves outcomes for patients with common disorders, such as depression.