{"id":66147,"date":"2016-06-07T18:33:30","date_gmt":"2016-06-07T22:33:30","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=66147"},"modified":"2016-06-07T18:45:53","modified_gmt":"2016-06-07T22:45:53","slug":"policy","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/06\/07\/policy\/","title":{"rendered":"policy…"},"content":{"rendered":"\n
I expect most readers are as phobic about reading health care policy as I am. But about once a century, I try to look in on what’s happening – operating on the principle that if I don’t keep up a little, I can’t complain when it happens. This post is about the programs the Federal Government is incentivizing<\/font><\/em> called Health Homes<\/a> for the States to build from in creating their own Medicaire Programs in the wake of the Affordable Care Act<\/font>:<\/div>\n
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The Medicaid Health Home State Plan Option<\/a>, authorized under the Affordable Care Act<\/font> [Section 2703], allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions. States will receive enhanced federal funding during the first eight quarters of implementation to support the roll out of this new integrated model of care.<\/div>\n

[participating states so far]<\/sup><\/div>\n<\/blockquote>\n
My interest here is how this particular version tries to deal with what actually constitutes expectable Mental Health Care. In reading the whole thing, it seems to count on on an intact Mental Health Center system to take care of severe mental illness or emergencies, so they focus on only outpatient care for Medicaire recipients. They’re trying to come up with some kind of compromise plan focusing on what they perceive to be the underserved or badly served: <\/div>\n
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…"only around 40 percent of Americans with a diagnosable mental illness received any specific mental health treatment in the prior year, and only around one-third of those – therefore, approximately one in seven overall – received treatment that could be characterized as minimally adequate based on practice guidelines."<\/div>\n<\/blockquote>\n
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"… and many of these patients do not receive these medications in sufficient doses or for a sufficient duration; while others continue to use medications even if they are not effective for them, rather than having their treatment adjusted, due to lack of regular monitoring and clinical inertia. As a result, as few as 20 percent of patients started on antidepressant medications in usual primary care show substantial clinical improvements. Many patients referred to psychotherapy receive an insufficient number of visits and\/or ineffective forms of psychotherapy, so that treatment response for this type of treatment is also as low as 20 percent under usual care. Finally, poor quality of medical care in patients with mental illness may explain a significant portion of their excess mortality."<\/div>\n<\/blockquote>\n
So what I’ve done below is pull out the bare bones from some of their very long documents about the government’s version of Collaborative Care au Medicaire. How the system actually works is not totally clear here, but it’s not clearer if you read all the pages. The States submit their own plans for approval – this is the template. As above, a number of States have implemented it and they’re all somewhat different. I’m going to hold judgement for a bit and cogitate. This, or something like this, is going to be the program for a whole lot of people.<\/div>\n
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The Collaborative Care Model: An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes<\/a><\/div>\n
By Jürgen Unützer, Henry Harbin, Michael Schoenbaum, and Benjamin Druss.<\/div>\n

EXECUTIVE SUMMARY<\/font><\/strong><\/p>\n