Health Reform Lives!

Yes, I baked these cookies yesterday.

3 quick comments regarding yesterday's events:

1) While good for the Obama campaign, the mandate will inevitably be spun as a new tax on Americans by  Romney & Co. (to the effect of $500bn (link) in new taxes according to his televised reaction yesterday)...I wonder where this figure comes from?

2) The NYTimes published an article today about mounting pressures to meet PPACA deadlines (link)  Some States, such as WI, are even holding out until November...this just does not seem very smart to me...arrogance > reason:

"Mr. Walker quickly raised the risk by announcing that, in spite of the ruling, he would continue to delay any imposition of the law while waiting to see whether Republicans took control of the White House or Congress in November. Republicans on Capitol Hill, and the party’s presumptive presidential nominee, Mitt Romney, have vowed to repeal the entire law if they gain power."

2) What about Medicaid expansions being left up to the States?  There wasn't too much talk about this yesterday, but I think it's an important point...will Health Reform help the poor attain health insurance?  From ABC: 

"Renee M. Landers of Suffolk University Law school says the impact of today’s ruling, “could reduce the number of people who will be eligible for Medicaid because it is easier for the states to opt out.”"

I suppose we'll find out in time.  Regardless, Team Obama has made history...and  some pretty Healthy Health Policy!

The Behavioral Health Medical Home (this is exciting)

The Patient-Centered Medical Home (PCMH) is like my younger brother, Kevin – it get tons of attention despite having very little proof of adding any value to society (okay, a bit of exaggeration – the PCMH (not my brother) has shown some promising results over time).  However, the idea of a specialty care medical home is talked about much less, but could serve a very important role in managing the needs of specific patient populations.

How about going even further, and introducing the concept of a Behavioral Health Medical Home (BHMH)?  Does this mean that a patient who experiences chronic mental illness that lacks primary care services or vice versa could get whatever he or she needs all in one place, you ask?  Why yes…I believe it does!  And it’s already being done at Cherokee Health System (CHS) in Tennessee. (http://www.cherokeehealth.com/)

I’m completely impressed by CHS's integrated behavioral health program – what a practical solution to managing a complex patient population.  CHS recognized early on that the needs of those with Severe Mental Illness (SMI) are very unique, and exacerbated by the fact that (especially for Medicaid patients) there is lack of social supports necessary to managing their conditions.  The case for a behavioral health medical home that integrates primary care is strong:

• Research has shown more mental health interventions occur in primary care than in specialty mental health settings
• Over one-third of patients in most primary practices have a psychiatric disorder
• PCP's often feel inadequate in addressing the behavioral health needs of their patients
• Treating mental health in the primary care setting may allow patients to overcome the stigma associated with receiving behavioral healthcare
• 80% of people with mental illnesses have 3+ chronic conditions
• Those with SMI have high rates of diabetes, hypertension, obesity, and hyperlipidemia (this is often a side-effect of newer antipsychotic drugs)

The design of CHS’s BHMH is simple.  A behavioral health consultant is co-located at the same site as Primary Care Physicians, and is an embedded, full-time member of the Primary Care team.  The behavioral health consultant provides brief, targeted assessments /interventions to address the psychosocial aspects of primary care

Typical Service Scenario:  The PCP determines that psychosocial factors underlie the patient’s presenting complaints or are adversely impacting response to treatment.  During the visit, the PCP “hands off” the patient to the BHC for consultation services (e.g., suicide risk assessment, anxiety and anger management, substance abuse intervention)

Insurers such as BCBS of Tennessee are already taking notice of some very positive results, that include reduced ER utilization, lower costs per patient, and fewer hospital admissions.  In addition, CHS has identified an unconventional revenue stream by offering BHMH integrated care training to other providers.  In short, the industry has taken note of the BHMH’s success.

“TN has a provider champion – Cherokee Health Systems – that is a nationally recognized model for primary and behavioral health integration” – National Academy for State Health Policy

State Medicaid programs take note: The National Alliance on Mental Illness has stated that Medicaid comprises over 50% of overall public mental health spending (link).  With States making moves to tighten budgets, they should focus on programs that can do more with less – why not start with a BHMH?