Behavioral & Mental Health Stuff We Found While Looking Around

Opioid Epidemic

We’ve been spending some time going down the rabbit hole again. This time, looking into the opioid epidemic and trying to understand the various contributors to the crisis, like the way our healthcare system addresses behavioral and mental health. From manufacturers to providers to patients, there’s certainly enough blame to go around. Can’t say we’re making any strides to solve the problem, but like GI Joe used to say, knowing is half the battle, so maybe there’s power in raising awareness.

Here are some alarming statistics:

And according to this NY Times article,the U.S. uses 98% of the opiates consumed in the world!”

In fact, “women have moved from popping prescription painkillers to shooting up street drugs. And they’re dying because of it in staggering, skyrocketing numbers.”

Opioids in the Media

It’s not particularly funny, but watch this comedic, but also dramatic video from ZDogg, offering the provider’s perspective of patients who have become addicted.

Dr. Drew and Dax Shepard had a long conversation on the Armchair Expert podcast about opioid treatment, alternative drugs, and how we as a culture address addition. Worth a listen:

dr. drew

Value-Based Care

Bringing the topic to HealthIT and Value-based Care, we wanted to know the current state and goals for the future. We found some footage from 2016 of Senator Patrick Kennedy speaking at the University of Chicago Institute of Politics about U.S. mental health policy and the need to treat patients holistically with quality-based measures.

“It’s not in our culture to think of about this whole-person health,” Kennedy says. But that is where the money is. The people who get their arms around it in the business world are going to be the people who make the biggest killing in terms of healthcare.”

According to a recent 3M article, Value-based behavioral health programs can certainly address under-diagnosis, under-treatment, poor medication adherence, as well as poor coordination and care transitions. The impact on total cost of care may be significant for patients with the highest severity conditions, as well as those with co-morbid physical chronic conditions, such as diabetes, heart disease, and cancer. Ultimately, the most successful programs will be those that extend beyond the healthcare system and address the social and community impacts of behavioral health and substance abuse treatment.

However, a report from Columbia University called out “the failure of the medical profession at every level — in medical school, residency training, continuing education and in practice” to adequately address addiction. You can read more about that here.

From Wellcentive’s blog, here are some practical recommendations on creating quality measures that track behavioral health performance in healthcare.

Examining performance measures

The current ways in which behavioral health performance is measured makes it hard to incentivize stakeholders to change. These measures include:

  • Control of core symptoms of psychiatric illnesses
  • Engagement and retention in care
  • Establishment of family/community supports
  • Access to recovery-oriented services
  • Personal and public safety

These measures, however, really address the quality of care for medical co-morbidities—such as diabetes and cardiovascular disease or medical readmissions—instead of focusing solely on individuals dealing with behavioral health issues. This makes it difficult to design shared savings programs based on them, or measure quality and understand when patients are suffering from substandard care.

There must be more focus on the acceptance of evidence-based practices. For example, standards for management of depression in primary care settings already exist. A great example is the PHQ-9 questionnaire that takes from two to five minutes to complete and can provide an accurate summary of depression severity. While this is a great start, there are three key tactics that can help improve the way mental healthcare is delivered:

1. Focusing on key treatment process rather than outcomes. When behavioral health problems lead to personal or public violence, or substance abuse, the patient must be engaged and retained in care for longer periods. During that time, the patient’s response and engagement levels hold greater value until more specific outcomes can be measured.

2. Apply better monitoring of acute care utilization for behavioral health cases. The 3M measure of potentially preventable readmissions is a great starting point: it includes behavioral health readmissions within 30 days as well as readmissions in which either the first or subsequent admission is to a behavioral health setting. Using such a measure can help prevent readmission and assess the impact of inpatient behavioral health interventions. There are also measures which focus on seven and 30- day follow-ups in mental health cases. Value-based payment arrangements can use these to incentivize better participation from hospital and community-based providers.

3. Make use of social determinant and functional outcomes. While claims data doesn’t offer insight into such measures, there has been strong support to include such information within patient records. Incentivizing providers to include such information with systems would be a step in the right direction to gaining reliable data that plays a vital role in the overall health assessment of patients.

From The Socials

We thought that some of the ways that mental and behavioral health is addressed in healthcare and the topic of Medication Adherence and Drug Monitoring showed up in some of our research. So we thought, hey, why don’t we get some input from the health IT community? We connected with @techguy and posed some questions for a Friday #HITsm (i.e. health IT social media) chat on Twitter.

We asked complicated questions, such as:

But don’t worry if you didn’t make it…

 

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