Tag: Behavioral healthcare

Case Management with Email Messaging

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Many of our customers include Case Management as part of the mix of services provided to clients. Among the seriously mentally ill (SMI) population, Case Management has become an essential service helping individuals gain the most from the services they receive. Helping the client take their medication as prescribed, assessing their current symptom status, intervening to alter treatment rapidly if a crisis is looming are all functions that Case Managers provide. These services are provided both in-person and by telephone.

A new study published in The Journal of General Internal Medicine suggests that email contact with a trained psychiatric nurse can dramatically improve the outcome of medication treatment for depression by internal medicine practices. Reported in Healthcare IT News on March 17, the study was a follow-up to a similar study using telephone contact with patients who had newly been started on antidepressant medication. According to the report, the email messaging was even more effective than a telephone call in improving the benefit of the medication.

The study utilized 208 members of Group Health, a consumer-governed, nonprofit, integrated healthcare organization that coordinates care and coverage for 600,000 individuals in Washington state and Idaho. The Group Health Research Institute (GHRI) was the responsible research organization. GHRI  is a non-proprietary, public-domain research institution within Group Health.

The Group Health plan includes a patient portal that has access into the organization’s electronic health record. According to the abstract of the article, the Intervention consisted of:

 Three online care management contacts with a trained psychiatric nurse. Each contact included a structured assessment (severity of depression, medication adherence, side effects), algorithm-based feedback to the patient and treating physician, and as-needed facilitation of follow-up care. All communication occurred through secure, asynchronous messages within an electronic medical record.

This study was motivated by poor improvement outcomes reported nationally for depressed individuals treated by their primary care providers with antidepressant medication. The goal of the entire research project is to determine if use of an organized plan of treatment including evidence-based follow-up services would result in greater effectiveness of medical therapy.

A significant movement is developing within the U.S. to improve outcomes of our healthcare system by providing services in non-traditional ways. The Connected Healthmovement seeks to improve healthcare services and outcomes by use of technology to remotely monitor and provide services. Partners Healthcare Center for Connected Health has been a pioneer in this effort. Their web site states the goal in this fashion:

Changing Healthcare Delivery

We are engaging patients, providers and the connected health community to deliver quality care outside of traditional medical settings. Telehealth, remote care and disease management initiatives reflect the opportunities for technology-enabled care programs.

What potentials do you see for the use of electronic methodologies like secure email communication with clients within your organization? Are you already engaged in such endeavors? What do you see as the obstacles to such care? What are the potential benefits to your clients? How do we get from here to there?

Please share your experiences, concerns and other comments below.

Trauma-informed Care . . . for most of your clients

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On February 24, 2011 I received an email letter from Linda Rosenberg, National Council President and CEO. The letter was entitled Trauma-informed Care: A Call to Arms. I was delighted to read it.

In my previous life, when I worked as a psychologist, I practice Feminist Therapy. Somehow, my practice had developed into one in which I saw mostly women. By the time I retired from practice in 1993, some 90% of my clientele were the survivors of some form of abuse. After 18 years out of direct service delivery, it has become obvious that women and girls do not begin to be the only people who are abused during their lives. Boys and men also suffer physical, emotional and sexual abuse. And every person who is abused experiences an impact on their lives from that abuse. Those who are abused repeatedly feel the greatest impact.

Linda’s letter presents a simple challenge: rather than ask clients what is wrong with them, she suggests that we ask what happened to them. This formulation was presented by a survivor named Tonier Cain who, after 83 arrests and 66 convictions, is now a team leader with SAMHSA’s National Center for Trauma Informed Care. She shares her story in speeches around the country and is the subject of the documentary “Healing Neen.”

The Adverse Childhood Experiences study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente reports the outcome of interviews with more than 17,000 individuals undergoing a comprehensive physical exam who chose to provide detailed information about their childhood experiences of abuse and family dysfunction. Almost two-thirds of the participants reported at least one experience; 20% reported three or more. The greater the number of adverse experiences, the greater the risk for health problems like alcoholism and alcohol abuse, chronic obstructive pulmonary disease, depression, fetal death, illicit drug use, ischemic heart disease, liver disease, intimate partner violence, suicide attempts, and unintended pregnancies, with risk increasing directly based on experiences. Trauma-related difficulties take a huge toll on individuals and our society.

Ms. Cain is one of many survivors of abuse who have recovered from their trauma and continue to progress by helping others. . .a standard part of the “recovery” model of care. But the recovery model is not enough. It is essential that providers become informed about trauma and learn the most effective ways of intervening. A good resource to start down this path is the report Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services.

Is it time for you and your organization to focus on “what happened to you” rather than “what’s wrong with you?”

Please share your organization’s approach to trauma. This old feminist would love to hear some inspiring stories. And, if you do not use trauma-informed methods, please let us know the bases for that decision. Just enter your comments below.

HIPAA Privacy Requirements: Serious business

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In the past year, the Office for Civil Rights, the federal office responsible for enforcing HIPAA privacy requirements, has finalized the rule by which all covered entities and their business associates are required to protect the personal and health information of patients they serve. The rule details the actions a breach of the privacy rule requires including notification of patients. In the past month, OCR has begun to publish significant fines to organizations who have been found responsible for a breach of that privacy rule.

Lots of folks have been waiting to see what kind of fines the OCR would impose upon organizations found responsible for breaches. We are beginning to find out.

On February 14, 2011, HHS entered into an agreement with Massachusetts General Hospital in which the hospital organization agreed to pay $1 million because of the loss of data of 192 patients of one of its outpatient practices. The information lost was on paper and was lost on a subway train. The hospital also agreed to enter into a Corrective Action Plan (CAP) including the implementation of policies and procedures to protect the PHI of its patients.

For those of you who thought these requirements do not affect you if you do not keep any patient information in an electronic form, it is clear that is not how OCR views it. Paper is also vulnerable and OCR is determined to protect that PHI.

The second announced fine was placed on Cignet Health of Prince George’s County Maryland. They were fined $4.3 million. They were accused of denying 42 patients access to their medical records, failed to cooperate with OCR in their investigation of the complaints, indeed failed to reply to OCR’s notifications. OCR determined that “the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule.”

For those of you who have thought that not keeping records of treatment might be the safest course of action, please think again. If you cannot provide the record when a patient requests it, they have every right to complain and to seek a judgement against you.

Of course, your organizations all have Privacy Policies. Do you know what they are? Do you follow the Procedures that your organization has developed? Does everyone? Part of the requirement is that employees be properly trained in what the policies and procedures are and that their training is regularly refreshed. Oh, and yes, part of the requirement is that the Privacy Officer makes sure the owners of the practice or the Executive Director or Board of Directors is well-informed about how the policies are implemented.

How is your organization doing with the stricter Privacy Rule requirements imposed by the HITECH Act? Please share your thoughts, fears and struggles with these requirements and how they affect your organization. Just enter your comments below.

Parity Act Slow to Catch On

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In January 2011, the American Psychological Association (APA) reported that nearly 90 percent of Americans have never heard about mental health parity or of the Mental Health Parity and Addiction Equity Act of 2008. In a survey conducted for the APA in December 2010 by Harris Interactive, 89% of those surveyed said they had not heard about the federal law that affects people who have health insurance through a group or employer plan. Only 7% even recognized the phrase ‘mental health parity.’

The American Psychiatric Association(aPa) participates in the Mental Health Parity Watchalong with 11 other organizations. This organization is aimed at educating the public about parity, recording and appealing problems experienced by consumers in accessing mental health benefits, and in general facilitating the broad dissemination of information about the parity law. The aPa reportedon it’s intervention with BCBS-IL regarding their new requirements for preauthorizations for mental health treatment. While BCBS-IL rescinded their requirement for 2011, it is this kind of action by insurers that the law was meant to prevent.

Companies like Aetna have added pages to their web sites on mental health parity. These are designed to communicate directly to members and panel providers what positions the company has decided to take relative to the law. This can be an excellent way for consumers who have health insurance to learn how their insurer plans to address the requirements of the law.

As part of the parity implementation coalition mentioned above (Mental Health Parity Watch), the National Council has produced fact sheets and other resources aimed at educating consumers and answering questions about the law. Their are additional resources available on their blog page including summary of the law, FAQ, and a Parity Toolkit.

What has been your organization’s experience with the parity legislation so far? Have you found that insurers are moving forward with equivalent benefits and preauthorization policies for both physical and mental health? If you have run into difficulties, what have they been and how have you handled them.

Please share your experience to date. Thanks for your comments!

Integrating Behavioral Health into the Healthcare Home

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One of the many provisions included in the Patient Protection and Affordable Care Act (health care reform law) was the creation of pilot programs to integrate all health care services into a Health Home. The development of the ‘medical home‘ concept will be most important among those with complicated health concerns and in vulnerable populations. Those with significant health issues in addition to behavioral health disorders will be in special focus.

This attempt to integrate care will likely have major impacts on how behavioral health care services are provided to the seriously mentally ill and chemically dependent populations. The National Council has been actively involved in this movement and has received funds to found the Center for Integrated Health Solutions.

The National Council for Community Behavioral Healthcare has won a competitive cooperative agreement from the U.S. Department of Health and Human Services (HHS) to establish the Center for Integrated Health Solutions. The Center will address the comprehensive health needs of clients with mental illnesses and/or substance use disorders by improving the coordination of healthcare services in publicly funded community settings. The Center is funded jointly by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources Services Administration (HRSA).

In that role, on January 19, 2011, the National Council participated in an extremely informative webinar on current integration projects initiated by community behavioral health organizations. Each of the organizations that participated came to their ‘Health Home’ program in a different way and developed programs using different models. The presentation made clear that there are likely to be as many ways to accomplish the purpose of integrating health care for the most vulnerable populations as there are organizations that will provide that care. Even so, there are significant issues to be considered, challenges to be met, and goals to be accomplished for the establishment of a successful program.

A recording of this webinar is to be posted at http://coce.samhsa.gov/ at an indefinite date. Information about Co-Occurring Disorders Integration & Innovation can be obtained at contact@codimail.org. 

The hope that these programs can provide more effective health care at a lower cost is high. I am sure we will all be watching carefully to see how these and other initiatives progress.

I invite those  of you who have interest and experience with integrated care to share your perspectives. Your input will be valuable to your colleagues.