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Behavioral Determinants
5
of Health Advancing psychology to improve lives
Behavioral Health Conditions
Relevant Mental
6
Health Research Advancing psychology to improve lives
Behavioral Health Conditions
Adapted from Figure 2: Melek, S. P., Norris, D. T., & Paulus, J. (2014). Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychiatry. Milliman
America Psychiatric Assocation. Denver: Milliman Inc.
Monthly 2012 Health Expenditures per Person, for Chronic
Conditions, with and without Comorbid Behavioral Health
Conditions Advancing psychology to improve lives 9
Financing Behavioral Health
Financing Behavioral Health
0
8 0 8 2 8 4 8 6 8 8 9 0 9 2 9 4 9 6 9 8 0 0 0 2 0 4 0 6 0 8 1 0 1 2 1 4
19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20
GDP refers to gross domestic product. Data in legend are for 2014.
Source: OECD Health Data 2016. Data are for current spending only, and exclude spending on capital formation of health care providers.
3.42%
13.88%
3.42%
Medical
Behavioral
Medical Rx
Behavioral Rx
79.28%
Adapted from Figure 2: Melek, S. P., Norris, D. T., & Paulus, J. (2014). Economic Impact of Integrated Medical-Behavioral Healthcare: Implications for Psychiatry. Milliman
America Psychiatric Assocation. Denver: Milliman Inc.
7; 14.00%
1; 10.00%
MH Spending =
6; 5.00% $179 Billion
2; 26.00%
5; 29.00%
3; 2.00%
4; 14.00%
Distribution of MH Spending
Advancing psychology to improve lives 11
By Payer, 2014
Financing Behavioral Health
From January 8, 2014 APA Practice Organization Letter to Federal Parity Enforcement Agencies
MEDICARE MEDICAID
is an insurance program is an assistance program
is a federal program, basically is a state and federal program.
the same everywhere in the It is run by state and local
United States. governments within federal
guidelines. It varies from state
to state.
serves people over 65 primarily, serves low-income people of
whatever their income; and every age
serves younger disabled people
and dialysis patients
Patients pay part of costs Patients usually pay no part of
through deductibles and small costs for covered medical
monthly premiums are required expenses
Medicare vs. Advancing psychology to improve lives 11
Financing Behavioral Health
Two SAMHSA block grants equaled $3.1 billion for fiscal year 2014
SAMHSA block grant funds are commingled with other public funds, as
well as with Medicaid, health care insurance, and private payments.
https://www.samhsa.gov/data/sites/default/files/report_2080/ShortReport-2080.html
https://www.samhsa.gov/grants/block-grants
15
SAMHSA Block Grants Advancing psychology to improve lives
Financing Behavioral Health
5,000+ psychologists
work in VA
VA spending on mental
health is $7.927 billion
Active duty military
separated under any
condition other than
dishonorable
Special focus on
suicide and trauma
Veterans Affairs Advancing psychology to improve lives 16
Financing Behavioral Health
Fee-for-service
18
Changing the Paradigm
Traditional Treatment Model
Our Current Treatment System
HEALTH
CARE 10%
ENVIRONMENT LIFESTYLE
19%
51%
Smoking
Obesity
Stress
Nutrition
HUMAN
20%
Blood Pressure
Alcohol
Drug Use
BIOLOGY
Case Studies and Policy Issues
Critical Systems and Policy Issues
Alternative
Payment
Arrangement
Improving
Efficiency
Improving
Effectiveness
Recovery/
Resilience
295
189
Before During
Arthur C. Evans Jr.
Day Treatment Transformation
Lower Cost of Inpatient Psychiatric Services
Initial 3 Agencies
$982,895
$561,011
Journey of Hope
Specialized residential substance abuse treatment programs for people
experiencing long-term homelessness
$70,000
$64,229
$60,000
$56,009
$52,763
$50,584
$50,000
Cost per Person
$40,000
$35,509
$30,872 $31,478
$30,000
$19,241
$20,000 $16,369
$14,738 $13,781
$11,011 $11,830
$10,305
$10,000 $6,745 $6,558
$-
Safe Haven (n=94) Journey of Hope (n=93) Residential Pilot (n=68) Total (n=255)
Referral Source
Year 2 Before Voucher Issuance (n=244) Year 1 Before Voucher Issuance (n=255)
During (n=252) Year 1 After Lease-Up (n=231)
Clinical Outcomes:
Length of stay reduced by half
Assaults reduced by 60%
Use of restraints lowered by two orders of magnitude
Use of intramuscular PRN medications reduced by 2/3 Arthur C. Evans Jr.
Financing Behavioral Health
60%
70%
63.12% 55.1%
60% 2011
50% 55.01% 46.6% 2012
42.7% 2013
50%
40%
40% 38.61%
30% 30.0%
30% 27.73% 25.9%
20%
20%
10%
0%
0%
2011 ASD 2012 Non-ASD
2013
Arthur C. Evans Jr.
Case Studies and Policy Issues
Other Policy Issues
Critical Systems and Policy Issues
Reducing Disparities 27
Critical Systems and Policy Issues
Barriers to Psychologists
28
Performing Service Advancing psychology to improve lives
Psychologists in Health Care System
Psychologists in Health Care System
www.apa.org
Staff experts
PsycINFO
90+ journals
Bryan, C. J., Morrow, C., & Appolonio, K. K. (2009). Impact of behavioral health consultant interventions on patient symptoms
and functioning in an integrated family medicine clinic. Journal of Clinical Psychology, 65(3), 281-293.
Corso, K. A., Bryan, C. J., Morrow, C. E., Appolonio, K. K., Dodendorf, D. M., & Baker, M. T. (2009). Managing posttraumatic
stress disorder symptoms in active-duty military personnel in primary care settings. Journal of Mental Health Counseling,
31(2), 119-136.
Goodie, J., Isler, W., Hunter, C., & Peterson, A. (2009). Using behavioral health consultants to treat insomnia in primary care: A
clinical case series. Journal of Clinical Psychology, 65, 294-304
Davis, D., Corrin-Pendry, S., & Savill, M. (2008). A follow-up study of the long-term effects of counselling in a primary care
counselling psychology service. Counseling and Psychotherapy Research, 8(2), 80-84.
Cigrang, J. A., Dobmeyer, A. C., Becknell, M. E., Roa-Navarrete, R. A, & Yerian S. R. (2006). Evaluation of a collaborative mental
health program in primary care: Effects on patient distress and health care utilization. Primary Care and Community Psychiatry,
11, P1-P7
Felker, B. L., Barnes, R. F., Greenberg, D. M., Chaney, E. F., Shores, M. M., Gillespie-Gateley, L., Morton, C. E. (2004).
Preliminary outcomes from an integrated mental health primary care team. Psychiatric Services, 55, 442-444.
Bryan CJ, Corso KA, Rudd MD, & Cordero L. (2008). Improving identification of suicidal patients in primary care through routine
screening. Primary Care and Community Psychiatry, 13(4), 143-147.
Gouge, N., Polaha, J., Rogers, R., & Harden, A. (in press). Integrating behavioral health into pediatric primary care: Implications for provider
time and cost. Southern Medical Journal, ##, pp-pp.
Lanoye, A., Stewart, K. E., Rybarczyk, B. D., Auerbach, S. M., Sadock, E., Aggarwal, A., Waller, R., Wolver, S. and Austin, K. (2016).The Impact
of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization. J. Clin. Psychol.. doi:10.1002/jclp.22367
Klein, S., & Hostetter, M. (2014). In focus: Integrating behavioral health and primary care. Quality Matters.
Funderburk, J.S., Dobmeyer, A.C., Hunter, C.L., Walsh, C.O. & Maisto, S.A. (2013). Provider practices in the Primary Care Behavioral Health
(PCBH) model: An initial examination in the Veterans Health Administration and United States Air Force. Families, Systems & Health, 31(4),
341-353.
Funderburk, J. S., Dobmeyer, A. C., Hunter, C. L., & Walsh, C. O. (2013). Provider practices in the primary care behavioral health (PCBH)
model: An initial examination in the Veterans Health Administration and United States Air Force, Families, Systems & Health, 31, 341-353.
McFeature, B. (2012). Primary care behavioral health consultation reduces depression levels among mood-disordered patients. Journal of
Health Disparities Research and Practice, 5, 36-44.
Meadows, T., Valleley, R., Haack, M. K., Thorson, R., & Evans, J. (2011). Physician "costs" in providing behavioral health in primary care.
Clinical Pediatrics, 50(5), 447-455.
Serrano, N. & Monden, K. (2011). The effect of behavioral health consultation on the care of depression by primary care clinicians.
Wisconsin Medical Journal, 110 (3), 113-118.
Brawer, P.A., Martielli, R., Pye, P.L., Manwaring, J. & Tierney, A. (2010). St. Louis Initiative for Integrated Care Excellence (SLICE): Integrated-
Collaborative care on a large scale model. Families, Systems & Health, 28(2), 175-187.
Felker, B. L., Barnes, R. F., Greenberg, D. M., Chaney, E. F., Shores, M. M., Gillespie-Gateley, L., Morton, C. E. (2004). Preliminary outcomes
from an integrated mental health primary care team. Psychiatric Services, 55, 442-444.
Layton, T.J., Ryan, A.M., (2015). Higher Incentive Payments in Medicare Advantages Pay-for-Performance Program Did Not
Improve Quality But Did Increase Plan Offerings, Health Services Research, 50 (6); 1810-1828.
Zhang, Zhiwei, Friedmann, Peter D., Gerstein, Dean R. (2003). Does Retention Matter? Treatment Duration And
Improvement In Drug Use, Addiction, 98 (5); 673-684.
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aevans@apa.org