News & Notes

Explaining the high costs of U.S. health care: The United States spends more on health care than any other country—$2.9 trillion every year, or $9,200 per person. Yet it also tops the list for deaths that are considered to be preventable with appropriate treatment. Is it possible to provide better care at a lower cost? An issue brief from the Commonwealth Fund addresses this question by examining the sources of high costs, obstacles to controlling them, and efforts under way to obtain better value. In addition to the fee-for-service reimbursement system, the high prices for many types of care, and avoidable hospital readmissions, a key driver of costs is poorly coordinated care, particularly for patients with complex, chronic conditions. As noted in the issue brief, just 5% of the U.S. population accounts for nearly half of total health care spending, and 20% accounts for four-fifths. The brief describes efforts to lower costs, such as accountable care organizations and bundled or “episode-based” payments that provide incentives for keeping patients with complex conditions healthy. Throughout the online document, hyperlinks take users to pages with more detailed information. Research cited in the brief shows that if U.S. health care spending had been the same for the past 30 years as the second-highest-spending country, the savings would equal $15.5 trillion—enough to transform the federal debt into a surplus and to send more than 175 million students to a four-year college. The brief is available on the Commonwealth Fund Web site at www.commonwealthfund.org/Publications.

NAMI program sends presentation teams to high schools: The National Alliance on Mental Illness (NAMI) has launched a new national program to educate high school students about mental illness. “NAMI Ending the Silence” features individuals and family members whose lives have been affected by mental illness. These individuals visit high schools to provide personal perspectives on living with and recovering from mental illness. The free 50-minute presentations are designed to complement health, science, or psychology classes and are typically presented in the freshman or sophomore year of high school. Each trained presentation team includes a young adult in recovery. Topics covered in the presentations include signs and symptoms of mental illnesses, statistics on how mental illness affects children and adolescents, recovery and coping strategies, ways to help reduce the stigma associated with mental illness, and how to help friends who are affected by mental illness. The presenters' message of empathy and hope encourages students to actively care for themselves and for peers. A discussion period allows students to ask questions and learn personal truths about mental illness. To request a presentation, contact a nearby NAMI affiliate (www.nami.org).

A new toolkit for integrating consulting psychiatry in primary care settings: An increasing number of primary care patients have mental health needs. Research has shown that referring these patients to specialty mental health care is not usually effective: less than one-third of the referrals are completed. Improving providers’ access to consulting psychiatry lays the groundwork for better management of primary care patients. A new toolkit provides a framework for a team approach to addressing the behavioral health needs of primary care patients. It includes a detailed flow diagram showing how primary care physicians, a behavioral health consultant, and a consulting psychiatrist can work together within a clinic, and it describes the key elements of communication during interactions between these collaborators. Developed by Access Community Health Centers—a federally qualified health center—and researchers in the Department of Family Medicine at the University of Wisconsin–Madison, the toolkit is intended for clinic directors, managers, primary care clinicians, behavioral health consultants, and psychiatrists. The Integrated Primary Care Consulting Psychiatry Toolkit can be downloaded from the university’s Health Innovation Program Web site (www.hipxchange.org/ACHCOverview).

Emory launches center for services research: Researchers from the Department of Health Policy and Management at Emory University’s Rollins School of Public Health have opened the Center for Behavioral Health Policy Studies (CBPS). The mission of the center is to improve the lives of people with mental and substance use disorders through research, education, and service. Led by center director, Benjamin Druss, M.D., M.P.H., of the Rollins School, the center supports the efforts of a multidisciplinary team of faculty, staff, and students from Emory, Morehouse School of Medicine, Georgia Institute of Technology, the University of South Carolina, and the Carter Center Mental Health Program. Examples of ongoing projects include intervention studies to develop and test new models of integrated care for people with serious mental disorders, studies examining access and quality of care for disadvantaged children, and evaluations of state- and federally funded mental health policies and programs. The CBPS seeks to attract and train master’s-level, doctoral, and postdoctoral students interested in mental health and substance use research and policy. More information about the Center is available on the Emory Web site (www.cbps.emory.edu/About-CBPS/index.html).

CSG Justice Center’s policy recommendations for use of Medicaid funds: People involved with the criminal justice system have rates of mental and substance use disorders, infectious diseases, and chronic health conditions that are as much as seven times higher than in the general population. In addition, they are likely to be uninsured. Failure to link these individuals to health coverage and services on release from incarceration is especially costly to state and local governments. A new policy brief from the Justice Center of the Council of State Governments (CSG) describes how states and communities can appropriately use federal Medicaid dollars to help expand coverage for this group and achieve reductions in state and local spending. The 30-page brief provides an overview of federal Medicaid law related to people involved with the criminal justice system, discusses policy options available to improve continuity of coverage while ensuring that federal funds are spent appropriately, and provides examples of best practices from various states, including an example from North Carolina, where a state law allows providers to bill Medicaid directly for services provided to incarcerated individuals as long as those individuals would be receiving Medicaid if not for their incarceration. The brief concludes with a list of policy recommendations and resources for state officials. Medicaid and Financing Health Care for Individuals Involved With the Criminal Justice System is available on the CSG Web site (csgjusticecenter.org/reentry/publications).

NCQA program for recognition of specialty practices: The National Committee for Quality Assurance (NCQA), developer of the nation’s most frequently used model of the patient-centered medical home, has extended medical home concepts to specialists with its Patient-Centered Specialty Practice Recognition (PCSP) Program. The program recognizes specialty practices that successfully coordinate patient care and communicate with their primary care colleagues, other specialists, and patients. Specialty practices that desire to become better “neighbors” to the medical home—informing its structure and processes and collaborating more closely with colleagues—and that seek to reduce waste and poor patient experiences can use resources on the program’s Web site (www.ncqa.org/Programs/Recognition/PatientCenteredSpecialtyPracticePCSP.aspx) to determine their readiness to pursue recognition by NCQA as a PCSP. A list of FAQs describes the program’s requirements, and an interactive graphic lays out a “start-to-finish pathway to recognition.” The site lists nearly 100 “early adopter” specialty programs across the country that have earned NCQA recognition.

Kaiser Commission brief on fiscal impacts of Medicaid expansion: An issue brief recently published by the Kaiser Commission on Medicaid and the Uninsured (KCMU) summarizes findings from 32 studies in 26 states that have been conducted to assess the fiscal implications for state and local economies of expanding—or not expanding—the state’s Medicaid program. The Affordable Care Act (ACA) calls for a Medicaid expansion to cover nearly all adults with incomes at or below 138% of the federal poverty level ($15,856 for an individual and $32,499 for a family of four). The federal government pays 100% of the cost of coverage from 2014 to 2016, eventually scaling down to 90% in 2020 and beyond (current federal matching rates range from 50% to 73%). Since June 2012 when the Supreme Court decided to make Medicaid expansion a state option, many states have sought to estimate the fiscal impacts of deciding to expand. Most such studies have looked at new state costs tied to the expansion and savings opportunities resulting from reductions in spending for uncompensated care or funding for other indigent care programs. Several studies have also estimated the broader economic effects of expansion, such as the impact on gross state product, state and local revenues, and jobs. At this time, it is estimated that the 25 states that are not moving forward with the Medicaid expansion will forgo $426 billion between 2013 and 2022, which they would have received in return for an additional $31.8 billion in new state spending tied directly to the expansion. The 12-page issue brief, The Role of Medicaid in State Economies and the ACA, is available on the KCMU Web site (http://kff.org/medicaid/issue-brief/the-role-of-medicaid-in-state-economies-and-the-aca).

New state Medicaid eligibility and enrollment policies: Full implementation of the ACA establishes new Medicaid standards, including simplified enrollment procedures and uniform rules for counting income when determining Medicaid eligibility. Two resources from the KCMU provide detailed new information on eligibility levels and enrollment policies in all 50 states and the District of Columbia. Getting Into Gear for 2014: Shifting New Medicaid Eligibility and Enrollment Policies Into Drive gives an overview of the new eligibility levels for adults and children, both in states that are expanding the program and those that are not. The 39-page report, co-authored with researchers at Georgetown University's Center for Children and Families, also provides an overview of how individuals will enroll through state Medicaid agencies and describes which strategies states have adopted as they work to implement more streamlined, consumer-friendly enrollment processes. To help states launch the expansion and efficiently enroll eligible individuals, the Centers for Medicare & Medicaid Services has offered states a series of facilitated or “fast track” enrollment options. A new KCMU issue brief, Fast Track to Coverage: Facilitating Enrollment of Eligible People Into the Medicaid Expansion, examines state experiences with the new options, which allow them to enroll eligible individuals into coverage by using data already available from their Supplemental Nutrition Assistance programs and their Medicaid or Children's Health Insurance Program. The eight-page brief is based on interviews with Medicaid officials in the four states that have implemented the strategies so far—Arkansas, Illinois, Oregon, and West Virginia. (New Jersey began implementation in November.) As of November 1, when the brief was published, the four states had enrolled more than 223,000 people through the fast-track options. The report and issue brief report are available on the KCMU site (kff.org/about-kaiser-commission-on-medicaid-and-the-uninsured).