News & Notes

Surgeon General’s report on smoking: Approximately 5.6 million American children alive today—or one of every 13 children—will die prematurely from smoking-related diseases unless current smoking rates drop, according to a new Surgeon General’s report, The Health Consequences of Smoking—50 Years of Progress. The report comes a half century after the historic 1964 Surgeon General’s report concluded that cigarette smoking causes lung cancer. Over the past 50 years, more than 20 million Americans have died from smoking. The new report concludes that smoking kills nearly half a million Americans each year and that an additional 16 million suffer from smoking-related medical conditions. The report puts the cost of smoking at more than $289 billion a year in direct medical care and other economic costs. The 943-page document cites new evidence that links smoking to diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, and age-related macular degeneration. Exposure to secondhand smoke is now known to cause strokes. Although smoking rates among youths declined by half between 1997 and 2011, each day 3,200 children under age 18 smoke their first cigarette and another 2,100 youths and young adults become daily smokers. Every adult who dies prematurely from smoking is replaced by two youths and young-adult smokers. To help communicate the report findings as widely as possible, the report is accompanied by a 20-page consumer guide and a 30-second public service announcement video. The report and related materials are available on the Surgeon General’s Web site at www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html.

SAMHSA’s Behavioral Health Barometer: A collection of new online reports from the Substance Abuse and Mental Health Services Administration (SAMHSA) summarizes data on the behavioral health of Americans. The 32-page overview report, Behavioral Health Barometer, United States, 2013, assembles dozens of figures and tables presenting national-level data on mental health and substance use problems and receipt of treatment among youths and adults, with a separate section on Medicare enrollees. The overview report is accompanied by 51 separate 20-page reports—for the 50 states and the District of Columbia—covering the same topic areas. The data provide a snapshot of the current status of behavioral health, as well as trend data for some indicators. For example, between 2006 and 2010, the number of people receiving buprenorphine treatment for opioid addiction jumped 400% and the number of Medicare enrollees receiving outpatient behavioral health care increased by more than 30%. The snapshot data provide a useful baseline as the nation implements health care reform and parity and as more people gain access to services. Data are separately analyzed by gender, age group, and race-ethnicity when possible to help decision makers identify disparities in their communities. Copies of the 52 reports are downloadable from the SAMHSA Web site at store.samhsa.gov/product/SMA13-4796?from=carousel&position=1&date=0130214.

PCPCC’s annual report on patient-centered medical homes: The Patient-Centered Primary Care Collaborative (PCPCC) has released its 2013 report highlighting published data on clinical, quality, and financial outcomes of U.S. initiatives to implement patient-centered medical homes (PCMHs). The 37-page report focuses on 21 studies published between August 2012 and December 2013, identifies the location and leaders of each initiative, and summarizes outcomes. An appendix describes 54 studies of PCMH initiatives that have been introduced since 2009. As noted in this year’s report, the evidence base for the PCMH model continues to build at a rapid pace. PCMHs have demonstrated notable improvements across a broad range of categories, including cost, utilization, population health, prevention, access to care, and patient satisfaction. The PCMH continues to play a role in strengthening the larger health care system, specifically accountable care organizations and the emerging medical neighborhood model. Significant payment reforms are incorporating many features of the PCMH model. When fully transformed primary care practices embrace the PCMH model of care, consistent positive outcomes will follow, the authors conclude. The report, which is available on the PCPCC Web site at www.pcpcc.org/resource/medical-homes-impact-cost-quality, was made possible with support from the Milbank Memorial Fund.

Commonwealth Fund report on ACA implementation: Provisions of the Affordable Care Act (ACA) delineate three mechanisms for increasing access to insurance coverage: implementation of market reforms, establishment of new health insurance marketplaces, and expansion of Medicaid eligibility for low-income adults. A new report from the Commonwealth Fund, Implementing the Affordable Care Act: The State of the States, finds that nearly all states will require or encourage compliance with the ACA’s market reforms, every state will have a marketplace, and more than half the states will expand their Medicaid programs. Federal regulators have stepped in where states have been unable or unwilling to take action, and the findings suggest that regulators will continue to help ensure that consumers receive the benefits of the law—regardless of the state where they live. To date, seven states—Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, Oregon, and Vermont—have fully embraced all three major components by implementing the market reforms, establishing a state-based marketplace, and expanding their Medicaid program. At the other end of the spectrum, five states—Alabama, Missouri, Oklahoma, Texas, and Wyoming—have fully declined to play a role in implementing these components. This variation reflects the flexibility afforded to states to implement the ACA. However, the 21-page report raises questions about how this variation may affect consumers as state insurance markets undergo significant transition in 2014. With no federal backup in the 20 states that declined to expand their Medicaid programs, millions of adults with low income may continue to face barriers to meaningful coverage. The full report is available on the Commonwealth Fund’s Web site at www.commonwealthfund.org/Publications/Fund-Reports/2014/Jan/Implementing-the-Affordable-Care-Act.aspx.

NASHP resources on Medicaid behavioral health services for children: The National Academy for State Health Policy (NASHP) has assembled a variety of resources to help states improve the delivery of behavioral health services to children and adolescents enrolled in Medicaid. These include a series of brief reports highlighting how six states—Connecticut, Illinois, Iowa, Minnesota, New York, and Oregon—are using the Medicaid benefit to meet the behavioral health needs of children. The reports explore coordination and collaboration efforts; screening, assessment and referral approaches; and treatment strategies. For example, Oregon has created a consolidated health purchasing authority, the Oregon Health Authority. The authority’s Addictions and Mental Health Division maintains a statewide, coordinated children’s mental health system, including a wraparound initiative for children. Managed care organizations support a package of community-based behavioral health benefits for children, which are provided through a county-based system of community mental health programs. Oregon has transitioned to the use of coordinated care organizations that will manage both general medical and behavioral health benefits for Medicaid beneficiaries. Reports from the six states and other materials are available on the NASHP Web site at www.nashp.org/behavioral-health-services.

Webinars on evidence-based practices for justice-involved individuals: SAMHSA is presenting a five-part monthly series (January–May) on evidence-based practices for people with mental illness who become involved with the criminal justice system. Several years ago, SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation convened an expert panel to develop briefs on implementing and disseminating these practices. Recently, the experts have updated the briefs to reflect current research and practices in the field. Hosted by SAMSHA, the Webinar series provides updates on the following topics: forensic assertive community treatment, employment for individuals with mental illnesses involved in the justice system, Illness Management and Recovery, integrating mental health and substance abuse services for people with co-occurring disorders involved in the justice system, and risk-needs-responsivity and cognitive-behavioral interventions. Information about registering for future Webinars and recordings of past presentations are available on the GAINS Center Web site at gainscenter.samhsa.gov/topical_resources/ebps.asp.

New NIDA resources on treatment approaches for teens: Findings from the 2012 National Survey on Drug Use and Health indicated that only 10% of adolescents who need treatment for substance use problems receive any services. This troubling statistic spurred the National Institute on Drug Abuse (NIDA) to develop resources to help health care professionals treat teenagers with substance use disorders and identify those who may be at risk. “Because critical brain circuits are still developing during the teen years, this age group is particularly susceptible to drug abuse and addiction,” said NIDA director Nora Volkow, M.D. “These new resources are based on recent research that has greatly advanced our understanding of the unique treatment needs of the adolescent.” The resources include a new online publication, Principles of Adolescent Substance Use Disorder Treatment: A Research Based Guide, which includes 13 principles to consider in treating youths with substance use disorders, as well as evidence-based approaches to the treatment of adolescent drug abuse. NIDA also released an online video curriculum for medical students and resident physicians, “Substance Use Disorders in Adolescents: Screening and Engagement in Primary Care Settings,” which demonstrates skills to use in screening adolescents who are at risk. The resources are available on the NIDA Web site at www.drugabuse.gov/news-events/news-releases/2014/01/new-substance-abuse-treatment-resources-focus-teens.

Kaiser brief explains ACA measures to regulate insurance competition: Some ACA provisions designed to make it easier for people with preexisting conditions to gain insurance may have unintended consequences for the insurance market. For example, insurers may try to avoid enrolling sicker individuals. As formerly uninsured—and “uninsurable”—people gain coverage, uncertainty in the early years of reform about how coverage should be priced may lead to premium volatility. A new issue brief from Kaiser Family Foundation explains three provisions of the ACA—risk adjustment, reinsurance, and risk corridors—that are intended to promote insurer competition on the basis of quality and value and to ensure insurance market stability. The 11-page brief first describes two key concepts—adverse selection and risk selection. The ACA’s risk adjustment, reinsurance, and risk corridors programs are intended to protect against the potential negative effects of adverse selection and risk selection. Specifically, risk adjustment is designed to mitigate any incentives for plans to attract healthier individuals and compensate those that enroll a disproportionately sick population. Reinsurance compensates plans for their high-cost enrollees and by the nature of its financing provides a subsidy for individual market premiums generally over a three-year period. Risk corridors reduce the general uncertainty that insurers face in the early years of implementation when the market is opened up to people with preexisting conditions who were previously excluded. The brief describes how the three programs vary by the types of plan that participate, the level of government responsible for oversight, the criteria for charges and payments, the sources of funds, and the duration of the program. The issue brief is available on the Kaiser Web site at kaiserfamilyfoundation.files.wordpress.com/2014/01/8544-explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors.pdf.