Improving Access and Quality Care ...

SAMHSA/HRSA Center for Integrated Health Solutions Resource List
Click on the hyperlinks to open the documents.

Behavioral Health/Primary Care Integration and the Person-Centered Healthcare Home
Released by the National Council in 2009, this report highlights the importance of implementing evidence-based approaches to developing a patient-centered health home for the SMI population. The report describes a health home that delivers care for the whole patient and manages multiple, interrelated and chronic health problems through a fully integrated system.

Implementing Medicaid Health Homes for Enrollees with Chronic Conditions
This factsheet provides a synopsis of CMS’s State Medicaid Directors Letter issued on November 16th, 2010. The letter offers guidance on how states can take advantage of the new Medicaid Health Home state option which was included as part of the Affordable Care Act.

Partnering with Health Homes and Accountable Care Organizations
In the face of growing healthcare costs, health homes and accountable care organizations (ACOs) are two viable service delivery models that have been shown to improve quality while reducing costs. This paper offers an in-depth look at the steps mental health and substance use providers need to take to ensure readiness to effectively partner with these models.

Substance Use Disorders and the Person-Centered Healthcare Home
The patient-centered health home model encourages the bi-directional integration of primary care with both mental health and substance use services. This paper provides details on the integration of substance use treatment with healthcare services and how it would come to fruition in a health home.

Additional Resources

A Consensus Operational Definition of Patient-Centered Medical Home
This operational definition of a PCMH was created by a group of 17 leaders in the healthcare field in order to provide a useful definition for implementers, researchers, payers, and policymakers. The definition consists of two components: 1) a paradigm case, and 2) fourteen specified parameters based on the program’s current level of development.

Accountable Care in the Safety-Net
This report, prepared for the Blue Shield of California Foundation, highlights the need for safety net providers to adopt integrated models of care, not only to accommodate expanded coverage in Medicaid due to federal health reform, but also in light of California’s Medicaid Waiver renewal. This paper explains the reasons and the need for safety net participation in Accountable Care Organizations (ACOs).

Collaborative Care for Patients with Depression and Chronic Illnesses
This study, led by Dr. Wayne J. Katon from the University of Washington, investigates the impact of coordinated care management on improving disease control in patients with multiple chronic conditions. Results indicate that the ability to control medical disease and depression was drastically improved in settings where nurses provided guideline-based, patient-centered care.

PCDC Medical Home Assessment Tool
The Primary Care Development Corporation offers this free, online patient-centered medical home assessment tool to enable primary care practices to measure their operations against the National Committee for Quality Assurance’s 2011 medical home standards. Access the electronic publication of the standards and guidelines here.
NCQA Accountable Care Organizations Draft 2011 Criteria
In fall 2010, the National Committee for Quality Assurance (NCQA) released the 2011 Draft Accountable Care Organizations (ACO) Criteria for comment. This site includes the draft criteria as well as an overview of the criteria and the development process.

RWJF Synthesis Project Report
This synthesis highlights the importance of focusing efforts in health care on individuals with comorbid mental and medical conditions. The report analyzes epidemiological data from the 2001-2003 National Comorbidity Survey Replication and is a beneficial resource in regards to supporting federal health reform efforts. Access the policy brief from this project here.

Bending the Health Care Cost Curve by Expanding Alcohol/ Drug Treatment
In 2005, the Washington State Legislature passed Senate Bill 5763, which states that the Department of Social and Health Services shall adopt an “initial screening tool that can be used by intake personnel system-wide” to detect the most common types of mental, chemical dependency, and co-occurring disorders. This article provides key findings from the initiative.

SAMHSA Site on Health Homes
This site offers several resources related to health homes including screening tools, models, outcomes, research information, and other documents.

Applying the Substance Abuse Confidentiality Regulations to Health Information Exchange (HIE)
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator (ONC) for Health Information Technology announced released Frequently Asked Questions (FAQs) for applying the Substance Abuse Confidentiality Regulations to Health Information Exchange (HIE).

The Substance Abuse Confidentiality Regulations, 42 CFR Part 2, govern the use and disclosure of alcohol and drug abuse patient records that are maintained at federally funded substance abuse programs. Both SAMHSA and ONC want to assure that our constituents receive every tool and resource possible to enable a more complete understanding of these federal regulations which were enacted in 1972 and in 1975. The FAQs set forth the general provisions of Part 2, provide guidance on the application of 42 CFR Part 2 (“Part 2”) to electronic health records (EHRs), and identify methods for including substance abuse patient record information into health information exchanges that are consistent with the Federal statute.

The FAQs will serve as a valuable resource to a variety of individuals, including specialty and medical providers as well as HIE technical developers and policy makers. The FAQs are not meant to provide legal advice.

Evolving Models of Behavioral Health Integration in Primary Care
This report assesses models of integration in their applicability to primary care settings and, in particular, to the
“medical home.” Many of the challenges and barriers to integration stem from differing clinical cultures, a fragmented delivery system, and varying reimbursement mechanisms. This report also provides an orientation to the field and, hopefully, a compelling case for integrated or collaborative care. It provides a concise summary of the various models and concepts and describes, in further detail, eight models that represent qualitatively different ways of integrating and coordinating care across a continuum—from minimal collaboration to partial integration to full integration. Each model is defined and includes examples and successes, any evidence-based research, and potential implementation and financial considerations. Also provided is guidance in choosing a model as well as specific information on how a state or jurisdiction could approach integrated care through steps or tiers. Issues such as model complexity and cost are provided to assist planners in assessing integration opportunities based on available resources and funding. The report culminates with specific recommendations on how to support the successful development of integrated care. Extensive research and literature exist about models of integration. A resource section at the end of this report provides a list of websites, toolkits, and other references.