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26-04-2012 | Legal medicine | Article

Integrated, incentivised mental healthcare improves patient outcomes


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MedWire News: An integrated care programme based on pay-for-performance (P4P) incentives improves outcomes in low-income patients with mental health problems, research shows.

"The time has now come for payers to provide the right incentives and tools for organizations to implement evidence-based programs that can serve large populations of patients with common behavioral health problems," Jürgen Unützer (University of Washington Seattle, USA) and colleagues comment in the American Journal of Public Health.

National surveys have demonstrated that more Americans receive mental health care from primary care providers than from mental health specialists.

Patients, however, tend to prefer an integrated approach in which primary care and mental health providers work together to address medical and behavioral health needs.

In reality, however, medical, mental health, and substance abuse services are fragmented and delivered in separate "silos" with little to no effective collaboration, Unützer et al point out.

The Washington State Mental Health Integration Program (MHIP) is an integrated care programme that provides medical and mental health services for low-income adults who are temporarily disabled and expected to be unemployed for at least 90 days.

Behavioral healthcare is provided in the primary care clinic through a collaborative approach that includes a primary care physician and a care coordinator, a consulting psychiatrist assigned to each of the primary care-based teams, and other behavioral health providers, if available.

In the current study MHIP was rolled-out in 29 community health clinics in the two most populous counties in Washington State.

After an initiation phase, a P4P incentive program went into effect on January 1, 2009, where 25% of the annual program funding was contingent on meeting several quality indicators, including timely follow up of patients in the program (two or more contacts per month for at least half of the active caseload), psychiatric consultation for patients who do not show clinical improvement, and regular tracking of psychotropic medications used.

Participating clinics and providers received regular feedback on their quality indicators through the web-based clinical tracking system

The researchers used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program.

After the implementation of the P4P incentive program, participants were substantially more likely to experience a significant improvement in depression severity, and the time to improvement was dramatically reduced compared with before the P4P incentive was implemented.

These improvements in clinical outcomes were consistent with improvements observed in the quality of care that were the intended aims of the P4P initiative, such as early follow up and psychiatric consultation for patients who were not improving.

"Health care reform, mental health parity, and the emergence of the patient-centered health care home provide important opportunities for the integration of mental health and primary care," Unützer et al comment.

By Andrew Czyzewski

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