Mental Health Care in the Accountable Care Organization
ABSTRACT The Centers for Medicare and Medicaid Services (CMS) is promoting formation of accountable care organizations (ACOs). In these population-based models, CMS aligns a Medicare beneficiary population to an ACO with associated expenditure and quality targets, transitioning away from purely volume-based revenue of fee-for-service Medicare. Patients with mental illness are among high-cost Medicare beneficiaries, but this population has received little attention in ACO implementation. Although the ACO goals of providing chronic and preventive care in a coordinated, patient-centered manner are consistent with what some mental health providers have long advocated, the population-based orientation may be unfamiliar. In addressing the needs of high-cost, high-risk patients to meet quality and expenditure targets, an ACO should examine the quality of mental health care it provides as well as medical quality for patients with mental illness. In addition, federal agencies should invest to ensure understanding of the impact of population-based initiatives on patients with mental illness.
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ABSTRACT: Alcoholics Anonymous (AA) is the most prevalent 12-step mutual-help organization (MHO), yet debate has persisted clinically regarding whether patients whose primary substance is not alcohol should be referred to AA. Narcotics Anonymous (NA) was created as a more specific fit to enhance recovery from drug addiction; however, compared with AA, NA meetings are not as ubiquitous. Little is known about the effects of a mismatch between individuals' primary substance and MHOs, and whether any incongruence might result in a lower likelihood of continuation and benefit. More research would inform clinical recommendations.Alcohol and alcoholism (Oxford, Oxfordshire). Supplement 10/2014; 49(6). DOI:10.1093/alcalc/agu066
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ABSTRACT: To describe the effect of age on psychotropic coprescribing, psychiatric diagnoses, and other clinical characteristics. Analysis of the National Ambulatory Medical Care Survey. A national sample of outpatient visits to physicians (N = 2,406) in office-based practice in 2010. Adults prescribed psychotropic medication (N = 31,229). Office visits at which antidepressant, anxiolytic, sedative, hypnotic, antipsychotic, or mood stabilizer medications were prescribed were grouped according to participant age (21-64, ≥65) and then compared within each medication class on visit characteristics. and then compared according to variables including provider type, sex, and race; presence of diagnosed mental illness; prescription of other psychotropic agents; total number of chronic conditions; time spent with physician; and total number of medications. In 2010, there were 90.3 million antidepressant office visits; 77.7 million anxiolytic/sedative/hypnotic visits; 15.5 million antipsychotic visits; and 9.5 million mood stabilizer visits. Nonpsychiatrists prescribed the majority of psychotropic medications for every class and age group; 17.3% of older adult antipsychotic visits and 44.9% of younger adult antipsychotic visits were to a psychiatrist (chi-square = 19.58, P = .001). Older adults in every medication class were less likely to have a diagnosed mental disorder. Older adults prescribed psychotropic medication were less likely to have a diagnosed mental disorder than their younger counterparts. Efforts to promote quality prescribing should seek to minimize nonspecific use of psychotropic medication.Journal of the American Geriatrics Society 01/2014; 62(2). DOI:10.1111/jgs.12640 · 4.22 Impact Factor
- Academic Psychiatry 04/2014; 38(3). DOI:10.1007/s40596-014-0104-0 · 0.81 Impact Factor