Best practices guide on integrating behavioral health into primary care for New England

Up to 70% of physician visits involve a mental health issue and health care costs for people with mental health issues are often up to three times higher than other patients with similar conditions. CEPAC, New England’s comparative effectiveness council, has published their latest guide featuring best practices for integrating behavioral health services into primary care practice. Based on the strongest evidence base, CEPAC’s membership of providers and consumer representatives from across the region, voted to endorse the Collaborative Care Model of integration. But the group noted that practices pursuing integration “should use available resources and seek guidance from organizations that have experience with the CCM and other models while accounting for differences in population, resources, treatment priorities, and funding.” In addition to the full report, CEPAC has published a guide for policymakers and other decision makers, and a New England-specific action guide that includes resources and implementation support for our region.

ERC states vary in Medicaid enrollment since ACA

Medicaid expansion has had varying effects on enrollment across CSG/ERC states. Under the Affordable Care Act, as of January 1, 2014 states have the option to expand Medicaid eligibility for all low-income Americans, regardless of age or family circumstances. Federal funds will reimburse states for all the costs of care for newly eligible members through next year. The reimbursement rate then tapers down to 90% in 2020 where it will remain permanently, far above the reimbursement rate for most Medicaid members.  All ERC states but Maine have elected to expand coverage so far but with varied implementation dates. According to the latest CMS report, all CSG/ERC states that reported have seen an increase in Medicaid enrollment since before the ACA, but the rise varies considerably from Pennsylvania with only a 6.4% increase so far to Rhode Island with a 42% increase. Nationally enrollment growth averaged 28% for states that chose to expand Medicaid, and 8.6% for those that haven’t expanded.

 

State Expanding Medicaid? Total Medicaid enrollmentMarch 2015 % change July-Sept 2013 to March 2015
CT Yes 726,253 Not reported
DE Yes 238,621 6.9%
MD Yes 1,182,067 38.0%
MA Yes 1,692,477 30.6%
ME No 284,206 Not reported
NH Yes 174,908 37.6%
NJ Yes 1,699,114 32.4%
NY Yes 6,398,893 12.7%
PA Yes 2,539,514 6.4%
RI Yes 271,524 42.3%
VT Yes 183,618 14.0%
US average for expanding states 28.1%
US average for non-expansion states 8.6%

Early numbers show CSG/ERC region leads the country in reducing uninsured rates

At 5.3% and 8.6% respectively, the New England and the Mid-Atlantic states led the nation in lowering uninsured rates last year, according to a new CDC survey. In the first year of coverage expansions under the Affordable Care Act, the US uninsured rate fell to 11.5% from 14.4% in 2013. States that expanded Medicaid enjoyed a 5.1% average drop in uninsured rate, compared to 2.1% in non-expansion states. CSG/ERC state uninsured levels varied considerably from 11.3% in Maine to 2.6% in Massachusetts. The report breaks down state coverage rates by age and type of coverage — uninsured, public and private coverage.

State % uninsured at the time of the interview, 2014
Connecticut 7.0%
Delaware 4.4
Maine 11.3
Maryland 7.9
Massachusetts 2.6
New Hampshire 8.0
New Jersey 9.4
New York 9.4
Pennsylvania 7.9
Rhode Island 6.4
Vermont 8.6
US average 11.5

 

Report

http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201506.pdf

Webinar: Caring for High-Need, High-Cost Patients – Lessons for Connecticut

Join us Monday, June 22nd at 2pm for a webinar on best practices in complex care management for the most fragile and costly patients. Evidence is growing that we cannot fix our health care system without addressing the needs of the small number of patients with very complex and costly health problems. Luckily CT can learn from other programs across the US as we build reforms for our state and our Medicaid program.  On the webinar we’ll hear from Clemons Hong, MD, MPH, of Massachusetts General Hospital and Harvard Medical School. In addition to coordinating complex care management programs on the ground, Dr. Hong has written extensively about lessons learned across the country. Click here to register for the webinar.