News & Notes

USPS Task Force recommends screening of all adults for depression: The U.S. Preventive Services Task Force (USPSTF) has released a final statement recommending screening of the general adult population, particularly pregnant and postpartum women, for depression. The recommendation was released with a grade of B: “There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.” The USPSTF found convincing evidence that screening improves the accurate identification of adult patients with depression and that identified patients who are treated—with antidepressant medication, psychotherapy, or both—show improvement. Harms posed by screening were found to be small to none, and the overall magnitude of harms posed by second-generation antidepressants (mostly SSRIs) was found to be small to moderate. The USPSTF found adequate evidence that treatment with cognitive-behavioral therapy (CBT) improves clinical outcomes among pregnant and postpartum women with depression, and the task force encourages clinicians to consider CBT or other evidence-based counseling interventions in lieu of antidepressants when managing depression of pregnant or breastfeeding patients. The USPSTF found little evidence regarding the optimal timing of screening or the optimal interval between screens. The task force also recommends that screening be implemented with adequate systems in place to ensure diagnosis, effective treatment, and appropriate follow-up. The final recommendation statement is available on the USPS Web site (www.uspreventiveservicestaskforce.org).

SAMHSA releases 2015 barometer reports on behavioral health: The Substance Abuse and Mental Health Services Administration (SAMHSA) has released its 2015 barometer reports summarizing current data on prevalence rates of behavioral health conditions and on use of treatments. Figures in each 20-page state report and the 21-page national report summarize the latest available data (2014) and show trends over the past decade. Separate sections cover mental and substance use disorders as well as children and adults, and analyses based on gender, age, income level, health insurance status, and race-ethnicity are presented. “The Barometer provides everyone with a better understanding of the nation's behavioral healthcare landscape and the particular needs of many communities,” said Kana Enomoto, M.A., SAMHSA’s acting administrator. The reports are available on SAMHSA’s Web site (www.samhsa.gov/data/browse-report-document-type?tab=46).

Toolkit to help stakeholders advocate for implementation of HCBS settings rule: In January 2014, the Centers for Medicare and Medicaid Services (CMS) released a final rule on home- and community-based services (HCBS) for Medicaid beneficiaries. The final rule, which was part of the Affordable Care Act, includes requirements for settings in which Medicaid HCBS programs operate—settings that must serve as alternatives to institutional care and that take into account the quality of individuals’ experiences. The goal is to provide participants full access to the benefits of community living, including competitive employment, and to ensure that services are offered in the most integrated settings. States have up to five years (until March 2019) to comply with the new rules. All states have submitted their initial transition plans to CMS, which has provided feedback about next steps for amending and implementing plans. The Bazelon Center for Mental Health Law, as part of a coalition of advocacy groups, has created a toolkit to help advocates push for strong implementation of the new HCBS settings rules in their states. “The next several months are a critical time for advocacy,” said Bazelon's Director of Advocacy Alison Barkoff, “because that is when states will be making important decisions about their transition plans.” The toolkit provides detailed information about the HCBS settings rule and outlines action steps for advocates to promote strong implementation of the new rules in their states. The Bazelon site also provides links to each state’s transition plan. The toolkit and other resources are available on the Bazelon site (www.bazelon.org/News-Publications/Press-Releases/HCBS-Settings-Rule.aspx).

NASHP issue brief encourages use of peer specialists in integrated care programs for Medicaid enrollees: Even though adults with serious mental illness have high rates of chronic general medical conditions, such as diabetes and cardiovascular disease, many do not have a primary care provider. Therefore, integrated care strategies that leverage services and supports offered through the mental health system, where these individuals are more likely to receive regular care, may be more effective than offering integrated care in primary care settings. A new issue brief from the National Academy for State Health Policy (NASHP) makes the case for hiring and training peer support specialists to bridge the gap between general medical and behavioral health services for people with serious mental illness as part of a whole-person, recovery-oriented system of care. The brief outlines four reasons for implementing this approach. First, peer support workers are already funded in a majority of state Medicaid systems and can be supported by using a number of Medicaid regulations. Second, states can leverage their existing peer service systems to enhance integrated care specifically for the population with serious mental illness. Third, peer support specialists provide an opportunity to expand the mental health workforce. Fourth, peers can be integrated into a number of service delivery models and approaches. The brief includes questions for state policy makers to consider as they explore the use of peer services to promote integrated care for Medicaid enrollees with serious mental illness. The brief is based on interviews with state mental health and Medicaid policy makers in Georgia, Kansas, and Oregon, three states that are providing leadership in this area through innovative initiatives and diverse funding approaches. The nine-page brief, Using Peers to Support Physical and Mental Health Integration for Adults With Serious Mental Illness, is available on the NASHP site (nashp.org/15220).

HHS issues guidance on HIPAA’s right of access to health information: Since 1996, when the Health Insurance Portability and Accountability Act (HIPAA) became law, the HIPAA privacy rule has provided individuals with the right to access and receive a copy of their health information from doctors, hospitals, and health insurance plans. In January 2016, the U.S. Department of Health and Human Services (HHS) took an important step toward ensuring that individuals can take advantage of their HIPAA right of access. HHS acknowledged the need to develop guidance after recent studies and its own enforcement experience showed that some individuals face obstacles to accessing their health information, even from entities required to comply with HIPAA. To address these obstacles, HHS has developed a fact sheet and the first in a series of topical frequently asked questions (FAQs) to clarify the HIPAA right of access. The FAQs address the scope of information covered by HIPAA’s access right, the very limited exceptions to this right, the form and format in which information is provided to individuals, the requirement to provide access in a timely manner, and the intersection of HIPAA’s right of access with the requirements for patient access under the HITECH Act’s Electronic Health Record Incentive Program. HHS also announced that its Office for Civil Rights will work with the White House Social and Behavioral Sciences Team and the HHS Office of the National Coordinator for Health Information Technology to produce consumer-friendly resources, including sample communication tools to encourage patients to access their digital health information. The fact sheet and FAQs are available on the HHS site (www.hhs.gov/blog/2016/01/07/understanding-individuals-right-under-hipaa-access-their.html).

Commonwealth Fund recommends U.S. focus on high-need older patients: U.S. health care costs are disproportionately concentrated among older adults with multiple chronic conditions, including mental illnesses—a population often referred to as “high-need” patients. A new analysis by the Commonwealth Fund of data from nine countries compares health care use, quality, and experiences among older adults with and without high needs. Findings show that those with high needs use more health care and experience more coordination problems and financial barriers than their counterparts without high needs and that disparities between the two groups are particularly pronounced in the United States. A major reason, according to the report, may be related to financial barriers to accessing care in this group. Among high-need U.S. adults, more than one of five (22%) reported that because of cost they did not visit the doctor, skipped recommended tests or treatment, or did not fill a prescription—the highest rate in any of the nine countries studied. The comparative success of other countries in lowering costs for this group may be attributable to policies that specifically target high-need patients. France, for example, has eliminated copayments for individuals with any of 32 chronic illnesses. Germany’s disease management programs for patients with chronic illnesses combine technology, quality assurance, and financial incentives for physicians, patients, and payers. The report’s authors recommend a similar focus in the United States as a way of improving health status of older adults and reducing overall costs. The 14-page report, How High-Need Patients Experience the Health Care System in Nine Countries, is available on the Commonwealth Fund Web site (www.commonwealthfund.org/publications/issue-briefs/2016/jan/high-need-patients-nine-countries?omnicid=EALERT966703).

PCPCC’s annual review of evidence on patient-centered medical homes: The Patient-Centered Primary Care Collaborative (PCPCC) has issued its latest report highlighting evidence linking the patient-centered medical home (PCMH) with lower costs and improved health care quality. The report highlights 30 primary care PCMH initiatives, analyzing data from peer-reviewed studies, evaluations by state and federal governments, and industry reports published between October 2014 and November 2015. It reviews recent evidence in light of long-awaited developments in health system payment reform, including Medicare’s transition to value-based payments, and examines a number of significant multipayer and state-level reforms that are occurring in conjunction with increasing commercial interest and investment in PCMHs. The report provides evidence that the most effective PCMHs participate in multipayer collaboratives, in which payers and providers align payment models and performance measures. The 40-page report, The Patient-Centered Medical Home's Impact on Cost and Quality: Annual Review of Evidence, 2014–2015, is available on the PCPCC Web site (www.pcpcc.org/resource/patient-centered-medical-homes-impact-cost-and-quality-2014-2015).

CMS posts new resources on Medicaid health homes: CMS’s Health Home Information Resource Center has developed new resources to assist states in developing Medicaid health homes for beneficiaries with chronic conditions: a new set of FAQs about the Medicaid Health Home State Plan Option, a map of health home activity by state, a fact sheet, an overview of State Plan Amendments by state, and a list of chronic conditions targeted by approved health home models. The Medicaid Health Home State Plan Option, authorized under the ACA, allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions. States receive enhanced federal funding to support implementation of this integrated model of care. The resources are available on the CMS Web site (www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Health-Home-Information-Resource-Center.html).