DB Strives To Heal Rift Separating Mind, Body

The initiative is still in the early stages, with negotiations ongoing between MPS and health plans in the state. But the vision behind the initiative promises a sea change in the way psychiatric conditions are treated.

“The Minnesota Psychiatric Society has been advocating for a shift in public policy toward psychiatric disorders, reframing psychiatric issues in a public health rather than a social services framework,” said MPS President William Dikel, M.D. “We recognized that most mental health treatment in the state was being provided by primary care physicians, who had insufficient training in screening, diagnosis, and treatment and who generally did not have close working relationships with psychiatrists. We have successfully advanced legislation that will reimburse psychiatric consultation to primary care physicians. We believe that, through integrating psychiatric and primary care services, we will succeed in early intervention efforts, reduce health care expenditures, eliminate mental health carveouts, and build a defense against psychologist prescription privileges.”

And Kathol said the integrated-care initiative has generated statewide enthusiasm. “There are a lot of general practitioners who are dying to have behavioral health support, because they can't get it now,” he said.“ They want someone there who can be available to help them and their patients.”

According to the MPS, the initiative is designed to encourage participating clinics to “create state-of-the-art, integrated care programs” with the hope that “health plans will collaborate by supporting `out-of-the-box' reimbursement approaches that fairly compensate for and encourage coordinated general medical and behavioral health care.”

Crucial to the program's success, according to the MPS, is “the development of a reimbursement environment for general medical and behavioral health specialists and participant general medical hospitals and clinics conducive to coordinated assessment and treatment of medical and psychiatric health care concerns or illness in the nonpsychiatric setting. This will be done through collaboration between providers, care delivery organizations, government agencies, health plans, and employers.”

Kathol said clinics will need to possess certain core components in order to participate, but the ability to “customize” their integrated service model to the population the clinic serves will be essential.

“We want to allow them to use their clinical setting as a model based on the strengths of their personnel and the targeted population they serve,” he said. “They can create a clinical setting that meets the needs they have rather than trying to meet outside service requests.”

According to the MPS, core components of participating outpatient clinics include the following:

Participating clinics will also be encouraged to use mental health teams, with active psychiatrist involvement, proactive screening for high-risk cases, a mechanism for patient follow-up to ensure adherence, and clinical and economic outcome measurement.

Kathol told Psychiatric News that critical to the success of the initiative is a common source of reimbursement for general medical physicians, psychiatrists, and behavioral health specialists working in general medical settings. And he said that carveouts have been a severe impediment to the integration of care.

“A critical component is that behavioral specialists working in the general medical setting are paid for clinical services they provide rather than being subsidized from outside,” Kathol said. “Integration is anathema to carveouts since they have a financial disincentive to support behavioral health care outside the psychiatric setting.

“A lot of psychiatrists feel that we have to learn to live with behavioral carveouts. But I would encourage people to consider working with medical, not behavioral, managed care companies, because it's the carveout system that prevents the coordination of care for their patients.”

A description of the Minnesota initiative is posted online at<www.mnpsychsoc.org/DESC.doc>.▪