News Briefs

Kaiser brief on care coordination for “dual eligibles”: A policy brief from the Kaiser Family Foundation summarizes 15 states' proposals to better coordinate care for people who are in both the Medicare and Medicaid programs—5.5 million low-income seniors and 3.4 million people with disabilities under age 65. In April 2011, design contracts of up to $1 million each were awarded to California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, and Wisconsin. The contracts, which are funded by the federal Center for Medicare and Medicaid Innovation, are an outgrowth of provisions in the health reform law to develop service delivery and payment models that integrate care for “dual eligibles,” whose needs and costs typically exceed those of other Medicare and Medicaid beneficiaries. States' ten-page proposals present the initial concepts in advance of meaningful stakeholder dialogue. The Kaiser brief provides an overview of the important features of each state's proposal, including the type of entity to deliver benefits, the target population and enrollment, benefits package, financing, beneficiary protections, stakeholder involvement, and proposed time frame. Over the next 12 months, states will further develop their proposed designs, and CMS will determine which proposals will move into the implementation phase in 2012, pending availability of funds. The 47-page brief is available on the Kaiser web site at www.kff.org/medicaid/8215.cfm. Also available is a related archived Webcast, “Managing Costs and Improving Care: Team-Based Care of the Chronically Ill” (available as a video or podcast at www.kff.org/ahr081111video.cfm). The panel discussion, held in August 2011 and cosponsored by the Alliance for Health Reform and the Commonwealth Fund, focused on ways to improve the quality of care for people with chronic illnesses while reducing the growth in spending for their care. Treating persons with multiple chronic conditions, including the elderly and disabled populations, accounted for 30% of total U.S. health care spending in 2010, half of which was spent on dual eligibles. Among solutions addressed are pilot programs and other innovations in the health reform law.

Kaiser brief on states' progress on health exchanges: Beginning in 2014, millions of Americans are expected to purchase coverage through state-based health insurance exchanges. In general, the exchanges will be open to those who buy coverage on their own and employees of small businesses that do not offer insurance. These online marketplaces will allow consumers to compare a selection of qualified insurance options. The exchanges are a key component of the health reform law, which requires states by January 2013 to demonstrate sufficient progress toward establishing an exchange. An issue brief from the Kaiser Foundation examines states' progress in setting up the exchanges. By July 2011, a total of 13 states had passed laws to establish exchanges, and two others—Utah and Massachusetts—had existing exchanges that may need modifications to comply with the law. In all, more than a third of states have begun to lay the foundation for the new exchanges. The Kaiser brief, available at www.kff.org/healthreform/8213.cfm, summarizes early trends that have emerged in terms of the governance, structure and financing of the new exchanges. The site also provides a link to an archived Webcast of a briefing in July 2011 on the development of exchanges in the states, sponsored by the Bipartisan Policy Center, in collaboration with the Kaiser Foundation and the University of Virginia's Batten School of Leadership and Public Policy (http://healthreform.kff.org/Scan/2011/July/KFF-CBP-Briefing-Addresses-Exchanges.aspx). Through panel discussions with state leaders and stakeholders, the briefing, explores states' progress and innovations and identifies next steps in building effective exchanges.

Kaiser monthly update on health disparities: Each month the Kaiser Foundation prepares a digest of news coverage from hundreds of print and broadcast sources related to health and health care issues affecting underserved and racial and ethnic communities. The update also summarizes recent research in the field and features a data slide from a relevant Kaiser publication. The latest update includes summaries of two recent studies in Medical Care. One found a significant relationship between self-reported racial and ethnic discrimination in health care and adverse health outcomes among diabetic patients. The other demonstrated the impact of patient-perceived racism and classism on patient-provider communication. The latest update also features a story that appeared in the Detroit Free Press that discussed obstacles and discrimination associated with mental health treatment for racial-ethnic minority groups and described efforts by a Detroit community mental health center to reach out to the African-American community. Visitors to the site (www.kff.org/minorityhealth/report.cfm) can sign up for e-mail notification when each monthly update is published.

NIMH RAISE project progress report: Researchers continue to make progress in the RAISE project—Recovery After an Initial Schizophrenia Episode—sponsored by the National Institute of Mental Health. The aim of the large-scale research project is to explore whether using early and aggressive treatment will reduce symptoms and prevent the gradual deterioration of functioning characteristic of chronic schizophrenia. Two research groups are working in parallel to develop and test approaches, and the progress report examines recent refinements in the two studies that will ensure that RAISE generates results that are relevant to consumers and health care policy makers. The RAISE Early Treatment Program (ETP), led by John Kane, M.D., of the Feinstein Institute for Medical Research in Manhasset, New York, is conducting a randomized controlled trial comparing two ways of providing treatment to people in the early stages of the disorder. Both emphasize early intervention but feature different approaches for initiating and coordinating care. Treatment may include personalized medication treatment, individual resiliency training, and supportive services, such as family psychoeducation and education or employment assistance. A total of 34 U.S locations are recruiting patients, with the aim of recruiting at least 400 for up to two years of treatment and evaluation. The RAISE Connection Program, led by Susan Essock, Ph.D., of Columbia University, and Lisa Dixon, M.D., M.P.H., of the University of Maryland, Baltimore, will identify ways to effectively integrate a comprehensive early intervention program into existing medical care systems, as well as how such programs benefit individuals receiving multicomponent treatment. With the goal of recruiting up to 100 participants in Baltimore and New York City, the Connection Program will provide participants with individually tailored medication treatment, illness management strategies, education or employment assistance, supportive services, and follow-up care for up to two years. The progress report, as well as more detailed information about the two studies, is available at www.nimh.nih.gov/science-news/2011/nimh-raise-project-makes-progress-as-teams-refine-research-approaches.shtml.

SAMHSA's new application process for block grants: The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced a new application process for its major block grant programs—the Substance Abuse Prevention and Treatment Block Grant and the Community Mental Health Services Block Grant. The change is designed to provide states greater flexibility to allocate resources for substance abuse and mental illness prevention, treatment, and recovery services in their communities. Formerly, the two block grant programs were administered somewhat differently by separate SAMHSA centers. As a result states have had different—and often duplicative—processes for accepting, planning, and accounting for the grants. The new process will streamline application and funding procedures by promoting uniform application, assurance, and reporting dates across both block grants and offer states and territories the option to submit a single coordinated plan for both grants. The effort is part of a larger series of innovative reforms SAMHSA is proposing to enhance states' ability to effectively apply these block grants, which constitute roughly 75% of SAMHSA's $3.4 billion budget. “In this time of budget cutbacks, especially for vital behavioral health services, it is more important than ever that we implement shrewd strategies for making the most of these precious resources,” said SAMHSA Administrator Pamela S. Hyde. “By reforming the block grants now in ways that empower the states, we are positioning these resources to be a critical component of our future health system.” Detailed information about proposed changes to the block grant programs, including application policies, is available on the SAMHSA Web site at samhsa.gov/grants/blockgrant.

CSG Justice Center guide for transforming probation departments: The Council of State Governments (CSG) Justice Center has released A Ten-Step Guide to Transforming Probation Departments to Reduce Recidivism. It provides community corrections officials and policy makers responsible for funding and overseeing probation with a roadmap to overhaul agency operations to increase public safety and improve rates of compliance among people they are supervising. While probation officials in every state are experiencing budget cuts, the number of people they are supervising is increasing. According to a recent Pew Center study more than five million people are currently on probation or parole in the United States, representing an increase of 59% over the past 20 years. The first section describes how to engage key stakeholders, evaluate agency policies, and develop a strategic plan for reform. The second section provides recommendations for redesigning departmental policies and practices, and the final section includes steps for making the transformation permanent. The report provides numerous examples of how these steps were used in the probation department in Travis County, Texas. Between 2005 and 2008, the department has seen felony probation revocations decline by 20% and the one-year rearrest rate for probationers fall by 17%. Work on the guide was supported by the U.S. Department of Justice's Bureau of Justice Assistance, the Public Safety Performance Project of the Pew Center on the States, the Texas Department of Criminal Justice-Community Justice Assistance Division, and the Travis County Community Supervision and Corrections Department. The guide is available at www.nationalreentryresourcecenter.org.

NASMHPD Webinar on outpatient civil commitment: The second in a series of Webinars sponsored the Legal Division of the National Association of State Mental Health Program (NASMHPD) has been archived on the association's site. The Webinar features presentations by Jeffrey Swanson, Ph.D., and Marvin Swartz, M.D., of Duke University, who each summarize research on the effectiveness of outpatient commitment. After the presentations, representatives of four states with outpatient commitment laws—Virginia, Oregon, New York, and New Jersey—respond with brief summaries of experiences and lessons learned in their states, including recent updates to their laws. The 90-minute Webinar, which concludes with a panel discussion and questions from online participants across the country, is available on the NASMHPD Web site at www.nasmhpd.org/presentations_webinars.cfm, along with the first Legal Division Webinar on recent Olmstead cases in New York, Georgia, and Oregon.