Evolving Models of Behavioral Health Integration in Primary Care

Integrating mental health services into a primary care setting offers a promising, viable, and efficient way of ensuring that people have access to needed mental health services. Additionally, mental health care delivered in an integrated setting can help to minimize stigma and discrimination, while increasing opportunities to improve overall health outcomes. Successful integration requires the support of a strengthened primary care delivery system as well as a long-term commitment from policymakers at the federal, state, and private levels. This report assesses models of integration in their applicability to primary care settings and, in particular, to the medical home.

The report also provides an orientation to the field and, hopefully, a compelling case for integrated or collaborative care. It provides a concise summary of the various models and concepts and describes, in further detail, eight models that represent qualitatively different ways of integrating and coordinating care across a continuum—from minimal collaboration to partial integration to full integration. Each model is defined and includes examples and successes, any evidence-based research, and potential implementation and financial considerations. Also provided is guidance in choosing a model as well as specific information on how a state or jurisdiction could approach integrated care through steps or tiers. Issues such as model complexity and cost are provided to assist planners in assessing integration opportunities based on available resources and funding. The report culminates with specific recommendations on how to support the successful development of integrated care.

Hypertension, High Serum Total Cholesterol, and Diabetes: Racial and Ethnic Prevalence Differences in U.S. Adults 1999-2006

According to a report issued by the CDC, forty-five percent of American adults had at least one of the following three chronic conditions—hypertension, hypercholesterolemia, or diabetes; one in eight adults (13%) had two of these conditions; and 3% of adults had all three chronic conditions. Nearly one in seven U.S. adults (15%) had one or more of these conditions undiagnosed. Stratifying by race, the CDC discovered striking differences in health status. The study found an increased risk of acquiring one of the three conditions among non-Hispanic black persons relative to non-Hispanic whites. In addition, researchers found Non-Hispanic blacks and whites alike were more susceptible to hypertension and hyper-cholesterolemia than Mexican Americans. The authors concluded that Hispanic black and Mexican-American persons were more likely than non-Hispanic white persons to have both diagnosed or undiagnosed hypertension and diabetes. From these findings, it is clear that the nation has much to achieve in the way of reducing health disparities as part of its Healthy People 2010, 2020 initiative and incredible hurdles to overcome on the road to improving cardiovascular health and reducing diabetes.  

Health Care Reform and Primary Care: The Growing Importance of the Community Health Center

Community health centers (CHCs), an important component of the national public safety net,  serve as the medical home to over 20 million Americans, providing care to medically underserved populations in medically underserved areas.  The Patient Protection and Affordable Care Act (PPAC) is strengthening CHCs, allowing them to serve as a model for the patient centered medical home (PCMH). The PPAC’s expansion of Medicaid and establishment of insurance exchanges will only increase the number of insured individuals using CHCs as their medical home. However, the influx of compensated care should improve CHCs’ infrastructure. 

The Medical Home as Community Effort: A Collaborative ACO Model is Yielding Clinical and Financial Results

Battle Creek, Michigan is one of the first sites in the country to test the relationship involving a patient-centered medical home, value-based insurance design, and a community collaborative that includes healthcare providers, local employers, and consumer groups.  The Collaborative ACO, "Pathways to Health," has attracted national attention because it demonstrates a new delivery model—the accountable care organization (ACO)—which was brought to center stage during the health care reform debate. This article highlights preliminary data from Battle Creek that suggest improvements in patient health as well as financial savings under the model.

The Future of Health Information Technology in the Patient-Centered Medical Home

Improving the efficiency, quality, and safety of the patient-centered medical home (PCMH) requires further investment in, and development of,electronic health records (EHRs). This article indicates the domains that need to be addressed in order to achieve these results. The authors suggest that the development of EHRs will be crucial in seven major areas: telehealth, measurement of quality and efficiency, care transitions, personal health records, registries, team care, and clinical decision support for chronic diseases. To encourage this development, the authors conclude by urging policy makers to include medical homes in emerging EHR regulations.

Changes in State-Specific Childhood Obesity and Overweight Prevalence in the United States from 2003

While the majority of available data neglects geographic disparities, this study indicates that geography is a statistically significant determinant of childhood obesity. The staggering differences in the rates of obesity in states like Mississippi (21.9%) and Oregon (9.6%) demonstrate the potential for improvement. In addition to such comparisons, the temporal changes between 2003 and 2007provided by this study are critical for assessing the effectiveness of interventions and determining the needs of particular states. State-specific data allows researchers to discover what characteristics are responsible for current trends and provides policy makers with crucial information to respond accordingly.  The authors conclude that examining state-specific changes in the rates of childhood obesity and overweight children should be of paramount importance to a national surveillance system, policy makers, prevention programs, and other stakeholders.