Integration: The Need for Delivery System and Payment Reform - - PowerPoint PPT Presentation

Behavioral and Physical Health Integration: The Need for Delivery System and Payment Reform

KENNETH E. THORPE, PH.D. EMORY UNIVERSITY KTHORPE@EMORY.EDU

Issues Forcing Payment and Delivery System Reforms

• Chronic disease accounts for rising share of healthcare
• spending. Accounts for 86% today compared to 67% in
• 1987. About 90% of the growth in Medicare spending since

1990 due to rising chronic disease prevalence

• Largest increase is among patients with multiple chronic

conditions

• Total health care spending among patients with a mental

disorder account for 44% of Medicaid and 31% of Medicare spending

Approximately 16Percent of Adults have a Diagnosed Mental Disorder – Most with a Comorbidity

10 20 30 40 50 60 0 Mental Disorder 1 Comorbidity 2 Comorbidity 3 Comorbidity 4+ Comorbidity 7.2% 12.7% 11.4% 11.8% 56.8%

Most Common Comorbid Conditions Among Those with a Medical Disorder

5 10 15 20 25 30 35 40 45 Hypertension Hyperlipidemia Arthritis Endocrine Pulmonary Disease 33% 32% 24% 23% 40%

Needed Reforms

• The growth, diversity and complexity of patients with multiple

chronic conditions requires interdisciplinary care teams for coordinating care. These teams need to be developed (though the personnel exists). Medicare can help accelerate the development of these teams.

• Need for collaborate care and community health teams
• Silo based fee for service payments continue to focus on single

patient conditions rather than the whole person. Alternative payment models can promote care across treatment silos and integrate team based care coordination into the care process

Health IT Framework Evaluation Framework

Primary Care Practice Hospitals Public Health Programs & Services Connector Health Team Patient and family Psychologists/psychiatrists Nurse Coordinators Social Workers Nutrition Specialists Community Health Workers Public Health Specialists Pharmacists Specialty Care & Disease Management Programs

• The Connector teams would

provide the links between population and community health interventions and more traditional medical care

• treatment. Any provider or health

plan could use the teams to serve this connector function.

• An RTI evaluation found that the

community health teams generated approximately a 4:1 ROI for Medicare

• Based on Vermont Blueprint for

Health

Mental Health & Substance Abuse Programs Social, Economic, & Community Services Self Management Workshops Primary Care Practice Primary Care Practice Primary Care Practice

Multi-Insurer Payment Reform Framework

October 21, 2103 6

Visiting Nurse/Home Health Agency

The Connector—Interdisciplinary Community Health Teams

How Do We Get There?

• Need both payment returns and organization of the multi-

specialty teams.

• Move away from silo-based payments into “aggregated” and

population–based payment

• CMS can build team based care coordination into traditional

Medicare by redirecting existing CPT coordination codes and contract directly (through competitive bidding) with salaried care teams